Trental: instructions for use, price, indications for use, reviews on forums and analogues

Compound

Trental tablets contain 100 mg of the active ingredient pentoxifylline and additional substances: silicon dioxide, starch, talc, lactose and magnesium stearate.
The shell consists of talc, titanium dioxide, sodium hydroxide, methacrylic acid copolymer, as well as macrogol 8000. The infusion solution concentrate in 1 ml contains 20 mg of the active substance pentoxifylline and additional substances: injection water and sodium chloride.

Long-acting tablets Trental 400 contain 400 mg of the active ingredient pentoxifylline and additional substances: magnesium stearate, povidone, talc, hyaetellose. The shell contains: benzyl alcohol, talc, macrogol 6000, hypromellose, titanium dioxide.

Pharmacodynamics and pharmacokinetics

The drug inhibits phosphodiesterase, has a positive effect on the rheological properties of blood, improves microcirculation, increases the concentration of ATP in erythrocytes and the concentration of cAMP in platelets. At the same time, under the influence of the medication, there is a saturation of the energy potential, which leads to a decrease in peripheral vascular resistance, vasodilation, an increase in VO and SV without a significant effect on the pulse. By expanding the lumen of the coronary arteries, pentoxifylline increases the flow of oxygen to myocardial tissues, providing an antianginal effect.

The drug improves blood oxygenation by expanding the lumen of the blood vessels of the lungs. Trental increases the tone of the respiratory muscles: the diaphragm and intercostal muscles. When administered intravenously, it enhances collateral blood circulation and increases the volume of blood per unit section. The drug has a positive effect on the bioelectrical activity of the brain, increasing the concentration of ATP. Trental 400 increases the elasticity of red blood cells, promotes platelet disaggregation, and reduces blood viscosity. In areas with impaired blood supply, pentoxifylline improves microcirculation. For intermittent claudication and occlusive lesions of the peripheral arteries, the medication eliminates pain at rest, relieves night cramps in the calf muscles, and helps lengthen the walking distance.

The active substance is well absorbed and metabolized. The half-life for tablets is about one and a half hours, for the solution - just over an hour. It is mainly excreted through the kidneys (more than 90 percent), and also with feces to a lesser extent.

Trental

Trental (INN - pentoxifylline) is an original drug from the group of vasodilators from the Indian division of the world famous pharmaceutical company. The first use of trental dates back to 1972, when it was used to treat intermittent claudication. In addition to the vasodilator, the drug has an antiplatelet (prevents platelets from adhering to each other) and angioprotective (protects blood vessels) effect. Due to its ability to improve blood fluidity, reduce platelet aggregation, stimulate capillary circulation and make red blood cells more elastic, trental has found wide use in various circulatory pathologies. The main “weapon” of trental, pentoxifylline, is very close in its chemical “pedigree” to theophylline and theobromine. All its pharmacological advantages are due to the exclusive possession of the secret inhibitory effect on type 4 phosphodiesterases, which entails an increase in the concentration of cAMP in platelets and ATP in erythrocytes against the background of a decrease in the content of calcium ions in cells. Numerous clinical studies conducted in accordance with all the rules of evidence-based medicine indicate the ability of trental to have a purely positive effect on microcirculation and blood circulation in general. And it cannot be otherwise: after all, this drug is capable of dilating blood vessels, simultaneously reducing their general and peripheral resistance, increasing stroke and minute blood volumes without a significant change in pulse rate.

The concentration of cAMP increases not only in platelets, but also in the smooth muscle cells of the vascular walls, which leads to their relaxation.

As already mentioned, Trental is a branded original drug. In the mid-2000s of the last century, a study of the rheological properties of trental in comparison with generic pentoxifylline preparations was carried out on the basis of Yaroslavl State University. At the same time, the original drug showed itself to be a more pronounced antiplatelet agent (46%) than generics (20-35%). Without exception, all drugs studied reduced the size and rate of formation of aggregates, but only trental showed a consistent and significant decrease in all aggregation characteristics.

Trental is available in three dosage forms: tablets, extended-release tablets and concentrate for the preparation of a solution for intravenous and intra-arterial administration. The frequency of administration and dosage regimen are established by the attending physician according to the individual characteristics of each individual patient. During the course of treatment using Trental, it is recommended to monitor blood pressure, and if the patient has recently undergone surgery, then systematic monitoring of hemoglobin levels and hematocrit is indicated. An important clarification: when administering trental intravenously, the patient must be in a supine position.

