Pentoxifylline: Difference between revisions

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{{DrugProjectFormSinglePage
{{DrugProjectFormSinglePage
|authorTag={{SS}}
|authorTag={{SS}}; {{AJ}}
|genericName=Pentoxifylline
|genericName=Pentoxifylline
|aOrAn=a
|aOrAn=a
|drugClass=Methylxanthine
|drugClass=[[methylxanthine]] and blood modifier agent
|indication=treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease of the limbs
|indicationType=treatment
|adverseReactions=nausea , vomiting
|indication=treatment of patients with [[intermittent claudication]] on the basis of [[arterial insufficiency|chronic occlusive arterial disease]] of the limbs
|adverseReactions=[[nausea ]], [[vomiting]]
|blackBoxWarningTitle=<b><span style="color:#FF0000;">TITLE</span></b>
|blackBoxWarningBody=<i><span style="color:#FF0000;">Condition Name:</span></i> (Content)
|blackBoxWarningBody=<i><span style="color:#FF0000;">Condition Name:</span></i> (Content)
|fdaLIADAdult======Intermittent claudication=====
|fdaLIADAdult======[[Intermittent Claudication]]=====


* Dosing Information
* Dosing Information


:* 400 mg PO tid
:* Dosing information: '''400 mg PO tid''' with meals
|offLabelAdultNoGuideSupport======Alcoholic hepatitis=====
:* Duration: ''' 8 weeks'''
:* [[Digestive]] and [[central nervous system]] side effects are dose related. If patients develop these effects it is recommended that the dosage be lowered to '''one tablet twice a day''' ('''800 mg/day'''). If side effects persist at this lower dosage, the administration of Pentoxifylline Extended-release Tablet should be discontinued.
|offLabelAdultGuideSupport=There is limited information about <i>Off-Label Guideline-Supported Use</i> of Pentoxifylline in adult patients.
|offLabelAdultNoGuideSupport=====Alcoholic hepatitis=====


* Dosing information
* Dosing information


:* 400 mg PO tid <ref name="pmid19340904">De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19340904 Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial.] ''World J Gastroenterol'' 15 (13):1613-9. PMID: [http://pubmed.gov/19340904 19340904]</ref><ref name="pmid18164508">Louvet A, Diaz E, Dharancy S, Coevoet H, Texier F, Thévenot T et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18164508 Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids.] ''J Hepatol'' 48 (3):465-70. [http://dx.doi.org/10.1016/j.jhep.2007.10.010 DOI:10.1016/j.jhep.2007.10.010] PMID: [http://pubmed.gov/18164508 18164508]</ref><ref name="pmid11113085">Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11113085 Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial.] ''Gastroenterology'' 119 (6):1637-48. PMID: [http://pubmed.gov/11113085 11113085]</ref>
:* '''400 mg PO tid''' <ref name="pmid19340904">De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19340904 Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial.] ''World J Gastroenterol'' 15 (13):1613-9. PMID: [http://pubmed.gov/19340904 19340904]</ref><ref name="pmid18164508">Louvet A, Diaz E, Dharancy S, Coevoet H, Texier F, Thévenot T et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18164508 Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids.] ''J Hepatol'' 48 (3):465-70. [http://dx.doi.org/10.1016/j.jhep.2007.10.010 DOI:10.1016/j.jhep.2007.10.010] PMID: [http://pubmed.gov/18164508 18164508]</ref><ref name="pmid11113085">Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11113085 Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial.] ''Gastroenterology'' 119 (6):1637-48. PMID: [http://pubmed.gov/11113085 11113085]</ref>


=====Cerebrovascular disease=====
=====Cerebrovascular disease=====
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* Dosing information
* Dosing information


:* 400 mg PO tid <ref name="pmid1293252">Blume J, Rùhlmann KU, de la Haye R, Rettig K (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1293252 Treatment of chronic cerebrovascular disease in elderly patients with pentoxifylline.] ''J Med'' 23 (6):417-32. PMID: [http://pubmed.gov/1293252 1293252]</ref><ref name="pmid8864715"> (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8864715 European Pentoxifylline Multi-Infarct Dementia Study.] ''Eur Neurol'' 36 (5):315-21. PMID: [http://pubmed.gov/8864715 8864715]</ref><ref name="pmid3602014">Parnetti L, Ciuffetti G, Mercuri M, Lupattelli G, Senin U (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3602014 The role of haemorheological factors in the ageing brain: long-term therapy with pentoxifylline ('Trental' 400) in elderly patients with initial mental deterioration.] ''Pharmatherapeutica'' 4 (10):617-27. PMID: [http://pubmed.gov/3602014 3602014]</ref><ref name="pmid6112386">Herskovits E, Vazquez A, Famulari A, Smud R, Tamaroff L, Fraiman H et al. (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6112386 Randomised trial of pentoxifylline versus acetylsalicylic acid plus dipyridamole in preventing transient ischaemic attacks.] ''Lancet'' 1 (8227):966-8. PMID: [http://pubmed.gov/6112386 6112386]</ref>
:* '''400 mg PO tid''' <ref name="pmid1293252">Blume J, Rùhlmann KU, de la Haye R, Rettig K (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1293252 Treatment of chronic cerebrovascular disease in elderly patients with pentoxifylline.] ''J Med'' 23 (6):417-32. PMID: [http://pubmed.gov/1293252 1293252]</ref><ref name="pmid8864715"> (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8864715 European Pentoxifylline Multi-Infarct Dementia Study.] ''Eur Neurol'' 36 (5):315-21. PMID: [http://pubmed.gov/8864715 8864715]</ref><ref name="pmid3602014">Parnetti L, Ciuffetti G, Mercuri M, Lupattelli G, Senin U (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3602014 The role of haemorheological factors in the ageing brain: long-term therapy with pentoxifylline ('Trental' 400) in elderly patients with initial mental deterioration.] ''Pharmatherapeutica'' 4 (10):617-27. PMID: [http://pubmed.gov/3602014 3602014]</ref><ref name="pmid6112386">Herskovits E, Vazquez A, Famulari A, Smud R, Tamaroff L, Fraiman H et al. (1981) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6112386 Randomised trial of pentoxifylline versus acetylsalicylic acid plus dipyridamole in preventing transient ischaemic attacks.] ''Lancet'' 1 (8227):966-8. PMID: [http://pubmed.gov/6112386 6112386]</ref>


=====Congestive heart failure=====
=====Congestive heart failure=====
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* Dosing information
* Dosing information


:* 400 mg PO tid <ref name="pmid12034156">Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12034156 The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy.] ''Eur J Heart Fail'' 4 (3):305-9. PMID: [http://pubmed.gov/12034156 12034156]</ref><ref name="pmid9660578">Sliwa K, Skudicky D, Candy G, Wisenbaugh T, Sareli P (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9660578 Randomised investigation of effects of pentoxifylline on left-ventricular performance in idiopathic dilated cardiomyopathy.] ''Lancet'' 351 (9109):1091-3. [http://dx.doi.org/10.1016/S0140-6736(97)09338-0 DOI:10.1016/S0140-6736(97)09338-0] PMID: [http://pubmed.gov/9660578 9660578]</ref>
:* '''400 mg PO tid''' <ref name="pmid12034156">Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12034156 The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy.] ''Eur J Heart Fail'' 4 (3):305-9. PMID: [http://pubmed.gov/12034156 12034156]</ref><ref name="pmid9660578">Sliwa K, Skudicky D, Candy G, Wisenbaugh T, Sareli P (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9660578 Randomised investigation of effects of pentoxifylline on left-ventricular performance in idiopathic dilated cardiomyopathy.] ''Lancet'' 351 (9109):1091-3. [http://dx.doi.org/10.1016/S0140-6736(97)09338-0 DOI:10.1016/S0140-6736(97)09338-0] PMID: [http://pubmed.gov/9660578 9660578]</ref>


