Drugs acting on the cerebral and peripheral circulations.

This review of the 2010 publications on drugs that act on the cerebral and peripheral circulations covers flunarizine, the triptans, and inhibitors of phosphodiesterase type V, and there is a special review on diosmin and hidrosmin. A progressive supranuclear palsy-like syndrome has been reported in a patient taking flunarizine and amiodarone; the signs and symptoms resolved almost completely after drug withdrawal. A post hoc analysis of the Norwegian Mother and Child Cohort Study showed no significant association between the use of triptans during the first semester and congenital malformations. However, the use of triptans during the second and/or third semester was associated with an increased risk of atonic uterus and significant blood loss during labor. In a comparison of the three main inhibitors of phosphodiesterase type 5, sildenafil, tadalafil, and vardenafil, there were no significant differences in the incidences of adverse reactions, but those who used tadalafil had a significantly longer mean duration of adverse reactions (15 hours) than sildenafil (3.9 hours) and vardenafil (7.7 hours).