Indications for use of Trental

What does the medicine help with?

Indications for use of the drug are peripheral circulatory disorders:

obliterating endarteritis;
intermittent claudication in diabetic angiopathy .

The drug is effective in treating tissue trophic disorders:

frostbite;
gangrene;
varicose veins;
postthrombotic syndrome;
trophic ulcers of the leg.

What other indications for the use of Trental exist? The medication is used:

for Raynaud's disease ;
for cerebral atherosclerosis ;
cerebrovascular accident;
with neuroinfection of viral origin;
dyscirculatory encephalopathy;
after myocardial infarction ;
with ischemic heart disease;
with impotence of vascular origin;
bronchial asthma;
COPD;
otosclerosis;
acute disturbances of blood supply in the choroid and retina.

Trental 400

Trental 400 (pentoxifylline) is a vasodilator. Increases the ability of red blood cells to change their shape under the influence of external forces, prevents blood platelets and red blood cells from sticking together, reduces the level of factor I of the blood coagulation system, suppresses the activity of white blood cells and prevents their adhesion to the inner wall of blood vessels. The above effects of the drug provide an improvement in the rheological characteristics of the blood and a decrease in its viscosity. The active component of the drug, pentoxifylline, inhibits the activity of the phosphodiesterase enzyme and causes the accumulation of cAMP in smooth muscles. By acting on the smooth muscle framework of blood vessels, it has a mild vasodilator effect, to a certain extent reduces the overall resistance of the entire vascular system to the blood flow ejected by the heart, slightly increases the lumen of the heart vessels, and improves blood circulation in areas with impaired blood circulation. Helps improve cerebral blood circulation. If there are obstacles to normal blood circulation in the arteries of the lower extremities, the use of the drug helps to make walking easier and increase the daily distance walked, reduce the number of episodes of night cramps in the lower leg muscles, and relieve pain at rest. After oral administration, the active substance is almost completely absorbed in the gastrointestinal tract. The dosage form of Trental 400 provides a prolonged release of the active component without sharp peaks and valleys, as a result of which patients better tolerate drug therapy. The half-life of the drug is 1.6 hours. Elimination of the drug from the body is carried out along with urine. In persons with renal failure, the elimination time of Trental 400 is slowed down. The drug is prescribed for generalized damage to large and small blood vessels in diabetes mellitus, transient pain in the legs that occurs while walking, long-term non-healing ulcers of the legs resulting from impaired blood supply, circulatory disorders in the vessels of the brain, in the retina and choroid of the eye, otospongiosis, for ischemia, for recovery after strokes.

The drug is not used for individual intolerance to pentoxifylline, other methylxanthines, auxiliary components, heavy bleeding, extensive hemorrhages in the retina, brain, during pregnancy and lactation due to insufficient research of the drug in this category of patients. Trental 400 is not used in pediatric practice. The dose is selected in accordance with the clinical situation and the severity of the therapeutic response to treatment. A single dose is usually 1 tablet. Frequency of administration – 2-3 times a day. Chewing the tablet is not allowed. The optimal time to take it is with food or immediately after it. In persons with arterial hypotension, severe coronary heart disease, and hemodynamically significant narrowing of cerebral vessels, treatment begins with low doses with the possibility of gradually increasing it. Pharmacotherapy is carried out under regular monitoring of blood pressure. In diabetics taking hypoglycemic drugs, submaximal and maximum doses of Trental 400 can provoke severe hypoglycemic syndrome. When using Trental 400 together with drugs that inhibit the activity of the blood coagulation system and prevent the formation of blood clots, it is necessary to monitor coagulation parameters. In persons who have recently undergone surgery, regular monitoring of hemoglobin and hematocrit is necessary. Elderly patients have higher bioavailability and a reduced rate of elimination of the drug from the body, which may require dose adjustment. Tobacco smoking may reduce the effectiveness of treatment. One of the side effects of the drug is dizziness, which requires special care when driving a car and working with potentially dangerous mechanisms.

Contraindications

The drug is not used for porphyria , acute myocardial infarction , intolerance to xanthine derivatives, breastfeeding, massive bleeding, hemorrhages in the retina, or hemorrhagic stroke .

Intravenous infusions are unacceptable in case of uncontrolled arterial hypotension , with severe atherosclerosis of the cerebral and coronary arteries, and with arrhythmias .