===== Adjunct treatment in the Diabetes mellitus=====
=====Adjunct treatment in the Diabetes mellitus=====


* Dosing information
* Dosing information


:* 400 mg PO tid <ref name="pmid2649042">Schwartz RW, Logan NM, Johnson PJ, Strodel WE, Fine JG, Kazmers A et al. (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2649042 Pentoxifylline increases extremity blood flow in diabetic atherosclerotic patients.] ''Arch Surg'' 124 (4):434-7. PMID: [http://pubmed.gov/2649042 2649042]</ref>
:* '''400 mg PO tid''' <ref name="pmid2649042">Schwartz RW, Logan NM, Johnson PJ, Strodel WE, Fine JG, Kazmers A et al. (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2649042 Pentoxifylline increases extremity blood flow in diabetic atherosclerotic patients.] ''Arch Surg'' 124 (4):434-7. PMID: [http://pubmed.gov/2649042 2649042]</ref>


=====Proteinuria in the Diabetes mellitus=====
=====Proteinuria<font color="#777777"> </font>in the Diabetes mellitus=====


* Dosing information
* Dosing information


:* 400 mg PO qd <ref name="pmid23169362">Ghorbani A, Omidvar B, Beladi-Mousavi SS, Lak E, Vaziri S (2012) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23169362 The effect of pentoxifylline on reduction of proteinuria among patients with type 2 diabetes under blockade of angiotensin system: a double blind and randomized clinical trial.] ''Nefrologia'' 32 (6):790-6. [http://dx.doi.org/10.3265/Nefrologia.pre2012.Jun.11242 DOI:10.3265/Nefrologia.pre2012.Jun.11242] PMID: [http://pubmed.gov/23169362 23169362]</ref>
:* '''400 mg PO qd''' <ref name="pmid23169362">Ghorbani A, Omidvar B, Beladi-Mousavi SS, Lak E, Vaziri S (2012) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23169362 The effect of pentoxifylline on reduction of proteinuria among patients with type 2 diabetes under blockade of angiotensin system: a double blind and randomized clinical trial.] ''Nefrologia'' 32 (6):790-6. [http://dx.doi.org/10.3265/Nefrologia.pre2012.Jun.11242 DOI:10.3265/Nefrologia.pre2012.Jun.11242] PMID: [http://pubmed.gov/23169362 23169362]</ref>
:* 400 mg PO tid <ref name="pmid7736673">Guerrero-Romero F, Rodríguez-Morán M, Paniagua-Sierra JR, García-Bulnes G, Salas-Ramírez M, Amato D (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7736673 Pentoxifylline reduces proteinuria in insulin-dependent and non insulin-dependent diabetic patients.] ''Clin Nephrol'' 43 (2):116-21. PMID: [http://pubmed.gov/7736673 7736673]</ref>
:* '''400 mg PO tid''' <ref name="pmid7736673">Guerrero-Romero F, Rodríguez-Morán M, Paniagua-Sierra JR, García-Bulnes G, Salas-Ramírez M, Amato D (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7736673 Pentoxifylline reduces proteinuria in insulin-dependent and non insulin-dependent diabetic patients.] ''Clin Nephrol'' 43 (2):116-21. PMID: [http://pubmed.gov/7736673 7736673]</ref>


=====Gangrenous disorder=====
=====Gangrenous disorder=====
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* Dosing information
* Dosing information


:* 400 mg PO tid <ref name="pmid8285387">Carr ME, Sanders K, Todd WM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8285387 Pain relief and clinical improvement temporally related to the use of pentoxifylline in a patient with documented cholesterol emboli--a case report.] ''Angiology'' 45 (1):65-9. PMID: [http://pubmed.gov/8285387 8285387]</ref>
:* '''400 mg PO tid''' <ref name="pmid8285387">Carr ME, Sanders K, Todd WM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8285387 Pain relief and clinical improvement temporally related to the use of pentoxifylline in a patient with documented cholesterol emboli--a case report.] ''Angiology'' 45 (1):65-9. PMID: [http://pubmed.gov/8285387 8285387]</ref>


=====Male infertility=====
=====Male infertility=====
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* Dosing information
* Dosing information


* 800-1200 mg/day for 3 months<ref name="pmid1867966">Shen MR, Chiang PH, Yang RC, Hong CY, Chen SS (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1867966 Pentoxifylline stimulates human sperm motility both in vitro and after oral therapy.] ''Br J Clin Pharmacol'' 31 (6):711-4. PMID: [http://pubmed.gov/1867966 1867966]</ref>
* '''800-1200 mg/day''' for 3 months<ref name="pmid1867966">Shen MR, Chiang PH, Yang RC, Hong CY, Chen SS (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1867966 Pentoxifylline stimulates human sperm motility both in vitro and after oral therapy.] ''Br J Clin Pharmacol'' 31 (6):711-4. PMID: [http://pubmed.gov/1867966 1867966]</ref>


=====Peyronie's disease, Early chronic=====
=====Peyronie's disease, Early chronic=====
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* Dosing information
* Dosing information


:* 400 mg PO bid <ref name="pmid19863517">Safarinejad MR, Asgari MA, Hosseini SY, Dadkhah F (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19863517 A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease.] ''BJU Int'' 106 (2):240-8. [http://dx.doi.org/10.1111/j.1464-410X.2009.09041.x DOI:10.1111/j.1464-410X.2009.09041.x] PMID: [http://pubmed.gov/19863517 19863517]</ref>
:* '''400 mg PO bid''' <ref name="pmid19863517">Safarinejad MR, Asgari MA, Hosseini SY, Dadkhah F (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19863517 A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease.] ''BJU Int'' 106 (2):240-8. [http://dx.doi.org/10.1111/j.1464-410X.2009.09041.x DOI:10.1111/j.1464-410X.2009.09041.x] PMID: [http://pubmed.gov/19863517 19863517]</ref>


=====Retinal vascular occlusion=====
=====Retinal vascular occlusion=====
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* Dosing information
* Dosing information


:* 1800 mg/day  <ref name="pmid11865834">De Sanctis MT, Cesarone MR, Belcaro G, Incandela L, Steigerwalt R, Nicolaides AN et al. (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11865834 Treatment of retinal vein thrombosis with pentoxifylline: a controlled, randomized trial.] ''Angiology'' 53 Suppl 1 ():S35-8. PMID: [http://pubmed.gov/11865834 11865834]</ref><ref name="pmid11865833">Incandela L, Cesarone MR, Belcaro G, Steigerwalt R, De Sanctis MT, Nicolaides AN et al. (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11865833 Treatment of vascular retinal disease with pentoxifylline: a controlled, randomized trial.] ''Angiology'' 53 Suppl 1 ():S31-4. PMID: [http://pubmed.gov/11865833 11865833]</ref>
:* '''1800 mg/day''' <ref name="pmid11865834">De Sanctis MT, Cesarone MR, Belcaro G, Incandela L, Steigerwalt R, Nicolaides AN et al. (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11865834 Treatment of retinal vein thrombosis with pentoxifylline: a controlled, randomized trial.] ''Angiology'' 53 Suppl 1 ():S35-8. PMID: [http://pubmed.gov/11865834 11865834]</ref><ref name="pmid11865833">Incandela L, Cesarone MR, Belcaro G, Steigerwalt R, De Sanctis MT, Nicolaides AN et al. (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11865833 Treatment of vascular retinal disease with pentoxifylline: a controlled, randomized trial.] ''Angiology'' 53 Suppl 1 ():S31-4. PMID: [http://pubmed.gov/11865833 11865833]</ref>


=====Rheumatoid arthritis=====
=====Rheumatoid arthritis=====
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* Dosing information
* Dosing information


:* 400 mg PO tid  
:* '''400 mg PO tid'''


