pentoxifylline: clinical use

Prescribing considerations

• Confirm that symptoms reflect peripheral vascular disease and assess realistic treatment goals; evidence for intermittent claudication benefit is heterogeneous and low certainty.
• Use caution with hypotension or severe coronary artery disease because transient hypotension may reduce coronary perfusion.
• Review renal and hepatic function because impaired clearance may increase exposure.
• Assess bleeding risk and concomitant anticoagulant, antiplatelet or NSAID use.
• Review diabetes treatment and medicines that may increase pentoxifylline or theophylline exposure.

Contraindications and cautions

• Hypersensitivity to pentoxifylline, another methylxanthine or a formulation excipient
• Cerebral haemorrhage
• Extensive retinal haemorrhage
• Acute myocardial infarction
• Severe cardiac arrhythmias

Monitoring

• Clinical response and tolerability
• Blood pressure where hypotension is a concern
• Renal and hepatic function when impairment is present or suspected
• Anticoagulant activity with vitamin K antagonists, particularly after initiation or treatment changes
• Blood glucose in people receiving glucose-lowering treatment
• Bleeding, cardiac symptoms and features of blood-cell or hepatic disorders

Clinical pharmacology

Pentoxifylline is a purine derivative with haemorrheological effects. It modifies blood-cell deformability and white-cell adhesion or activation, is extensively metabolised mainly in the liver, and has substantial renal elimination.

Formulation and product differences

• The selected products are oral modified-release tablets that should be swallowed whole.
• Trental is a brand of pentoxifylline; the selected generic and branded product information describe the same active ingredient and modified-release presentation.

Modified-release tablet

Route: Oral

Strengths: 400 mg