For peptic ulcers of the digestive system , for CHF, lability of blood pressure, for insufficiency of the renal and hepatic systems, after surgical interventions, pentoxifylline is prescribed with caution.

Trental is not used during pregnancy.

Special instructions for the use of the drug Trental

The drug is prescribed with caution to patients with severe atherosclerosis of the cerebral and coronary vessels, especially with concomitant hypertension (arterial hypertension), heart rhythm disturbances, angina attacks, as well as patients with arterial hypotension or labile blood pressure. In these cases, the dose of the drug should be increased gradually, especially when administered parenterally. Caution is also required when prescribing the drug to patients with a history of peptic ulcers of the stomach and duodenum; patients who have recently undergone surgery. In these cases, the risk of bleeding is increased, so systematic monitoring of hemoglobin and hematocrit levels is necessary. Before prescribing Trental, patients with chronic heart failure should achieve circulatory compensation. For patients with labile or low blood pressure, patients at risk (severe coronary artery disease or severe stenosis of the main vessels of the brain), treatment should begin with the drug in low doses, select doses individually and increase them gradually, taking into account the tolerability of treatment. In patients with diabetes mellitus receiving insulin therapy or treatment with oral hypoglycemic agents, when using Trental in a high dose, the effect of these drugs on blood glucose levels may be enhanced. In these cases, the dose of insulin or oral hypoglycemic agents should be reduced and regular clinical monitoring should be carried out. If renal function is impaired (creatinine clearance 30 ml/min), the dose of the drug is selected individually, reducing it by approximately 30–50%. In case of severe liver failure, the dose of Trental should also be reduced depending on individual tolerability of the drug.

Side effects

Nervous system: convulsions, anxiety, dizziness, headache, sleep disturbances.

Subcutaneous fat, skin: increased fragility of nails, swelling, “flushes” of blood flow to the face, chest, hyperemia of the skin.

Digestive tract: cholestatic hepatitis , exacerbation of cholecystitis , intestinal atony , decreased appetite, dry mouth.

Side effects from the sensory organs: visual disturbances, scotoma .

Cardiovascular system: drop in blood pressure, progression of angina , cardialgia , arrhythmia , tachycardia .

Hemostasis system, hematopoietic organs: bleeding in the intestines, stomach, mucous membranes, skin, hypofibrinogenemia , pancytopenia , leukopenia , thrombocytopenia . Allergic reactions in the form of anaphylactic shock , urticaria , itching , angioedema , hyperemia of the skin. An increase in liver enzymes and alkaline phosphatase is also recorded.

Pharmacological properties of the drug Trental

Pentoxifylline (3,7-dimethyl-1-(5-oxohexyl)-3,7-dihydro-1H-purine-2,6-dione) is a methylxanthine derivative. The mechanism of action of pentoxifylline is due to the inhibition of phosphodiesterase and the accumulation of cAMP in vascular smooth muscle cells, blood cells, as well as in other tissues and organs. Pentoxifylline inhibits the aggregation of platelets and erythrocytes, increases their elasticity, reduces the increased concentration of fibrinogen in the blood plasma and enhances fibrinolysis, helping to reduce blood viscosity and improve its rheological properties. In addition, pentoxifylline has a weak myotropic vasodilator effect, slightly reduces the peripheral vascular resistance and has a positive inotropic effect. Due to the use of pentoxifylline, microcirculation and oxygen supply to tissues improves, to a greater extent in the extremities, the central nervous system, and moderately in the kidneys. The drug slightly dilates the coronary vessels. After oral administration in a dose of 100 mg, pentoxifylline is almost completely absorbed in the digestive tract. The maximum concentration of pentoxifylline and its main metabolite is achieved 1 hour after administration. The drug has a first pass effect through the liver. The bioavailability of pentoxifylline averages 19% (6–32%). The main pharmacologically active metabolite 1-(5-hydroxyhexyl)-3,7-dimethylxanthine is determined in the blood plasma in a concentration that is 2 times higher than the concentration of the unchanged substance and is in a state of reverse biochemical equilibrium with it. In this regard, pentoxifylline and its metabolite should be considered as an active entity. The half-life of pentoxifylline is 1.6 hours. Pentoxifylline is completely metabolized, more than 90% is excreted by the kidneys in the form of unconjugated water-soluble polar metabolites. Less than 4% of the administered dose is excreted in the feces. In patients with severe renal impairment, the excretion of metabolites is slowed down. In patients with impaired liver function, an increase in the half-life of pentoxifylline and an increase in its bioavailability are noted.