=====Sepsis=====


|contraindications=[[Enoxaparin_label_01.jpg|thumb|400px]]
* Dosing information
}}
{{drugbox |
| IUPAC_name        = 3,7-Dihydro-3,7-dimethyl-1-(5-oxohexyl)-''1H''-purine-2,6-dione
| image            = Pentoxifylline.png
| CAS_number        = 6493-05-6
| ATC_prefix        = C04
| ATC_suffix        = AD03
| PubChem          =
| DrugBank          =
| C=13 | H=18 | N=4 | O=3
| molecular_weight  = 278.31
| bioavailability  = Near 100% for oral dosing
| protein_bound    =
| metabolism        = Hepatic and via erythrocytes
| elimination_half-life = 0.4 - 0.8 hours (1 - 1.6 hours for active metabolite)
| excretion        = Mainly urine (<4% feces)
| pregnancy_AU      =  <!-- A / B1 / B2 / B3 / C / D / X -->
| pregnancy_US      =  C
| pregnancy_category= 
| legal_AU          =  <!-- Unscheduled / S2 / S3 / S4 / S5 / S6 / S7 / S8 / S9 -->
| legal_CA          =  <!--            / Schedule I, II, III, IV, V, VI, VII, VIII -->
| legal_UK          =  <!-- GSL        / P      / POM / CD / Class A, B, C -->
| legal_US          =  <!-- OTC                  / Rx-only  / Schedule I, II, III, IV, V -->
| legal_status      =
| routes_of_administration = Oral
}}


'''Pentoxifylline''' is the [[International Nonproprietary Name]] (INN) of a drug sold by [[Aventis]] under the name Trental.  Its chemical name is 1-(5-oxohexyl)-3, 7-dimethylxanthine. Pentoxifylline is a [[xanthine]] derivative.
:* '''400 mg PO tid''' <ref name="pmid23235582">Jull AB, Arroll B, Parag V, Waters J (2012) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=23235582 Pentoxifylline for treating venous leg ulcers.] ''Cochrane Database Syst Rev'' 12 ():CD001733. [http://dx.doi.org/10.1002/14651858.CD001733.pub3 DOI:10.1002/14651858.CD001733.pub3] PMID: [http://pubmed.gov/23235582 23235582]</ref>


This drug is passed into the [[breast milk]]. Animal studies have shown no evidence of teratogenicity at high doses.
=====Prophylaxis of Thromboembolic disorder=====


==Uses==
* Dosing information
It is used to treat [[intermittent claudication]] resulting from obstructed [[artery|arteries]] in the limbs, and [[multi-infarct dementia|vascular dementia]].<ref name="MID">(1996) ''European Pentoxifylline Multi-Infarct Dementia Study.'' Eur Neurol. 36(5):315-21. PMID 8864715 </ref>


Pentoxifylline improves blood flow through blood vessels and therefore helps with blood circulation in the arms and legs (e.g. intermittent claudication).
:* '''400 mg PO tid''' <ref name="pmid3304027">Radmilović A, Borić Z, Naumović T, Stamenković M, Muśikić P (1987) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3304027 Shunt thrombosis prevention in hemodialysis patients--a double-blind, randomized study: pentoxifylline vs placebo.] ''Angiology'' 38 (7):499-506. PMID: [http://pubmed.gov/3304027 3304027]</ref><ref name="pmid6465619">Lucas MA (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6465619 Prevention of post-operative thrombosis in peripheral arteriopathies. Pentoxifylline vs. conventional antiaggregants: a six-month randomized follow-up study.] ''Angiology'' 35 (7):443-50. PMID: [http://pubmed.gov/6465619 6465619]</ref><ref name="pmid8840947">Young BA, Marsh CL, Alpers CE, Davis CL (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8840947 Cyclosporine-associated thrombotic microangiopathy/hemolytic uremic syndrome following kidney and kidney-pancreas transplantation.] ''Am J Kidney Dis'' 28 (4):561-71. PMID: [http://pubmed.gov/8840947 8840947]</ref>


It also helps prevent strokes, can be used in managing [[sickle cell disease]] and improves blood flow to the brain.
=====Prophylaxis of Thromboembolic disorder=====


Pentoxifylline has also been used to treat nausea and headaches in the mountains ([[altitude sickness]]).
* Dosing information


==Mechanism==
:* '''1800 mg/day for 4 weeks'''<ref name="pmid11865830">Incandela L, Cesarone MR, Belcaro G, De Sanctis MT, Nicolaides AN, Griffin M et al. (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11865830 Treatment of vascular inner ear disease with pentoxifylline: a 4-week, controlled, randomized trial.] ''Angiology'' 53 Suppl 1 ():S19-22. PMID: [http://pubmed.gov/11865830 11865830]</ref>
Pentoxifylline is a [[Phosphodiesterase inhibitor|PDE4 inhibitor]] increasing intracellular [[Cyclic adenosine monophosphate|cAMP]] and stimulating [[cAMP-dependent protein kinase|PKA]] activity.
:* '''1600 mg/day for 4 weeks''' <ref name="pmid11865831">Cesarone MR, Incandela L, Belcaro G, De Sanctis MT, Nicolaides AN, Griffin M et al. (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11865831 Treatment of vascular inner ear disease in vascular patients with pentoxifylline: a controlled, randomized trial.] ''Angiology'' 53 Suppl 1 ():S23-6. PMID: [http://pubmed.gov/11865831 11865831]</ref>


It is also a known inhibitor of [[Tumor necrosis factor-alpha]].
=====Vasculitis=====


==Drug interaction==
* Dosing information
Co-administration of pentoxifylline and [[sodium thiopental]] causes death by acute [[pulmonary oedema]] in rats.<ref> Pereda J, Gómez-Cambronero L, Alberola A, Fabregat G, Cerdá M, Escobar J, Sabater L, García-de-la-Asunción J, Viña J, Sastre J.
Department of Physiology, School of Medicine, University of Valencia, Valencia, Spain. Br J Pharmacol. 2006 Oct;149(4):450-5. Epub 2006 Sep 4.PMID: 16953192.</ref>


:* '''400 mg PO tid''' <ref name="pmid3197446">Ely H, Bard JW (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3197446 Therapy of livedo vasculitis with pentoxifylline.] ''Cutis'' 42 (5):448-53. PMID: [http://pubmed.gov/3197446 3197446]</ref>
:* '''1200 mg qd''' plus '''[[dapsone]] 100 mg qd''' <ref name="pmid7906000">Nürnberg W, Grabbe J, Czarnetzki BM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7906000 Synergistic effects of pentoxifylline and dapsone in leucocytoclastic vasculitis.] ''Lancet'' 343 (8895):491. PMID: [http://pubmed.gov/7906000 7906000]</ref>
:* '''400 mg PO tid''' for 8 months followed by '''800 mg/day''' for 2 years <ref name="pmid8101717">Calderón MJ, Landa N, Aguirre A, Diaz-Perez JL (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8101717 Successful treatment of cutaneous PAN with pentoxifylline.] ''Br J Dermatol'' 128 (6):706-8. PMID: [http://pubmed.gov/8101717 8101717]</ref>
|fdaLIADPed=Safety and effectiveness in pediatric patients have not been established.
|offLabelPedGuideSupport=There is limited information about <i>Off-Label Guideline-Supported Use</i> of Pentoxifylline in pediatric patients.
|offLabelPedNoGuideSupport=There is limited information about <i>Off-Label Non–Guideline-Supported Use</i> of Pentoxifylline in pediatric patients.
|contraindications=TRENTAL should not be used in patients with recent [[Cerebral haemorrhage|cerebral]] and/or [[Retinal haemorrhage]]<font color="#777777"> </font>or in patients who have previously exhibited intolerance to this product or [[methylxanthines]] such as [[caffeine]], [[theophylline]], and [[theobromine]].
|warnings=At the first sign of [[anapylactic]]/[[anaphylactoid reaction]], TRENTAL must be discontinued.
Patients with [[arterial insufficiency|chronic occlusive arterial disease]] of the [[limbs]] frequently show other manifestations of [[arteriosclerotic]] disease. TRENTAL has been used safely for treatment of peripheral arterial disease in patients with concurrent [[coronary artery disease|coronary artery]] and [[cerebrovascular diseases]], but there have been occasional reports of [[angina]], [[hypotension]], and [[arrhythmia]]. Controlled trials do not show that TRENTAL causes such adverse effects more often than [[placebo]], but, as it is a [[methylxanthine]] derivative, it is possible some individuals will experience such responses. Patients on [[Warfarin]] should have more frequent monitoring of [[prothrombin time]]s, while patients with other risk factors complicated by [[hemorrhage]](e.g., recent [[surgery]], [[peptic ulceration]], [[cerebral hemorrhage|cerebral]] and/or [[Retinal hemorrhage|retinal bleeding]]) should have periodic examinations for [[bleeding]] including, [[hematocrit]] and/or [[hemoglobin]].
|clinicalTrials=[[Clinical trials]] were conducted using either extended-release TRENTAL tablets for up to 60 weeks or immediate-release TRENTAL capsules for up to 24 weeks. Dosage ranges in the tablet studies were 400 mg bid to tid and in the capsule studies, 200–400 mg tid. The table summarizes the incidence (in percent) of adverse reactions considered drug related, as well as the numbers of patients who received extended-release TRENTAL tablets, immediate-release TRENTAL capsules, or the corresponding [[placebo]]s. The incidence of adverse reactions was higher in the capsule studies (where dose related increases were seen in [[digestive]] and [[nervous system]] side effects) than in the tablet studies. Studies with the capsule include domestic experience, whereas studies with the extended-release tablets were conducted outside the U.S.
The table indicates that in the tablet studies few patients discontinued because of adverse effects.


