Pentoxifylline, also known as oxpentifylline, is a xanthine derivative used as a drug to treat muscle pain in people with peripheral artery disease.[4] It is generic and sold under many brand names worldwide.[1]
An interesting off-label indication of pentoxifylline is the supportive treatment of distal diabetic neuropathy, where it can be added, for example, to thioctic acidorgabapentin.[17] Theoretically, it can (among other things) act prophylactically against ulcerative changes of the lower limbs associated with chronically decompensated diabetes. Patients with measurable impairment in arterial supply are more likely to benefit from adjunctive treatment with pentoxifylline.[18] The administration of higher doses of pentoxifylline in hospitalization for complications of distal diabetic neuropathy is usually conditioned by the joint agreement of the neurologist with the physicians of internal medicine (diabetology and angiology).
The combination of tocopherol and pentoxifylline has been evaluated for the treatment of medication-related osteonecrosis of the jaw.[19]
Pentoxifylline may be used transdermally for cellulite treatment.
Common side effects are belching, bloating, stomach discomfort or upset, nausea, vomiting, indigestion, dizziness, and flushing. Uncommon and rare side effects include angina, palpitations, hypersensitivity, itchiness, rash, hives, bleeding, hallucinations, arrhythmias, and aseptic meningitis.[2][3][5][6]
Contraindications include intolerance to pentoxifylline or other xanthine derivatives, recent retinal or cerebral haemorrhage, and risk factors for haemorrhage.[3]
There is some evidence that pentoxifylline can lower the levels of some biomarkers in non-alcoholic steatohepatitis but evidence is insufficient to determine if the drug is safe and effective for this use.[26] Animal studies have been conducted exploring the use of pentoxifylline for erectile dysfunction[27] and hearing loss.[28] Human studies have been conducted for Peyronie's disease.[29]
Pentoxifylline, in combination with tocopherol and clodronate, has been found to heal refractory osteoradionecrosis of the jaw,[30]
and to be prophylactic against osteoradionecrosis.[31]
In a Cochrane systematic review on the use of pentoxifylline for intermittent claudication in 2015, the following was concluded "The quality of included studies was generally low, and very large variability between studies was noted in reported findings including duration of trials, doses of pentoxifylline and distances participants could walk at the start of trials. Most included studies did not report on randomisation techniques or how treatment allocation was concealed, did not provide adequate information to permit judgement of selective reporting and did not report blindingofoutcome assessors. Given all these factors, the role of pentoxifylline in intermittent claudication remains uncertain, although this medication was generally well tolerated by participants".[32][needs update]
^Zabel P, Entzian P, Dalhoff K, Schlaak M (May 1997). "Pentoxifylline in treatment of sarcoidosis". American Journal of Respiratory and Critical Care Medicine. 155 (5): 1665–1669. doi:10.1164/ajrccm.155.5.9154873. PMID9154873.
^Tong Z, Dai H, Chen B, Abdoh Z, Guzman J, Costabel U (October 2003). "Inhibition of cytokine release from alveolar macrophages in pulmonary sarcoidosis by pentoxifylline: comparison with dexamethasone". Chest. 124 (4): 1526–1532. doi:10.1378/chest.124.4.1526. PMID14555589.
^Legendre DP, Muzny CA, Swiatlo E (January 2012). "Hansen's disease (Leprosy): current and future pharmacotherapy and treatment of disease-related immunologic reactions". Pharmacotherapy. 32 (1): 27–37. doi:10.1002/PHAR.1009. PMID22392826. S2CID46569413.
^Page JC, Chen EY (August 1997). "Management of painful diabetic neuropathy. A treatment algorithm". Journal of the American Podiatric Medical Association. 87 (8): 370–379. doi:10.7547/87507315-87-8-370. PMID9274092.
^Marques LJ, Zheng L, Poulakis N, Guzman J, Costabel U (February 1999). "Pentoxifylline inhibits TNF-alpha production from human alveolar macrophages". American Journal of Respiratory and Critical Care Medicine. 159 (2): 508–511. doi:10.1164/ajrccm.159.2.9804085. PMID9927365.
^Rodríguez-Morán M, Guerrero-Romero F (February 2008). "Efficacy of pentoxifylline in the management of microalbuminuria in patients with diabetes". Current Diabetes Reviews. 4 (1): 55–62. doi:10.2174/157339908783502343. PMID18220696.
^Patel V, Gadiwalla Y, Sassoon I, Sproat C, Kwok J, McGurk M (June 2016). "Prophylactic use of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of the head and neck". The British Journal of Oral & Maxillofacial Surgery. 54 (5): 547–50. doi:10.1016/j.bjoms.2016.02.024. PMID26975577.
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