Instructions for use of Trental (Method and dosage)

The drug is taken orally, and also administered intraarterially, intravenously, intramuscularly. The dose must be prescribed by a doctor.

For pathology of the renal system, the drug is prescribed at a dose of 50-70% of the standard dose.

Trental ampoules, instructions for use

Typically, 2 intravenous infusions are given in the morning and afternoon, 200-300 mg of the active substance together with a sodium chloride solution. Intravenous infusions are carried out slowly, 50 mg is administered over 10 minutes (together with 10 ml of sodium chloride), after which they switch to administering 100 mg on a dropper (together with 250 ml of sodium chloride, administered for at least an hour). The maximum dose per day can be 0.6 mg of active substance per 1 kg of person’s weight per hour.

Intramuscular injections are carried out deeply 2-3 times a day, 100-200 mg.

Parallel administration of oral forms of the drug is possible at a dose of 800-1200 mg per day for 2-3 doses. The initial dosage is 600 mg per day. If the dynamics are positive, the amount of pentoxifylline is reduced to 300 mg per day.

Trental tablets, instructions for use

Take 100 mg tablets orally with water, during or after meals, 3 times a day, gradually increasing the dose to 200 mg.

Instructions for use Trental 400

Typically take 1 tablet 3 times a day. The maximum dose you can take is 1200 mg of the active substance per 24 hours.

Areas of application of Trental (pentoxifylline) in neurology

Among the drugs aimed at improving the rheological properties of blood, one of the most widely used is Trental (pentoxifylline). The authors provide the main indications for the use of Trental and evidence of the drug’s effectiveness in the treatment of neurological disorders, such as vascular cognitive disorders, transient ischemic attacks, chronic dyscirculatory encephalopathy, chronic cerebrovascular insufficiency, etc.

Trental (pentoxifylline) is a drug from the group of vasodilators, whose chemical structure (methylxanthine derivative) is close to theobromine and theophylline. Its main pharmacological properties are associated with the ability to nonspecifically inhibit the activity of phosphodiesterase type 4, which leads to an increase in the content of cyclic 3′,5′-AMP in platelets and ATP in erythrocytes and a decrease in the intracellular concentration of calcium ions. Clinical studies indicate that the drug has a pronounced positive effect on microcirculation and hemodynamics due to vasodilation with a decrease in total and regional peripheral vascular resistance, an increase in systolic and cardiac output without a significant change in heart rate [14].

After almost complete absorption, pentoxifylline is metabolized in red blood cells and the liver. The main active metabolite 1-(5-hydroxyhexyl)-3,7-dimethylxanthine (metabolite-1) has a plasma concentration that is 2 times higher than the initial concentration of pentoxifylline. Pentoxifylline and its metabolites do not bind to plasma proteins. The absolute bioavailability of the original substance is 19 ± 13%. When taken orally, pentoxifylline is quickly and almost completely absorbed, the half-life is 1.6 hours, with intravenous administration of 100 mg - approximately 1.1 hours. In case of severe renal impairment, the elimination of metabolites is slowed down; in case of liver dysfunction, the half-life of pentoxifylline is prolonged, absolute bioavailability increases. More than 90% of the administered dose of pentoxifylline is excreted through the kidneys in the form of unconjugated water-soluble metabolites, 3–4% in feces [14].

Trental improves the rheological properties of blood (fluidity) by increasing the deformability of red blood cells (reduced in pathology), as well as inhibiting platelet aggregation and reducing high blood viscosity. Trental improves microcirculation in areas of poor circulation. Providing a weak myotropic antispasmodic effect, the drug slightly dilates the coronary vessels. The mechanism of its action is associated with the inhibition of phosphodiesterase and the accumulation of cAMP in the cells of vascular smooth muscles and blood cells.