==Alternate brand names==
[[File:Pentoxifylline table 01.jpg|thumb|none|400px|This image is provided by the National Library of Medicine.]]
* Pentoxil ([[Upsher Smith]])
* Pentoxin ([[Ratiopharm]])
* Artal ([[Leiras]])


==References==
TRENTAL has been marketed in Europe and elsewhere since 1972. In addition to the above symptoms, the following have been reported spontaneously since marketing or occurred in other [[clinical trials]] with an incidence of less than 1%; the causal relationship was uncertain:
<div class="references-small">
   
<references/>
Cardiovascular - [[dyspnea]], [[edema]], [[hypotension]].
</div>
   
Digestive - [[anorexia]], [[cholecystitis]], [[constipation]], [[dry mouth]]/[[thirst]].
   
Nervous - [[anxiety]], [[confusion]], [[depression]], [[seizures]], [[aseptic meningitis]].
   
Respiratory - [[epistaxis]], [[flu|flu-like symptoms]], [[laryngitis]], [[nasal congestion]].
   
Skin and Appendages - [[brittle fingernails]], [[pruritus]],[[ rash]], [[urticaria]], [[angioedema]].
   
Special Senses - [[blurred vision]], [[conjunctivitis]], [[earache]], [[scotoma]].
   
Miscellaneous - bad taste, excessive [[salivation]], [[leukopenia]], [[malaise]], [[sore throat]]/[[lymhadenopathy|swollen neck glands]], weight change.
|postmarketing=A few rare events have been reported spontaneously worldwide since marketing in 1972. Although they occurred under circumstances in which a causal relationship with pentoxifylline could not be established, they are listed to serve as information for physicians. Cardiovascular — [[angina]], [[arrhythmia]], [[tachycardia]]. [[Digestive]] — [[hepatitis]], [[jaundice]], [[cholestasis]], increased [[liver enzymes]]; and Hemic and [[Lymphatic]] — decreased serum [[fibrinogen]], [[pancytopenia]], [[aplastic anemia]], [[leukemia]], [[purpura]], [[thrombocytopenia]]. Immune system disorders — [[anaphylactic reaction]], [[anaphylactoid reaction]], [[anaphylactic shock]].
|drugInteractions=Although a causal relationship has not been established, there have been reports of [[bleeding]] and/or [[prothrombin time|prolonged prothrombin time]] in patients treated with TRENTAL with and without [[anticoagulants]] or [[Platelet aggregation inhibitor|platelet aggregation inhibitors]]. Patients on [[Warfarin]] should have more frequent monitoring of [[prothrombin time]]s, while patients with other risk factors complicated by [[hemorrhage]] (e.g., recent [[surgery]], [[peptic ulceration]]) should have periodic examinations for [[bleeding]] including [[hematocrit]] and/or [[hemoglobin]].
Concomitant administration of TRENTAL and [[theophylline]]-containing drugs leads to increased [[theophylline]] levels and [[theophylline]] toxicity in some individuals. Such patients should be closely monitored for signs of [[toxicity]] and have their [[theophylline]] dosage adjusted as necessary.
TRENTAL has been used concurrently with [[beta blockers]], [[digitalis]], [[diuretics]], [[antidiabetic agents]], and [[antiarrhythmics]], without observed problems. Small decreases in [[blood pressure]] have been observed in some patients treated with TRENTAL plus [[nifedipine]] or [[captopril]]; periodic systemic [[blood pressure]] monitoring is recommended for patients receiving concomitant [[antihypertensive therapy]]. If indicated, dosage of the [[antihypertensive agents]] should be reduced.
Postmarketing cases of increased [[anticoagulant]] activity have been reported in patients concomitantly treated with pentoxifylline and [[vitamin K antagonists]]. Monitoring of [[anticoagulant]] activity in these patients is recommended when pentoxifylline is introduced or the dose is changed.
|FDAPregCat=C
|useInPregnancyFDA=[[Teratogenicity]] studies have been performed in rats and rabbits using oral doses up to 576 and 264 mg/kg, respectively. On a weight basis, these doses are 24 and 11 times the maximum recommended human daily dose (MRHD); on a body-surface-area basis, they are 4.2 and 3.5 times the MRHD. No evidence of [[Congenital Abnormalities|fetal malformation]] was observed. Increased resorption was seen in rats of the 576 mg/kg group. There are no adequate and well controlled studies in [[pregnant]] women. TRENTAL (pentoxifylline) should be used during [[pregnancy]] only if the potential benefit justifies the potential risk to the [[fetus]].
|useInNursing=Pentoxifylline and its metabolites are excreted in human milk. Because of the potential for [[tumor|tumorigenicity]] shown for pentoxifylline in rats, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
|useInPed=Safety and effectiveness in [[pediatric]] patients have not been established.
|useInGeri=Clinical studies of TRENTAL did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased [[hepatic]], [[renal]], or [[cardiac]] function, and of concomitant disease or other drug therapy.
The active metabolite is known to be substantially excreted by the [[kidney]], and the risk of toxic reactions to this drug may be greater in patients with [[impaired renal function]]. Because elderly patients are more likely to have [[impaired renal function|decreased renal function]], care should be taken in dose selection, and it may be useful to monitor [[renal function]].
|administration=The usual dosage of TRENTAL in extended-release tablet form is one tablet (400 mg) three times a day with meals.
While the effect of TRENTAL may be seen within 2 to 4 weeks, it is recommended that treatment be continued for at least 8 weeks. [[Efficacy]] has been demonstrated in double-blind clinical studies of 6 months duration.
[[Digestive]] and [[central nervous system]] side effects are dose related. If patients develop these effects it is recommended that the dosage be lowered to one tablet twice a day (800 mg/day). If side effects persist at this lower dosage, the administration of TRENTAL should be discontinued.
|monitoring=*  Patients on [[Warfarin]] should have more frequent monitoring of [[prothrombin time]]s, while patients with other risk factors complicated by [[hemorrhage]] (e.g., recent [[surgery]], [[peptic ulceration]], [[cerebral hemorrhage|cerebral]] and/or [[retinal hemorrhage|retinal bleeding]]) should have periodic examinations for [[bleeding]] including, [[hematocrit]] and/or [[hemoglobin]].
* Concomitant administration of TRENTAL and [[theophylline]]-containing drugs leads to increased [[theophylline]] levels and [[theophylline]] [[toxicity]] in some individuals. Such patients should be closely monitored for signs of [[toxicity]] and have their [[theophylline]] dosage adjusted as necessary.
* Periodic [[blood pressure|systemic blood pressure]] monitoring is recommended for patients receiving concomitant [[antihypertensive therapy]]
* Monitoring of [[anticoagulant]] activity in these patients is recommended when pentoxifylline is introduced or the dose is changed
* Because elderly patients are more likely to have [[renal insufficiency|decreased renal function]], care should be taken in dose selection, and it may be useful to monitor [[renal function]].
|IVCompat=There is limited information about the IV Compatibility.
|overdose=Overdosage with TRENTAL has been reported in [[pediatric]] patients and adults. Symptoms appear to be dose related. A report from a poison control center on 44 patients taking overdoses of enteric-coated pentoxifylline tablets noted that symptoms usually occurred 4–5 hours after ingestion and lasted about 12 hours. The highest amount ingested was 80 mg/kg; [[flushing]], [[hypotension]], [[convulsions]], [[somnolence]], [[loss of consciousness]], [[fever]], and [[agitation]] occurred. All patients recovered. In addition to symptomatic treatment and [[gastric lavage]], special attention must be given to supporting [[respiration]], maintaining systemic [[blood pressure]], and controlling [[convulsions]]. [[Activated charcoal]] has been used to absorb pentoxifylline in patients who have overdosed.
|mechAction=Pentoxifylline and its metabolites improve the flow properties of [[blood]] by decreasing its [[viscosity]]. In patients with [[arterial insufficiency|chronic peripheral arterial disease]], this increases blood flow to the affected [[microcirculation]] and enhances [[tissue]] [[oxygenation]]. The precise mode of action of pentoxifylline and the sequence of events leading to clinical improvement are still to be defined. Pentoxifylline administration has been shown to produce dose-related [[hemorrheologic]] effects, lowering [[blood]] [[viscosity]], and improving [[erythrocyte]] flexibility. Leukocyte properties of [[hemorrheologic]] importance have been modified in animal and in vitro human studies. Pentoxifylline has been shown to increase [[leukocyte]] deformability and to inhibit [[neutrophil]] adhesion and activation. [[Tissue]] [[oxygen]] levels have been shown to be significantly increased by therapeutic doses of pentoxifylline in patients with [[peripheral arterial disease]].
|structure=Pentoxifylline Extended-release Tablets for oral administration, contains 400 mg of the active drug and the following inactive ingredients: hydroxyethyl [[cellulose]], [[isopropyl alcohol]], [[magnesium stearate]], [[povidone]], and [[talc]] in an extended-release formulation. Pentoxifylline is a tri-substituted xanthine derivative designated chemically as 1-(5-oxohexyl)-3,7-dimethylxanthine that, unlike [[theophylline]], is a [[hemorrhage|hemorrheologic]] agent, i.e. an agent that affects blood [[viscosity]]. Pentoxifylline is soluble in water and [[ethanol]], and sparingly soluble in [[toluene]].
The chemical structure is:


