Hemorheological Agent (Methylxanthine)
Pregnancy: C
Pentoxifylline
Brand names: Trental
Adult dose
Dose: 400 mg two to three times daily with meals
Route: oral
Frequency: two to three times daily
Max: 1200 mg/day
Take with meals to reduce GI side effects; modest benefit in peripheral arterial disease; limited evidence — not routinely recommended in NICE guidelines
Paediatric dose
Route:
Not licensed in children
Dose adjustments
Renal
Reduce dose if eGFR <30 ml/min
Hepatic
Reduce dose in hepatic impairment
Clinical pearls
- Improves red blood cell deformability and reduces blood viscosity — modest benefit in claudication
- Limited evidence — Cochrane review shows small benefit in walking distance but clinical significance uncertain
- Also used in vasculitic leg ulcers and radiation-induced tissue necrosis (off-label)
Contraindications
- Recent cerebral haemorrhage
- Acute MI
- Severe cardiac arrhythmias
- Hypersensitivity to methylxanthines
Side effects
- Nausea
- Vomiting
- Dizziness
- Flushing
- Headache
- Palpitations
Interactions
- Theophylline (seizure risk)
- Warfarin (enhanced anticoagulation)
- Antihypertensives (enhanced hypotension)
- Cimetidine (increases levels)
Monitoring
- Walking distance assessment
- Blood pressure
- Signs of GI intolerance
Reference: BNFc; BNF 86; Cochrane review 2012. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.