Indications for use of Trental in neurology

The following indications for prescribing Trental in neurology can be distinguished: peripheral circulatory disorders of atherosclerotic origin (intermittent claudication, diabetic angiopathy), cerebrovascular accident, post-stroke conditions, consequences of cerebral atherosclerosis (decreased concentration, dizziness, memory impairment). Trental is a highly effective drug for the complex treatment of a number of neurological diseases associated with microcirculation disorders; it is well tolerated and can be combined with many medications. However, the dose of the drug and the duration of treatment can vary widely depending on the specific clinical situation. This is facilitated by the presence of various dosage forms of the drug with a fairly wide range of doses (tablets 400 mg No. 20, tablets 100 mg No. 60, ampoules 100 mg/5 ml) [11]. It is recommended to take Trental tablets 400 mg (extended form) 2-3 times a day during or immediately after meals, swallowing the tablets whole and drinking them with a sufficient amount of water [14]. The effect of taking pentoxifylline appears between the 2nd and 4th weeks, but treatment should continue for at least 8 weeks. When administering pentoxifylline intravenously, single infusions of 200 to 300 mg are used (but not more than 1200 mg per day) [1]. There are results of open studies of intravenous use of Trental for 10 days at a dose of 1200 mg (the maximum daily dose registered in the Russian Federation) to 1500 mg per day, clinical improvement was detected in 9 out of 10 patients [3]. This improvement was combined with a significant increase in the deformability of erythrocytes. A marked improvement in the condition of subjects receiving Trental at a dose of 300–600 mg per day for more than 7 weeks was also reported, compared with the control group without treatment. The effect of pentoxifylline was also assessed by the average duration of hospital treatment - in the case of using this drug, a decrease in hospitalization time was noted from 7.5 to 4.8 weeks. In acute vascular disorders caused by cerebral thrombosis, embolism and intracranial hemorrhage, the use of Trental at a dose of 600 mg per day for 1-7 months had a similar effect: significant improvement in 60% of cases and moderate improvement in 25%, no effect was noted in 15%. The therapeutic effect of pentoxifylline was also studied in case of fresh lacunar disorders of cerebral circulation: 40 patients were treated with Trental at a dose of 800–1200 mg per day for 3 months, which led to complete or partial regression of neurological deficit in 34 patients, while an improvement in the deformability of erythrocytes was found, as well as a decrease in aggregation and viscosity of blood plasma [3].

Trental is well tolerated by patients; taking the drug in an adequate daily dosage of 400–600 mg is extremely rarely accompanied by side effects, such as skin hyperemia, palpitations, hot flashes, weakness, and headache. These manifestations are usually mild and do not require specific treatment or discontinuation of the drug (as a rule, it is enough to reduce the daily dose). In cases of individual intolerance, hemorrhagic syndromes, gastric and duodenal ulcers, severe intractable arterial hypotension, the drug should be prescribed with caution [14]. Considering that prescribing some direct and indirect antihypertensive drugs simultaneously with pentoxifylline can potentiate the effect, and therefore the advisability of combination treatment should always be considered individually [6]. It is very important that the drug prescribed in rational dosages does not cause negative redistribution of blood in the cranial cavity (intracerebral steal syndrome).

Trental in the treatment of chronic dyscirculatory encephalopathy

Trental has been widely used in the treatment of patients with various forms of chronic progressive cerebral circulatory disorders - discirculatory encephalopathies (DE). The approach to the treatment and secondary prevention of chronic cerebrovascular disorders involves the most complete elimination of cardiovascular risk factors, including strict control of blood pressure and blood glucose, the use of antiplatelet agents and statins. Pentoxifylline improves microcirculation by increasing the deformability of erythrocytes, reducing platelet aggregation and viscosity of whole blood. The beneficial effect on the properties of red blood cells distinguishes the original drug Trental from generics. Pentoxifylline stimulates the release of prostacyclin and reduces vasospasm. A study in which erythrocytes from healthy donors were incubated with pentoxifylline for 15 minutes, followed by recording the aggregation index, aggregate size and rate of aggregation (optical microscopy method), measuring (on an automatic rheometer) the fluidity of erythrocyte suspensions (value, inverse viscosity), revealed statistically a significant decrease in all three indicators of erythrocyte aggregation and suspension viscosity [8]. The study compared Trental and three generic drugs. In terms of its effect on platelet aggregation, Trental was significantly superior to generics (a decrease of 46 and 20–35%, respectively). Similar data were obtained when studying the viscosity of the suspension (decrease by 16 and 6–10%, respectively).

The presence of lesions in the corresponding parts of the cerebral cortex may be accompanied by a violation of higher brain functions (apraxia, agnosia, aphasia), although the functional deficit does not always correspond to the localization of pathological changes. Emotional disorders are manifested by apathy and symptoms of depression. Some patients experience dyssomnia in the form of increased sleepiness and disturbances in the sleep-wake cycle. The clinical picture of DE is characterized by progressive neurological, emotional, and cognitive disorders. Stage I DE is characterized by a predominance of subjective disturbances in the form of emotional instability, increased irritability, dysmnesic and dissomnic disorders, decreased mental performance, but no focal neurological deficit is observed. Stage II DE is distinguished by the presence of asthenic disorders, significant intellectual and emotional disorders, and small-focal neurological symptoms. In stage III DE, intellectual-mnestic impairments (dementia) and clear focal (multifocal) neurological symptoms predominate. Pyramidal disorders in patients with DE rarely reach the severity of paresis. Patients lose their ability to work, become dependent on others, and often require constant outside care. It is the combination of emotional and cognitive disorders that is the cause of social maladaptation in many patients with DE [7].

In order to clarify the effectiveness of the use of Trental (pentoxifylline) in patients with chronic cerebrovascular disorders in the Moscow outpatient clinic network, a study was conducted that included 55 patients with the consequences of a non-disabling stroke who received prolonged-release pentoxifylline 1200 mg per day [2]. Before and after treatment, patients underwent a standard comprehensive examination using neurological and neuropsychological rating scales, and a study of the rheological properties of blood. Neurological status was assessed using the Barthel and Matthew rating scales, a neuropsychological study using the Mini Mental Function Examination (MMSE), the Beck Depression Inventory and the Wechsler test, and an assessment of the quality of life of patients. Positive dynamics of a number of neurological indicators were noted, the level of fibrinogen in the blood decreased, and MMSE indicators significantly increased. Thus, a positive effect of Trental in high doses on the restoration of cognitive functions was revealed.

Trental in the treatment of chronic cerebrovascular insufficiency and stroke prevention

Chronic cerebrovascular insufficiency, the most common cerebrovascular pathology, is also one of the most common causes of disability. Among the factors leading to chronic cerebral circulatory failure are atherosclerosis, hypertension and their combinations, diabetes mellitus, various diseases, including systemic ones, accompanied by vascular damage, blood diseases leading to an increase in its viscosity. The treatment strategy for chronic cerebrovascular insufficiency involves influencing the main pathological process, the basic links of which are hypertension and atherosclerosis. An adequate combination of antihypertensive drugs with diuretics, statins, adrenergic blockers, tranquilizers, and antidepressants leads in most cases to encouraging results. Therapeutic measures for chronic

cerebrovascular insufficiency should be aimed at improving cerebral hemodynamics and increasing the functional capabilities of the brain [1].

An open comparative randomized analysis of a 3-year follow-up of the use of the drug Trental in patients with DE was conducted [16]. At the initial stage of the study [15], 57 patients (27 men, 29 women) aged 63.1 ± 5.8 years with DE were observed, receiving Trental (tablets) 100 mg 3 times a day. The patients were observed for 8 months with two courses of treatment of 2 months each: in the 1st–2nd and 7th–8th months of observation. A total of 132 patients (68 men, 64 women) aged 67.3 ± 5.1 years with stage III DE who received Trental 400 mg per day against the background of basic therapy were subsequently examined [16]. The duration of treatment courses was 2 months. During treatment (three courses per year), the patients experienced stabilization of the course of chronic cerebral vascular insufficiency, and the risk of stroke decreased by approximately 2 times compared to the control group receiving basic therapy (acetylsalicylic acid + dipyridamole, betaxolol, glycine).

Trental in the treatment of transient ischemic attacks (TIA)

The effectiveness of the use of prolonged forms of pentoxifylline in the treatment of patients with TIA is confirmed by the following results: overall clinical effectiveness - 86%, improvement in subjective assessment of the dynamics of symptoms by patients - 87%, reduction in the average duration of hospital treatment by 1.5 times [3]. Two studies assessed the preventive efficacy of pentoxifylline (Trental) and combination antiplatelet therapy for TIA. Both studies used oral pentoxifylline (1200 mg daily) or the antiplatelet therapy of aspirin (1050 mg daily) plus dipyridamole (150 mg daily). It was found that new ischemic episodes during 12-month follow-up in the first and second studies were observed in 10 and 13% of patients taking pentoxifylline, and in 28 and 31% in the group receiving combination antiplatelet therapy. The mortality rate of patients was significantly lower when using pentoxifylline (14.2 versus 32.5%). The frequency of episodes of cerebrovascular accidents over a 12-month period in both groups was less than 5%, which is significantly lower than in patients before treatment [12]. Another comparative study of TIA showed that treatment with pentoxifylline (total dose 500 to 700 mg per day) resulted in faster improvements in mood and significant reductions in scores of motor and speech deficits than treatment with xanthinol nicotinate (total dose 2250 to 3150 mg per day). [14].

