Trental

Tren·tal (trntl)

A trademark for the drug pentoxifylline.

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pentoxifylline

Apo-Pentoxyphylline (CA), Neotren (UK), Nu-Pentoxyphylline SR (CA), Pentoxil, Trental

Pharmacologic class: Hemorrheologic, xanthine derivative

Therapeutic class: Hematologic agent

Pregnancy risk category C

Action

Unknown. Thought to enhance blood flow to the circulatory system by increasing vasoconstriction and oxygen concentrations.

Availability

Tablets (controlled-release, extended-release): 400 mg

⊘Indications and dosages

➣ Intermittent claudication

Adults: 400 mg t.i.d. If adverse reactions occur, decrease to 400 mg b.i.d.

Dosage adjustment

• Renal impairment

Off-label uses

• Diabetic angiopathies and neuropathies
• Transient ischemic attacks
• Severe idiopathic recurrent aphthous stomatitis
• Raynaud's phenomenon

Contraindications

• Hypersensitivity to drug or methylxanthines (such as caffeine, theophylline, theobromine)
• Recent cerebral or retinal hemorrhage

Precautions

Use cautiously in:
• patients at risk for bleeding
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give with meals to minimize GI distress.
• Make sure patient swallows tablets whole without crushing, breaking, or chewing.

Route	Onset	Peak	Duration
P.O.	Variable	2-4 hr	8 hr

Adverse reactions

CNS: agitation, dizziness, drowsiness, headache, insomnia, nervousness, tremor, anxiety, confusion, malaise

CV: angina, edema, hypotension, arrhythmias

EENT: blurred vision, epistaxis, laryngitis, nasal congestion, sore throat

GI: nausea, vomiting, constipation, diarrhea, abdominal discomfort, belching, bloating, dyspepsia, flatus, cholecystitis, dry mouth, excessive salivation, anorexia

Hematologic: leukopenia

Respiratory: dyspnea

Skin: rash, urticaria, pruritus, brittle fingernails, flushing, angioedema

Other: bad taste, weight changes, thirst, flulike symptoms, lymphadenopathy

Interactions

Drug-drug. Anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs): increased risk of bleeding

Antihypertensives: additive hypotension

Theobromide, theophylline: increased risk of theophylline toxicity

Drug-herbs. Anise, arnica, asafetida, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, licorice: increased risk of bleeding

Drug-behaviors. Smoking: decreased pentoxifylline efficacy

Patient monitoring

• Monitor vital signs and cardiovascular status. Watch for arrhythmias, angina, edema, and hypotension.
• Frequently monitor prothrombin time and International Normalized Ratio in patients receiving warfarin concurrently.
• Assess theophylline level in patients receiving theophylline-containing drugs concurrently.

Patient teaching

• Instruct patient to take with meals and to swallow tablets whole without crushing, breaking, or chewing.
☞ Inform patient that drug can cause serious adverse effects. Instruct him to immediately report chest pain, swelling, and flulike symptoms.
• Tell patient smoking may make drug less effective and that many over-the-counter preparations (including aspirin, NSAIDs, and herbs) increase risk of bleeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, herbs, and behaviors mentioned above.

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Trental Pentoxifylline, see there