Indications :
- Raynaud’s phenomenon: 400 mg three to four times daily.
- Livedoid vasculopathy.
- Necrobiosis lipoidica: 400 mg twice daily.
- Psoriasis.
- Pemphigus vulgaris: 400 mg pentoxifylline + 500 mg sulfasalazine three times daily as adjunctive therapy.
- Behçet disease and recuurent aphthosis.
- Venous insuffciency with ulcers: 400 mg 3 times daily.
- Cutaneous polyarteritis nodosa.
- Schamberg’s disease.
- Cutaneous and mucocutaneous leishmaniasis : djuvant to pentavalent antimony.
- Pain and pruritus associated with giant keloids.
- Renal pruritus: 600 mg iv
- Pruritus in HIV-infected patients.
- Peyronie’s disease.
- Radiation induced fibrosis and burns.
- Lipodermatosclerosis.
Dosage
- Usual dose : 400 mg 3–4 times daily for 2–4 months to obtain the maximal therapeutic effect.
- It may take up to 2–4 months to obtain the maximal therapeutic beneft from pentoxifylline.
Mechanism of action
- Immune modulation
- Pentoxifylline increases erythrocyte and leukocyte deformability.
- Decreases endothelial leukocyte adhesion.
- Decreases leukocyte responsiveness to interleukin 1 (IL-1) and TNF.
- Inhibits T and B lymphocyte activation.
- Decreases natural killer cell activity.
- Inhibits neutrophil adhesion and activation.
- Anti-fibrinolytic
- Pentoxifylline increases fibroblast collagenases and decreases the production of collagen, fibronectin and glycosaminoglycan.
- Hemorheological effects
- It reduces platelet aggregation and activation.
- It increases red blood cell deformability and decreased blood viscosity.
- Anti-TNF-α effects
- Inhibitor of tumor necrosis factor-α.
- Other
- It is a non-selective inhibitor of cyclic-3’, 5’-phospho-diesterase (PDE), leading to a broad-spectrum effect against cell proliferation and inflammation.
Monitoring
Baseline
- Check if allergic to caffeine containing products (coffee, tea, colas), pentoxifylline, theobromine, theophylline or any other drugs.
- Ask about anticoagulants (“blood thinners”) such as warfarin (Coumadin) and vitamins.
- Ask about Kidney disease.
- Ask if pt is Pregnant, planning pregnancy or lactating.
- Any surgery in the near future.
Follow Up
- PERIODICALLY: blood pressure monitoring.
Side effects
- Used with caution in patients with severe cardiac disease.
- Nausea, gastrointestinal disturbances.
- Dizziness, and headache.
Contraindications
- Hypersensitivity to pentoxifylline or xanthine derivatives.
- Recent retinal or cerebral hemorrhage.
Interactions
- There may be an interaction between pentoxifylline and any of the following:
- Antidiabetes medications (e.g., glyburide, insulin, metformin).
- Blood pressure reducing medications (e.g., metoprolol, ramipril).
- Cimetidine.
- Ciprofloxacin.
- Erythromycin.
- Medications that affect blood clotting (e.g., clopidogrel, heparin, warfarin).
- Sympathomimetic medications (e.g., pseudoephedrine).
- Theophylline.
Pregnancy & Lactation
- Pregnancy category: C.
- Lactation: Drug excreted in breast milk; discontinue therapy, or do not nurse.
Precautions
- Use caution with risk factors for hemorrhage.
- Discontinue at first sign of anaphylaxis.
- Use with caution in renal impairment; exposure to pentoxifylline and/or active metabolites may increase; significance unknown.
- Use with caution in the elderly due to potential for renal impairment.
- Use with caution in hepatic impairment; exposure to pentoxifylline and/or active metabolites may increase; significance unknown.
- Advice to avoid driving a car or operating machinery.
Drug Info
- The safety and effectiveness of using this medication have not been established for children below the age of 18 years.
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