Trental in complex therapy of patients with ischemic stroke against the background of metabolic syndrome

At the Scientific Center of Neurology of the Russian Academy of Medical Sciences, 44 patients with chronic cerebrovascular diseases (CVD) were examined: 12 patients suffered acute cerebrovascular accident, 4 suffered from transient ischemic attacks, 28 had stage I–II DE [10]. 22 of the examined patients were diagnosed with metabolic syndrome (MS). Therapy with pentoxifylline (Trental) was carried out for 21 days at a dose of 100 mg daily in the form of intravenous infusions. To assess the state of hemorheology, blood viscosity at various shear rates, hematocrit, and platelet aggregation under the influence of aggregation inducers - ADP and adrenaline - were studied. The aggregation and deformability of erythrocytes were determined using a laser optical rotary cell analyzer. The clinical picture of the examined patients was dominated by signs of DE: decreased memory, concentration, dizziness, headache, tinnitus, sleep disorders, etc. To objectify the severity of neurological symptoms, the Barthel index was used, the value of which was slightly higher in the group of patients without MS – 67% – compared to the group of patients with MS – 62%. When studying erythrocyte aggregation, more significant disturbances were identified in patients with concomitant MS. The amplitude of aggregation, reflecting the final size of erythrocyte aggregates, is also significantly higher in patients with MS. After the therapy, there was a significant regression of neurological symptoms - the Barthel index increased from 62 to 87%. On the 21st day of therapy, a significant improvement in hemorheological parameters was noted. The study demonstrated the high effectiveness of pentoxifylline (Trental) in the treatment of hemorheological and hemostatic disorders in patients with chronic cerebrovascular diseases associated with MS. Therapy with pentoxifylline (Trental) leads to a significant regression of neurological symptoms and improvement in hemorheological and hemostatic parameters. The unique effect of pentoxifylline on erythrocyte aggregation and deformability - one of the leading causes of hemorheology and microcirculation disorders in MS - allows us to consider pentoxifylline the drug of choice in the treatment of patients with chronic CVD with concomitant MS.

In 2008, a meta-analysis of 5 randomized placebo-controlled trials was conducted, which included 763 patients receiving pentoxifylline (Trental) [5]. It was noted that the risk of death during the first 4 weeks of the disease was slightly reduced in the main group compared with patients receiving placebo, while in one of the studies the reduction in mortality was regarded as significant. It was found that the use of Trental in the acute stage of the disease did not have a significant effect on long-term stroke outcomes, which may be due to a number of associated factors (timing of initiation of treatment, features of the pathogenetic subtype of stroke, etc.). At the same time, the authors of the meta-analysis note the undoubted positive effect of the use of Trental in comparison with comparator drugs, however, due to the heterogeneous design of the studies, in particular, the effectiveness criteria used, the results cannot be fully comparable, which makes it necessary to conduct new studies. The main effect of pentoxifylline in cerebral diseases - an increase in cerebral blood flow (in the absence of steal syndrome) - is realized through several mechanisms [7]:

improvement of microcirculation;
increased deformability and decreased erythrocyte aggregation;
decreased platelet aggregation;
decreased viscosity of whole blood.

In addition, pentoxifylline has anti-inflammatory and immunomodulatory properties:

suppression of the activity of circulating mononuclear cells, neutrophils and T-lymphocytes;
decreased synthesis of anti-inflammatory cytokines, in particular tumor necrosis factor alpha.

Trental in complex therapy of vascular cognitive disorders

In order to prevent acute cerebrovascular accidents and the possible development of post-stroke cognitive impairment, drugs that affect the rheological properties of blood are widely used. It was noted that with the use of Trental, cerebral blood flow increases due to an increase in the lumen of blood vessels without the occurrence of steal syndrome. In addition, the accumulation of cyclic AMP in platelets and erythrocytes has some antiplatelet effect, increases the deformability of blood cells and helps reduce its viscosity. The effectiveness of Trental in chronic cerebrovascular insufficiency has been confirmed by numerous clinical observations. More than 20 randomized controlled trials performed in European countries have shown that with the use of Trental in patients with vascular dementia and less severe cognitive impairment, there is a statistically significant positive dynamics in cognitive indicators and other neurological disorders [4]. In patients with vascular dementia who received antiplatelet therapy (or anticoagulants for cardioembolism), the risk of death is markedly lower, but there is no convincing evidence that the rate of progression of cognitive impairment is also reduced.

