Trental (pentoxifylline) is a hemorheologic agent specifically indicated to improve microcirculatory flow and oxygen delivery in patients with peripheral arterial disease. By reducing blood viscosity and enhancing erythrocyte flexibility, it addresses the underlying hemodynamic impairments associated with chronic occlusive arterial conditions. This xanthine derivative offers a targeted pharmacologic approach for symptomatic relief and functional improvement in affected individuals, supported by decades of clinical use and evidence.

Features

• Active ingredient: Pentoxifylline 400 mg (in extended-release tablet form)
• Pharmacologic class: Hemorheologic agent, xanthine derivative
• Mechanism: Improces erythrocyte deformability, reduces blood viscosity, decreases platelet aggregation, and modestly reduces fibrinogen levels
• Formulation: Film-coated, extended-release tablets for twice-daily dosing
• Bioavailability: Approximately 20% following oral administration
• Half-life: 0.4–0.8 hours (pentoxifylline); 1–1.6 hours (primary metabolites)
• Metabolism: Hepatic, via erythrocytes and tissue walls
• Excretion: Primarily renal (≥95% as metabolites)

Benefits

• Improves walking distance and reduces pain in intermittent claudication
• Enhances tissue oxygenation through improved microcirculatory flow
• Reduces blood viscosity for better peripheral perfusion
• Provides symptomatic relief in chronic occlusive arterial disease
• Supported by clinical studies demonstrating functional improvement
• Well-tolerated profile with established safety data

Common use

Trental is primarily prescribed for the symptomatic treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease of the limbs. It is indicated to improve pain-free walking distance and overall functional capacity. While not intended to replace more definitive interventions such as surgical bypass or exercise programs, it serves as an important pharmacologic adjunct in comprehensive management strategies. The medication is typically used in conjunction with risk factor modification, including smoking cessation, lipid management, and diabetes control.

Dosage and direction

The recommended adult dosage is one 400 mg tablet three times daily with meals. Tablets should be swallowed whole and not crushed, chewed, or divided. Administration with food minimizes potential gastrointestinal discomfort. Therapeutic response may require 2–4 weeks to become apparent, with continued improvement often observed over 8+ weeks of treatment. Dosage adjustment is recommended in patients with renal impairment (creatinine clearance below 30 mL/min) – typically reduced to 400 mg twice daily. Hepatic impairment warrants careful monitoring and potential dosage reduction.

Precautions

Patients should be monitored for therapeutic response and potential adverse effects. Regular assessment of walking distance and symptomatic improvement is recommended. Use with caution in patients with recent surgical procedures, bleeding tendencies, or those receiving anticoagulant therapy. Pentoxifylline may enhance the effects of antihypertensive medications; blood pressure monitoring is advised. The drug should be used cautiously in patients with cardiac arrhythmias, as xanthine derivatives have potential cardiac effects. Renal and hepatic function should be assessed periodically during prolonged therapy.

Contraindications

Trental is contraindicated in patients with known hypersensitivity to pentoxifylline, other xanthine derivatives (such as caffeine, theophylline, or theobromine), or any component of the formulation. It should not be used in patients with recent cerebral or retinal hemorrhage. The medication is contraindicated in patients with severe cardiac arrhythmias that are not adequately controlled. It is not recommended for use during the acute phase of myocardial infarction.

Possible side effect

The most commonly reported adverse reactions involve the gastrointestinal system (approximately 30-50% of patients), including:

• Nausea
• Dyspepsia
• Vomiting
• Abdominal discomfort
• Flushing
• Dizziness
• Headache

Less frequent but potentially serious effects include:

• Chest pain
• Arrhythmias
• Hypotension
• Agitation
• Tremor
• Blurred vision
• Angioedema
• Thrombocytopenia

Drug interaction

Trental demonstrates several clinically significant interactions:

• Anticoagulants (warfarin): May potentiate anticoagulant effect; monitor INR closely
• Antihypertensive agents: May enhance hypotensive effects
• Theophylline: Increased theophylline levels and potential toxicity
• Cimetidine: May increase pentoxifylline concentrations
• CYP1A2 inhibitors (fluvoxamine): May increase pentoxifylline exposure
• Sympathomimetics: Potential for increased hypertensive effects

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent dosing is important for maintaining therapeutic effect, but occasional missed doses are unlikely to significantly impact overall efficacy.

Overdose

Symptoms of overdose may include flushing, hypotension, convulsions, somnolence, fever, and agitation. Management should include supportive measures with particular attention to maintaining blood pressure and cardiac monitoring. Gastric lavage may be considered if ingestion was recent. Activated charcoal may be administered. There is no specific antidote for pentoxifylline overdose. Hemodialysis may be effective due to the drug’s relatively low molecular weight and partial protein binding.

Storage

Store at controlled room temperature (20-25°C or 68-77°F), with excursions permitted between 15-30°C (59-86°F). Protect from moisture and excessive heat. Keep in the original container with the lid tightly closed. Do not store in bathroom areas where moisture levels may be high. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Trental is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to therapy may vary. Patients should consult their physician for proper diagnosis and treatment recommendations. The complete prescribing information should be reviewed before initiating therapy.

Reviews

Clinical studies demonstrate that approximately 40-45% of patients experience significant improvement in pain-free walking distance compared to 20-25% with placebo. Meta-analyses of randomized controlled trials show consistent modest benefits in functional capacity. Many patients report reduced claudication pain and improved quality of life. The medication is generally well-tolerated, with most adverse effects being mild and gastrointestinal in nature. Long-term users often note sustained symptomatic improvement when combined with lifestyle modifications.