==External links==
[[File:Pentoxifylline structure 01.jpg|thumb|none|400px|This image is provided by the National Library of Medicine.]]
*[http://www.aventis-us.com/PIs/trental_TXT.html Trental information from Aventis]
 
*[http://www.jaaha.org/cgi/reprint/37/3/218.pdf Reprinted article on veterinary use]
Molecular weight: 278.31
Molecular formula: C13H18N4O3
|PD=TRENTAL® (pentoxifylline) tablets for oral administration contain 400 mg of the active drug and the following inactive ingredients: FD&C Red No. 3, [[hypromellose]] USP, [[magnesium stearate]] NF, [[polyethylene glycol]] NF, [[povidone]] USP, talc USP, [[titanium dioxide]] USP, and [[hydroxyethyl cellulose]] USP in an extended-release formulation. TRENTAL is a tri-substituted [[xanthine]] derivative designated chemically as 1-(5-oxohexyl)-3,7-dimethylxanthine that, unlike [[theophylline]], is a [[hemorrhage|hemorrheologic agent]], i.e. an agent that affects blood viscosity. Pentoxifylline is soluble in water and [[ethanol]], and sparingly soluble in toluene. The CAS Registry Number is 6493-05-6.
The chemical structure is:
 
[[Pentoxifylline_table_02.jpg|thumb|400px|This image is provided by the National Library of Medicine.]]
|PK=After oral administration in aqueous solution pentoxifylline is almost completely absorbed. It undergoes a first-pass effect and the various metabolites appear in [[plasma]] very soon after dosing. Peak plasma levels of the parent compound and its metabolites are reached within 1 hour. The major metabolites are Metabolite l (1-[5-hydroxyhexyl]-3,7-dimethylxanthine) and Metabolite V (1-[3-carboxypropyl]-3,7-dimethylxanthine), and [[plasma]] levels of these metabolites are 5 and 8 times greater, respectively, than pentoxifylline.
Following oral administration of aqueous solutions containing 100 to 400 mg of pentoxifylline, the [[pharmacokinetics]] of the parent compound and Metabolite l are dose-related and not proportional (non-linear), with half-life and area under the blood-level time curve (AUC) increasing with dose. The elimination [[kinetics]] of Metabolite V are not dose-dependent. The apparent [[plasma]] half-life of pentoxifylline varies from 0.4 to 0.8 hours and the apparent [[plasma]] half-lives of its [[metabolites]] vary from 1 to 1.6 hours. There is no evidence of accumulation or [[enzyme]] induction ([[Cytochrome P450]]) following multiple oral doses.
Excretion is almost totally [[urinary]]; the main [[biotransformation]] product is Metabolite V. Essentially no parent drug is found in the urine. Despite large variations in [[plasma]] levels of parent compound and its [[metabolites]], the [[urinary]] recovery of Metabolite V is consistent and shows dose proportionality. Less than 4% of the administered dose is recovered in [[feces]]. Food intake shortly before dosing delays absorption of an immediate-release dosage form but does not affect total absorption. The [[pharmacokinetics]] and metabolism of TRENTAL have not been studied in patients with [[renal failure|renal]] and/or [[hepatic dysfunction]]. The pentoxifylline AUC was increased and elimination rate decreased in an older population (60–68 years, n=6) compared to younger individuals (22–30 years, n=6) (see ''[[{{PAGENAME}}#Warnings|Precautions]]'', ''[[{{PAGENAME}}#Geriatric Use|Geriatric Use]]'').
After administration of the 400 mg extended-release TRENTAL tablet, [[plasma]] levels of the parent compound and its metabolites reach their maximum within 2 to 4 hours and remain constant over an extended period of time. Coadministration of TRENTAL tablets with meals resulted in an increase in mean [[Cmax]] and AUC by about 28% and 13% for pentoxifylline, respectively. [[Cmax]] for Metabolite 1 also increased by about 20%. The extended release of pentoxifylline from the tablet eliminates peaks and troughs in [[plasma]] levels for improved [[gastrointestinal]] tolerance.
|nonClinToxic=Long-term studies of the [[carcinogenic]] potential of pentoxifylline were conducted in mice and rats by dietary administration of the drug at doses up to 450 mg/kg (approximately 19 times the maximum recommended human daily dose (MRHD) in both species when based on body weight; 1.5 times the MRHD in the mouse and 3.3 times the MRHD in the rat when based on body surface area). In mice, the drug was administered for 18 months, whereas in rats, the drug was administered for 18 months followed by an additional 6 months without drug exposure. In the rat study, there was a statistically significant increase in benign [[fibroadenoma|mammary fibroadenomas]] in females of the 450 mg/kg group. The relevance of this finding to human use is uncertain. Pentoxifylline was devoid of [[mutagenic]] activity in various strains of [[Salmonella]] (Ames test) and in cultured mammalian cells (unscheduled [[DNA]] synthesis test) when tested in the presence and absence of metabolic activation. It was also negative in the in vivo mouse [[micronucleus]] test.
|howSupplied=TRENTAL (pentoxifylline) is available for oral administration as 400-mg pink film-coated oblong tablets imprinted Trental; supplied in bottles of 100 (NDC 0039-0078-10).
|storage=Store between 59 and 86° F (15 and 30° C).
Dispense in well-closed, light-resistant containers.
|alcohol=Alcohol-Pentoxifylline interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
|brandNames=* TRENtal
* Pentoxil
* Pentopak
|lookAlike=* TRENtal - TEGretol
|nlmPatientInfo=For patient information about Pentoxifylline from NLM, click [[Pentoxifylline (patient information)|here]].
|drugShortage===[http://www.goodrx.com/{{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}/price Price]==
}}
{{PillImage
|fileName=Pentoxifylline_400 mg_NDC 0093-5116.jpg
|drugName=Pentoxifylline
|NDC=0093-5116
|drugAuthor=Teva Pharmaceuticals USA Inc
|ingredients=hydroxyethyl cellulose (2000 mpa.s at 1%), isopropyl alcohol, magnesium stearate, talc
|pillImprint=BVF;0117
|dosageValue=400
|dosageUnit=mg
|pillColor=White
|pillShape=Oval
|pillSize=16.00
|pillScore=1
}}
{{LabelImage
|fileName=Pentoxifylline_label_01.jpg
}}
{{LabelImage
|fileName=Pentoxifylline_panel_01.jpg
}}


