From the Guidelines
Pentoxifylline is not recommended as a first-line treatment for intermittent claudication due to its limited clinical effectiveness, and its use should be considered on a case-by-case basis for patients with severe alcoholic hepatitis who have a contraindication to glucocorticoids. The medication has been shown to have marginal benefits in improving walking distance in patients with intermittent claudication, with a study published in the Journal of the American College of Cardiology in 2013 stating that pentoxifylline may be considered as second-line alternative therapy to cilostazol to improve walking distance in patients with intermittent claudication 1. However, a more recent study published in 2017 in the same journal found that pentoxifylline is not effective for the treatment of claudication and is therefore not recommended 1. In terms of dosage, the standard dosage of pentoxifylline is 400 mg three times daily with meals, though some patients may start with 400 mg twice daily to minimize gastrointestinal side effects. Pentoxifylline has also been used off-label for the treatment of severe alcoholic hepatitis, particularly in patients who have a contraindication to glucocorticoids, with a study published in Clinical Gastroenterology and Hepatology in 2017 recommending pentoxifylline 400 mg three times daily with meals as an alternative treatment option 1. It is essential to monitor patients for common side effects, including gastrointestinal disturbances, dizziness, and headache, and to adjust the dose as necessary in patients with renal impairment. Some key points to consider when prescribing pentoxifylline include:
- The medication's limited clinical effectiveness in improving walking distance in patients with intermittent claudication
- The potential benefits and risks of using pentoxifylline in patients with severe alcoholic hepatitis who have a contraindication to glucocorticoids
- The importance of monitoring patients for common side effects and adjusting the dose as necessary in patients with renal impairment. Overall, the use of pentoxifylline should be carefully considered on a case-by-case basis, taking into account the patient's individual needs and medical history.
From the FDA Drug Label
INDICATIONS AND USAGE Pentoxifylline Extended-Release Tablets are indicated for the treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease of the limbs. The indications for Pentoxyfilene are:
- Treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease of the limbs 2. Pentoxyfilene is not intended to replace more definitive therapy, such as surgical bypass, or removal of arterial obstructions when treating peripheral vascular disease.
From the Research
Indications for Pentoxyfilene (Pentoxifylline)
Pentoxifylline is indicated for the treatment of various conditions, including:
- Intermittent claudication, a symptom of peripheral arterial disease (PAD) characterized by pain in the legs during walking 3, 4, 5, 6, 7
- Cerebrovascular disease, including multi-infarct dementia and transient ischemic attacks 3
- Critical limb ischemia, with intravenous administration of pentoxifylline decreasing rest pain in patients 3
- Venous ulcers of the leg, with oral administration of pentoxifylline increasing the healing of ulcers when used as an adjunct to standard compression bandaging 3
Mechanism of Action
The exact mechanism of action of pentoxifylline is unclear, but it may be related to its effects on:
- White blood cell function 3
- Haemorrheological parameters, including blood viscosity and erythrocyte flexibility 3, 6, 7
- Platelet adhesiveness and whole blood viscosity 4
Dosage and Administration
The recommended dose of pentoxifylline varies depending on the condition being treated, but common dosages include: