The next step in guiding medical therapy is considering whether the patient is symptomatic. Two therapies are approved to reduce symptoms of claudication in PAD: cilostazol and pentoxifylline. Cilostazol appears to be effective but pentoxifylline provides little to no benefit. Cilostazol should be offered to patients who have lifestyle-limiting symptoms. In general, it has a favorable safety profile; however, some patients have gastrointestinal side effects. In addition, due to risks observed with other agents in this class, it should not be given to patients with heart failure.