[[Category:Xanthines]]
[[Category:Xanthines]]
[[Category:drugs]]
[[Category:Vasodilators]]
 
[[Category:Cardiovascular Drugs]]
{{pharma-stub}}
[[Category:Drug]]
{{Peripheral vasodilators}}
[[de:Pentoxifyllin]]
[[hu:Pentoxifillin]]
[[pl:Pentoksyfilina]]
{{WikiDoc Sources}}

Latest revision as of 16:55, 20 August 2015

Pentoxifylline
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sheng Shi, M.D. [2]; Adeel Jamil, M.D. [3]

Disclaimer

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Overview

Pentoxifylline is a methylxanthine and blood modifier agent that is FDA approved for the treatment of treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease of the limbs. Common adverse reactions include nausea , vomiting.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Intermittent Claudication
  • Dosing Information
  • Dosing information: 400 mg PO tid with meals
  • Duration: 8 weeks
  • Digestive and central nervous system side effects are dose related. If patients develop these effects it is recommended that the dosage be lowered to one tablet twice a day (800 mg/day). If side effects persist at this lower dosage, the administration of Pentoxifylline Extended-release Tablet should be discontinued.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information about Off-Label Guideline-Supported Use of Pentoxifylline in adult patients.

Non–Guideline-Supported Use

Alcoholic hepatitis=

  • Dosing information
Cerebrovascular disease
  • Dosing information
Congestive heart failure
  • Dosing information
Adjunct treatment in the Diabetes mellitus
  • Dosing information
Proteinuria in the Diabetes mellitus
  • Dosing information
Gangrenous disorder
  • Dosing information
Male infertility
  • Dosing information
  • 800-1200 mg/day for 3 months[14]
Peyronie's disease, Early chronic
  • Dosing information
Retinal vascular occlusion
  • Dosing information
Rheumatoid arthritis
  • Dosing information
  • 400 mg PO tid
Sepsis
  • Dosing information
Prophylaxis of Thromboembolic disorder
  • Dosing information
Prophylaxis of Thromboembolic disorder
  • Dosing information
  • 1800 mg/day for 4 weeks[22]
  • 1600 mg/day for 4 weeks [23]
Vasculitis
  • Dosing information
  • 400 mg PO tid [24]
  • 1200 mg qd plus dapsone 100 mg qd [25]
  • 400 mg PO tid for 8 months followed by 800 mg/day for 2 years [26]

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Safety and effectiveness in pediatric patients have not been established.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information about Off-Label Guideline-Supported Use of Pentoxifylline in pediatric patients.

Non–Guideline-Supported Use

There is limited information about Off-Label Non–Guideline-Supported Use of Pentoxifylline in pediatric patients.

Contraindications

TRENTAL should not be used in patients with recent cerebral and/or Retinal haemorrhage or in patients who have previously exhibited intolerance to this product or methylxanthines such as caffeine, theophylline, and theobromine.

Warnings

At the first sign of anapylactic/anaphylactoid reaction, TRENTAL must be discontinued. Patients with chronic occlusive arterial disease of the limbs frequently show other manifestations of arteriosclerotic disease. TRENTAL has been used safely for treatment of peripheral arterial disease in patients with concurrent coronary artery and cerebrovascular diseases, but there have been occasional reports of angina, hypotension, and arrhythmia. Controlled trials do not show that TRENTAL causes such adverse effects more often than placebo, but, as it is a methylxanthine derivative, it is possible some individuals will experience such responses. Patients on Warfarin should have more frequent monitoring of prothrombin times, while patients with other risk factors complicated by hemorrhage(e.g., recent surgery, peptic ulceration, cerebral and/or retinal bleeding) should have periodic examinations for bleeding including, hematocrit and/or hemoglobin.

Adverse Reactions

Clinical Trials Experience

Clinical trials were conducted using either extended-release TRENTAL tablets for up to 60 weeks or immediate-release TRENTAL capsules for up to 24 weeks. Dosage ranges in the tablet studies were 400 mg bid to tid and in the capsule studies, 200–400 mg tid. The table summarizes the incidence (in percent) of adverse reactions considered drug related, as well as the numbers of patients who received extended-release TRENTAL tablets, immediate-release TRENTAL capsules, or the corresponding placebos. The incidence of adverse reactions was higher in the capsule studies (where dose related increases were seen in digestive and nervous system side effects) than in the tablet studies. Studies with the capsule include domestic experience, whereas studies with the extended-release tablets were conducted outside the U.S. The table indicates that in the tablet studies few patients discontinued because of adverse effects.

This image is provided by the National Library of Medicine.

TRENTAL has been marketed in Europe and elsewhere since 1972. In addition to the above symptoms, the following have been reported spontaneously since marketing or occurred in other clinical trials with an incidence of less than 1%; the causal relationship was uncertain:

Cardiovascular - dyspnea, edema, hypotension.

Digestive - anorexia, cholecystitis, constipation, dry mouth/thirst.

Nervous - anxiety, confusion, depression, seizures, aseptic meningitis.

Respiratory - epistaxis, flu-like symptoms, laryngitis, nasal congestion.

Skin and Appendages - brittle fingernails, pruritus,rash, urticaria, angioedema.

Special Senses - blurred vision, conjunctivitis, earache, scotoma.

Miscellaneous - bad taste, excessive salivation, leukopenia, malaise, sore throat/swollen neck glands, weight change.

Postmarketing Experience

A few rare events have been reported spontaneously worldwide since marketing in 1972. Although they occurred under circumstances in which a causal relationship with pentoxifylline could not be established, they are listed to serve as information for physicians. Cardiovascular — angina, arrhythmia, tachycardia. Digestivehepatitis, jaundice, cholestasis, increased liver enzymes; and Hemic and Lymphatic — decreased serum fibrinogen, pancytopenia, aplastic anemia, leukemia, purpura, thrombocytopenia. Immune system disorders — anaphylactic reaction, anaphylactoid reaction, anaphylactic shock.

