From the Guidelines
Pentoxifylline is not recommended as a treatment for claudication due to its lack of effectiveness, as shown in a Cochrane review of 24 studies with 3,377 participants 1. The use of Pentoxifylline (PTX) has been studied in various contexts, including peripheral vascular disease and nonalcoholic fatty liver disease. However, the most recent and highest quality study, a 2017 guideline from the American College of Cardiology/American Heart Association, recommends against the use of Pentoxifylline for the treatment of claudication due to its lack of benefit 1. Some studies have suggested that Pentoxifylline may have marginal benefits in improving walking distance in patients with intermittent claudication, but these effects are not well established and are considered to be of limited clinical importance 1. In other contexts, such as nonalcoholic fatty liver disease, Pentoxifylline has shown some promise in improving histologic features of the disease, but the evidence is limited and more studies are needed to fully understand its potential benefits and risks 1. In terms of dosage and administration, Pentoxifylline is typically taken orally at a dose of 400 mg three times daily with meals. Common side effects include nausea, dizziness, headache, and stomach discomfort. Key points to consider when using Pentoxifylline include:
- Lack of effectiveness for claudication treatment 1
- Potential marginal benefits in improving walking distance in patients with intermittent claudication 1
- Limited evidence for use in nonalcoholic fatty liver disease 1
- Typical dosage of 400 mg three times daily with meals
- Common side effects include nausea, dizziness, headache, and stomach discomfort Overall, the use of Pentoxifylline should be approached with caution and in the context of careful consideration of the potential benefits and risks, as well as the availability of alternative treatments.
From the FDA Drug Label
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 use of Pentoxifylline (PTX) is for the treatment of intermittent claudication due to chronic occlusive arterial disease of the limbs 2.
- The main goal is to improve function and symptoms.
- It 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
Use of Pentoxifylline (PTX)
Pentoxifylline (PTX) is used for various therapeutic purposes, including:
- Treatment of intermittent claudication, a symptom of peripheral arterial disease (PAD) 3, 4, 5, 6, 7
- Management of cerebrovascular disease, including multi-infarct dementia 3
- Improvement of walking distances in patients with intermittent claudication 3, 4, 5, 6
- Decreasing rest pain in patients with critical limb ischemia 3
- Increasing the healing of venous ulcers of the leg when used as an adjunct to standard compression bandaging 3
Mechanism of Action
The exact mechanism of action of PTX is unclear, but it may be related to:
- Effects on white blood cell function and haemorrheological parameters 3
- Decreasing blood viscosity, improving erythrocyte flexibility, and promoting microcirculatory flow and tissue oxygen concentration 4, 5, 6, 7
- Reduction in fibrinogen concentration, platelet adhesiveness, and whole blood viscosity 7
Dosage and Administration
The recommended dose of PTX is:
- 400 mg three times daily with meals for intermittent claudication 7
- 1200 mg/day for up to 6 months for improvement of walking distances in patients with intermittent claudication 3
- 1200 mg/day for 21 days for decreasing rest pain in patients with critical limb ischemia 3
Efficacy and Safety
PTX has been shown to:
- Improve walking distances in patients with intermittent claudication 3, 4, 5, 6
- Decrease rest pain in patients with critical limb ischemia 3
- Increase the healing of venous ulcers of the leg when used as an adjunct to standard compression bandaging 3
- Be generally well tolerated, with gastrointestinal effects reported in fewer than 3% of treated patients 3, 4, 5, 6