What are the uses of Vasoglor (pentoxifylline) tablets?

Uses of Vasoglor (Pentoxifylline) Tablets

Pentoxifylline (Vasoglor) tablets are primarily indicated for the treatment of intermittent claudication due to chronic occlusive arterial disease of the limbs, but should be considered only as a second-line alternative therapy to cilostazol due to its marginal clinical effectiveness. 1

Primary FDA-Approved Indication

• Intermittent Claudication: Pentoxifylline is FDA-approved for treating patients with intermittent claudication caused by chronic occlusive arterial disease of the limbs 1
  • Recommended dosage: 400 mg three times daily 2
  • Important note: It is not intended to replace more definitive therapy such as surgical bypass or removal of arterial obstructions 1

Efficacy in Peripheral Arterial Disease (PAD)

• Second-line therapy: Guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) classify pentoxifylline as a Class IIb recommendation (may be considered) for intermittent claudication 2

  • Clinical effectiveness is considered marginal and not well established (Level of Evidence: C) 2
  • Significantly less effective than cilostazol, which is the preferred pharmacological agent 3

• Comparative efficacy: A randomized, double-blind, placebo-controlled trial demonstrated that:

  • Cilostazol improved walking distance by 54% from baseline
  • Pentoxifylline improved walking distance by only 30%, which was similar to placebo (34%) 3
  • The ACC/AHA 2016 guidelines downgraded pentoxifylline to Class III: No Benefit (not effective for treatment of claudication) 2

Other Potential Uses (Off-Label)

• Chronic Kidney Disease: May be considered as adjunctive therapy in CKD patients with:

  • Persistent proteinuria despite optimal RAAS blockade
  • Rapid GFR decline
  • Evidence of inflammation 4

• Anemia in Hemodialysis: Some evidence suggests pentoxifylline may improve hemoglobin levels in hemodialysis patients with refractory anemia 5

  • Dosage used: 800 mg/day
  • Resulted in improved hemoglobin levels and reduced erythropoiesis-stimulating agent requirements

• Critical Limb Ischemia: Guidelines specifically state that parenteral administration of pentoxifylline is not useful for the treatment of critical limb ischemia (Class III recommendation) 2

Mechanism of Action

Pentoxifylline acts as a:

• Hemorheologic agent that decreases blood and plasma viscosity
• Increases erythrocyte and leukocyte deformability
• Inhibits neutrophil adhesion and activation
• May lower plasma fibrinogen concentrations 2

Side Effects and Safety

• Common side effects include:
  • Gastrointestinal symptoms (sore throat, dyspepsia, nausea, diarrhea) in approximately 3% of patients 2
  • No life-threatening side effects have been reported in clinical trials 2

Clinical Pearls

1. Pentoxifylline should not be considered first-line therapy for intermittent claudication; cilostazol is more effective 2, 3

2. When prescribing for PAD, set realistic expectations with patients about the modest benefits (average improvement in walking distance of only 21-29 meters for pain-free walking and 43-48 meters for maximal walking) 2

3. For patients with renal impairment, dose adjustment may be necessary as active metabolite exposure increases significantly 4

4. Treatment should be continued for at least 6-8 weeks before assessing efficacy in PAD 6

5. Pentoxifylline should not be used as a substitute for more definitive therapies like supervised exercise programs, endovascular procedures, or surgical bypass when these are indicated 1