Drug Interactions

Although a causal relationship has not been established, there have been reports of bleeding and/or prolonged prothrombin time in patients treated with TRENTAL with and without anticoagulants or platelet aggregation inhibitors. Patients on Warfarin should have more frequent monitoring of prothrombin times, while patients with other risk factors complicated by hemorrhage (e.g., recent surgery, peptic ulceration) should have periodic examinations for bleeding including hematocrit and/or hemoglobin. Concomitant administration of TRENTAL and theophylline-containing drugs leads to increased theophylline levels and theophylline toxicity in some individuals. Such patients should be closely monitored for signs of toxicity and have their theophylline dosage adjusted as necessary. TRENTAL has been used concurrently with beta blockers, digitalis, diuretics, antidiabetic agents, and antiarrhythmics, without observed problems. Small decreases in blood pressure have been observed in some patients treated with TRENTAL plus nifedipine or captopril; periodic systemic blood pressure monitoring is recommended for patients receiving concomitant antihypertensive therapy. If indicated, dosage of the antihypertensive agents should be reduced. Postmarketing cases of increased anticoagulant activity have been reported in patients concomitantly treated with pentoxifylline and vitamin K antagonists. Monitoring of anticoagulant activity in these patients is recommended when pentoxifylline is introduced or the dose is changed.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): C Teratogenicity studies have been performed in rats and rabbits using oral doses up to 576 and 264 mg/kg, respectively. On a weight basis, these doses are 24 and 11 times the maximum recommended human daily dose (MRHD); on a body-surface-area basis, they are 4.2 and 3.5 times the MRHD. No evidence of fetal malformation was observed. Increased resorption was seen in rats of the 576 mg/kg group. There are no adequate and well controlled studies in pregnant women. TRENTAL (pentoxifylline) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Pentoxifylline in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Pentoxifylline during labor and delivery.

Nursing Mothers

Pentoxifylline and its metabolites are excreted in human milk. Because of the potential for tumorigenicity shown for pentoxifylline in rats, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatic Use

Clinical studies of TRENTAL did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. The active metabolite is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.

Gender

There is no FDA guidance on the use of Pentoxifylline with respect to specific gender populations.

Race

There is no FDA guidance on the use of Pentoxifylline with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Pentoxifylline in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Pentoxifylline in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Pentoxifylline in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Pentoxifylline in patients who are immunocompromised.

Administration and Monitoring

Administration

The usual dosage of TRENTAL in extended-release tablet form is one tablet (400 mg) three times a day with meals. While the effect of TRENTAL may be seen within 2 to 4 weeks, it is recommended that treatment be continued for at least 8 weeks. Efficacy has been demonstrated in double-blind clinical studies of 6 months duration. Digestive and central nervous system side effects are dose related. If patients develop these effects it is recommended that the dosage be lowered to one tablet twice a day (800 mg/day). If side effects persist at this lower dosage, the administration of TRENTAL should be discontinued.

Monitoring

IV Compatibility

There is limited information about the IV Compatibility.

Overdosage

Overdosage with TRENTAL has been reported in pediatric patients and adults. Symptoms appear to be dose related. A report from a poison control center on 44 patients taking overdoses of enteric-coated pentoxifylline tablets noted that symptoms usually occurred 4–5 hours after ingestion and lasted about 12 hours. The highest amount ingested was 80 mg/kg; flushing, hypotension, convulsions, somnolence, loss of consciousness, fever, and agitation occurred. All patients recovered. In addition to symptomatic treatment and gastric lavage, special attention must be given to supporting respiration, maintaining systemic blood pressure, and controlling convulsions. Activated charcoal has been used to absorb pentoxifylline in patients who have overdosed.

Pharmacology

There is limited information regarding Pentoxifylline Pharmacology in the drug label.

Mechanism of Action

Pentoxifylline and its metabolites improve the flow properties of blood by decreasing its viscosity. In patients with chronic peripheral arterial disease, this increases blood flow to the affected microcirculation and enhances tissue oxygenation. The precise mode of action of pentoxifylline and the sequence of events leading to clinical improvement are still to be defined. Pentoxifylline administration has been shown to produce dose-related hemorrheologic effects, lowering blood viscosity, and improving erythrocyte flexibility. Leukocyte properties of hemorrheologic importance have been modified in animal and in vitro human studies. Pentoxifylline has been shown to increase leukocyte deformability and to inhibit neutrophil adhesion and activation. Tissue oxygen levels have been shown to be significantly increased by therapeutic doses of pentoxifylline in patients with peripheral arterial disease.

Structure

Pentoxifylline Extended-release Tablets for oral administration, contains 400 mg of the active drug and the following inactive ingredients: hydroxyethyl cellulose, isopropyl alcohol, magnesium stearate, povidone, and talc in an extended-release formulation. Pentoxifylline is a tri-substituted xanthine derivative designated chemically as 1-(5-oxohexyl)-3,7-dimethylxanthine that, unlike theophylline, is a hemorrheologic agent, i.e. an agent that affects blood viscosity. Pentoxifylline is soluble in water and ethanol, and sparingly soluble in toluene. The chemical structure is:

This image is provided by the National Library of Medicine.

Molecular weight: 278.31 Molecular formula: C13H18N4O3

Pharmacodynamics

TRENTAL® (pentoxifylline) tablets for oral administration contain 400 mg of the active drug and the following inactive ingredients: FD&C Red No. 3, hypromellose USP, magnesium stearate NF, polyethylene glycol NF, povidone USP, talc USP, titanium dioxide USP, and hydroxyethyl cellulose USP in an extended-release formulation. TRENTAL is a tri-substituted xanthine derivative designated chemically as 1-(5-oxohexyl)-3,7-dimethylxanthine that, unlike theophylline, is a hemorrheologic agent, i.e. an agent that affects blood viscosity. Pentoxifylline is soluble in water and ethanol, and sparingly soluble in toluene. The CAS Registry Number is 6493-05-6. The chemical structure is:

thumb|400px|This image is provided by the National Library of Medicine.

Pharmacokinetics

After oral administration in aqueous solution pentoxifylline is almost completely absorbed. It undergoes a first-pass effect and the various metabolites appear in plasma very soon after dosing. Peak plasma levels of the parent compound and its metabolites are reached within 1 hour. The major metabolites are Metabolite l (1-[5-hydroxyhexyl]-3,7-dimethylxanthine) and Metabolite V (1-[3-carboxypropyl]-3,7-dimethylxanthine), and plasma levels of these metabolites are 5 and 8 times greater, respectively, than pentoxifylline. Following oral administration of aqueous solutions containing 100 to 400 mg of pentoxifylline, the pharmacokinetics of the parent compound and Metabolite l are dose-related and not proportional (non-linear), with half-life and area under the blood-level time curve (AUC) increasing with dose. The elimination kinetics of Metabolite V are not dose-dependent. The apparent plasma half-life of pentoxifylline varies from 0.4 to 0.8 hours and the apparent plasma half-lives of its metabolites vary from 1 to 1.6 hours. There is no evidence of accumulation or enzyme induction (Cytochrome P450) following multiple oral doses. Excretion is almost totally urinary; the main biotransformation product is Metabolite V. Essentially no parent drug is found in the urine. Despite large variations in plasma levels of parent compound and its metabolites, the urinary recovery of Metabolite V is consistent and shows dose proportionality. Less than 4% of the administered dose is recovered in feces. Food intake shortly before dosing delays absorption of an immediate-release dosage form but does not affect total absorption. The pharmacokinetics and metabolism of TRENTAL have not been studied in patients with renal and/or hepatic dysfunction. The pentoxifylline AUC was increased and elimination rate decreased in an older population (60–68 years, n=6) compared to younger individuals (22–30 years, n=6) (see Precautions, Geriatric Use). After administration of the 400 mg extended-release TRENTAL tablet, plasma levels of the parent compound and its metabolites reach their maximum within 2 to 4 hours and remain constant over an extended period of time. Coadministration of TRENTAL tablets with meals resulted in an increase in mean Cmax and AUC by about 28% and 13% for pentoxifylline, respectively. Cmax for Metabolite 1 also increased by about 20%. The extended release of pentoxifylline from the tablet eliminates peaks and troughs in plasma levels for improved gastrointestinal tolerance.

Nonclinical Toxicology

Long-term studies of the carcinogenic potential of pentoxifylline were conducted in mice and rats by dietary administration of the drug at doses up to 450 mg/kg (approximately 19 times the maximum recommended human daily dose (MRHD) in both species when based on body weight; 1.5 times the MRHD in the mouse and 3.3 times the MRHD in the rat when based on body surface area). In mice, the drug was administered for 18 months, whereas in rats, the drug was administered for 18 months followed by an additional 6 months without drug exposure. In the rat study, there was a statistically significant increase in benign mammary fibroadenomas in females of the 450 mg/kg group. The relevance of this finding to human use is uncertain. Pentoxifylline was devoid of mutagenic activity in various strains of Salmonella (Ames test) and in cultured mammalian cells (unscheduled DNA synthesis test) when tested in the presence and absence of metabolic activation. It was also negative in the in vivo mouse micronucleus test.

Clinical Studies

There is limited information regarding Pentoxifylline Clinical Studies in the drug label.

How Supplied

TRENTAL (pentoxifylline) is available for oral administration as 400-mg pink film-coated oblong tablets imprinted Trental; supplied in bottles of 100 (NDC 0039-0078-10).

Storage

Store between 59 and 86° F (15 and 30° C). Dispense in well-closed, light-resistant containers.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Pentoxifylline Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Pentoxifylline interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

  • TRENtal
  • Pentoxil
  • Pentopak

Look-Alike Drug Names

  • TRENtal - TEGretol

Drug Shortage Status

Price

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P (2009) Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial. World J Gastroenterol 15 (13):1613-9. PMID: 19340904
  2. Louvet A, Diaz E, Dharancy S, Coevoet H, Texier F, Thévenot T et al. (2008) Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids. J Hepatol 48 (3):465-70. DOI:10.1016/j.jhep.2007.10.010 PMID: 18164508
  3. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000) Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology 119 (6):1637-48. PMID: 11113085
  4. Blume J, Rùhlmann KU, de la Haye R, Rettig K (1992) Treatment of chronic cerebrovascular disease in elderly patients with pentoxifylline. J Med 23 (6):417-32. PMID: 1293252
  5. (1996) European Pentoxifylline Multi-Infarct Dementia Study. Eur Neurol 36 (5):315-21. PMID: 8864715
  6. Parnetti L, Ciuffetti G, Mercuri M, Lupattelli G, Senin U (1986) The role of haemorheological factors in the ageing brain: long-term therapy with pentoxifylline ('Trental' 400) in elderly patients with initial mental deterioration. Pharmatherapeutica 4 (10):617-27. PMID: 3602014
  7. Herskovits E, Vazquez A, Famulari A, Smud R, Tamaroff L, Fraiman H et al. (1981) Randomised trial of pentoxifylline versus acetylsalicylic acid plus dipyridamole in preventing transient ischaemic attacks. Lancet 1 (8227):966-8. PMID: 6112386
  8. Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P (2002) The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Heart Fail 4 (3):305-9. PMID: 12034156
  9. Sliwa K, Skudicky D, Candy G, Wisenbaugh T, Sareli P (1998) Randomised investigation of effects of pentoxifylline on left-ventricular performance in idiopathic dilated cardiomyopathy. Lancet 351 (9109):1091-3. DOI:10.1016/S0140-6736(97)09338-0 PMID: 9660578
  10. Schwartz RW, Logan NM, Johnson PJ, Strodel WE, Fine JG, Kazmers A et al. (1989) Pentoxifylline increases extremity blood flow in diabetic atherosclerotic patients. Arch Surg 124 (4):434-7. PMID: 2649042
  11. Ghorbani A, Omidvar B, Beladi-Mousavi SS, Lak E, Vaziri S (2012) The effect of pentoxifylline on reduction of proteinuria among patients with type 2 diabetes under blockade of angiotensin system: a double blind and randomized clinical trial. Nefrologia 32 (6):790-6. DOI:10.3265/Nefrologia.pre2012.Jun.11242 PMID: 23169362
  12. Guerrero-Romero F, Rodríguez-Morán M, Paniagua-Sierra JR, García-Bulnes G, Salas-Ramírez M, Amato D (1995) Pentoxifylline reduces proteinuria in insulin-dependent and non insulin-dependent diabetic patients. Clin Nephrol 43 (2):116-21. PMID: 7736673
  13. Carr ME, Sanders K, Todd WM (1994) Pain relief and clinical improvement temporally related to the use of pentoxifylline in a patient with documented cholesterol emboli--a case report. Angiology 45 (1):65-9. PMID: 8285387
  14. Shen MR, Chiang PH, Yang RC, Hong CY, Chen SS (1991) Pentoxifylline stimulates human sperm motility both in vitro and after oral therapy. Br J Clin Pharmacol 31 (6):711-4. PMID: 1867966
  15. Safarinejad MR, Asgari MA, Hosseini SY, Dadkhah F (2010) A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease. BJU Int 106 (2):240-8. DOI:10.1111/j.1464-410X.2009.09041.x PMID: 19863517
  16. De Sanctis MT, Cesarone MR, Belcaro G, Incandela L, Steigerwalt R, Nicolaides AN et al. (2002) Treatment of retinal vein thrombosis with pentoxifylline: a controlled, randomized trial. Angiology 53 Suppl 1 ():S35-8. PMID: 11865834
  17. Incandela L, Cesarone MR, Belcaro G, Steigerwalt R, De Sanctis MT, Nicolaides AN et al. (2002) Treatment of vascular retinal disease with pentoxifylline: a controlled, randomized trial. Angiology 53 Suppl 1 ():S31-4. PMID: 11865833
  18. Jull AB, Arroll B, Parag V, Waters J (2012) Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev 12 ():CD001733. DOI:10.1002/14651858.CD001733.pub3 PMID: 23235582
  19. Radmilović A, Borić Z, Naumović T, Stamenković M, Muśikić P (1987) Shunt thrombosis prevention in hemodialysis patients--a double-blind, randomized study: pentoxifylline vs placebo. Angiology 38 (7):499-506. PMID: 3304027
  20. Lucas MA (1984) Prevention of post-operative thrombosis in peripheral arteriopathies. Pentoxifylline vs. conventional antiaggregants: a six-month randomized follow-up study. Angiology 35 (7):443-50. PMID: 6465619
  21. Young BA, Marsh CL, Alpers CE, Davis CL (1996) Cyclosporine-associated thrombotic microangiopathy/hemolytic uremic syndrome following kidney and kidney-pancreas transplantation. Am J Kidney Dis 28 (4):561-71. PMID: 8840947
  22. Incandela L, Cesarone MR, Belcaro G, De Sanctis MT, Nicolaides AN, Griffin M et al. (2002) Treatment of vascular inner ear disease with pentoxifylline: a 4-week, controlled, randomized trial. Angiology 53 Suppl 1 ():S19-22. PMID: 11865830
  23. Cesarone MR, Incandela L, Belcaro G, De Sanctis MT, Nicolaides AN, Griffin M et al. (2002) Treatment of vascular inner ear disease in vascular patients with pentoxifylline: a controlled, randomized trial. Angiology 53 Suppl 1 ():S23-6. PMID: 11865831
  24. Ely H, Bard JW (1988) Therapy of livedo vasculitis with pentoxifylline. Cutis 42 (5):448-53. PMID: 3197446
  25. Nürnberg W, Grabbe J, Czarnetzki BM (1994) Synergistic effects of pentoxifylline and dapsone in leucocytoclastic vasculitis. Lancet 343 (8895):491. PMID: 7906000
  26. Calderón MJ, Landa N, Aguirre A, Diaz-Perez JL (1993) Successful treatment of cutaneous PAN with pentoxifylline. Br J Dermatol 128 (6):706-8. PMID: 8101717

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