A 2009 analytical review demonstrated the effectiveness of Trental (pentoxifylline) for vascular dementia in a double-blind, randomized, placebo-controlled study using the drug at a dose of 400 mg per day for 36 weeks. The results of another study are presented, where a significant improvement in the condition of patients who received Trental at a daily dose of 1200 mg in two courses of 12 weeks with a break of 4 weeks is also observed. Moreover, the drug not only prevented the progression of cognitive impairment, but also improved the rheological properties of blood [9].

Conclusion

Thus, a number of studies have shown the high effectiveness of Trental in chronic cerebrovascular accidents and cerebrovascular disorders, such as transient ischemic attacks, the consequences of cerebral thrombosis, and chronic cerebrovascular insufficiency.

Overdose

Manifested by tonic-clonic convulsions, agitation, drowsiness, tachycardia , fainting, decreased blood pressure, dizziness, weakness, vomiting “coffee grounds” and other signs of gastrointestinal bleeding .

Interaction

According to the annotation, Trental enhances the effect of medications that affect blood clotting (thrombolytics, anticoagulants of direct and indirect effects), antibiotics ( cefotetan , Cefoperazone , cefamandole and other cephalosporins), valproic acid .

Pentoxifylline enhances the effect of oral hypoglycemic agents, insulin, and antihypertensive drugs. Cimetidine can increase the level of the drug in the blood and increase the severity of side effects. With the simultaneous use of other xanthines, excessive nervous excitement of patients is observed.

Side effects of the drug Trental

Nausea, vomiting, heaviness in the epigastric region, diarrhea, headache, dizziness, aseptic meningitis (when taken in high doses), anxiety, sleep disturbances, facial flushing, flushing, tachycardia, angina pectoris, arterial hypotension, skin itching, rash, urticaria, angioedema, extremely rarely - anaphylactic shock. Very rarely, mainly when used simultaneously with anticoagulants or antiplatelet agents, bleeding (capillary from the skin and mucous membranes, gastrointestinal). The cause-and-effect relationship of bleeding with taking Trental has not been proven. In isolated cases, thrombocytopenia was observed.

special instructions

Monitoring of blood clotting is required during simultaneous therapy with anticoagulants.

Therapy with pentoxifylline is carried out under mandatory monitoring of blood pressure levels.

In patients with diabetes mellitus , the medication may cause hypoglycemia .

After surgical interventions, monitoring of hematocrit and hemoglobin levels is necessary.

In case of unstable and low blood pressure, the dosage of the drug is reduced.

There is no reliable data on the safety and effectiveness of Trental in children.

Inhalation of tobacco smoke causes a decrease in the therapeutic effectiveness of the drug.

During intravenous infusions, the patient should be in a supine position.

Trental's analogs

Level 4 ATC code matches:
Agapurin

Vazonite

Xanthinol nicotinate

Pentoxifylline

Analogues of Trental in tablets are the following drugs:

Agapurin
Vazonite
Pentilin
Pentoxifylline

Which is better: Trental or Pentoxifylline?

Pentoxifylline is the active ingredient in Trental, but there is also a medicine with the same name that costs much less. The action of both drugs is essentially the same.

Reviews about Trental

The drug works effectively, performing the tasks for which it is intended. However, side effects such as dizziness, nausea, insomnia are common. Often, when taking this medication, you experience a headache and high blood pressure.

Very effective, really improves microcirculation, used for diabetes. You can use Trental intravenously and in tablets of 100 and 400 mg of the active substance. Side effects are common. The fluidity of the blood from the Trental solution and tablets increases, which can cause hemorrhage in the eyes, so it is better to consult an ophthalmologist before use.

Trental price, where to buy

The price of Trental in tablets 100 mg is about 500 rubles per pack of 60 pcs.

The price of Trental in ampoules of 5 ml is about 2000 rubles per pack of 5 pcs.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine
Online pharmacies in KazakhstanKazakhstan

LuxPharma* special offer

Trental solution for injection 5 ml (100 mg) N5
1930 rub. order
Trental tab. 100mg N60
1680 rub. order

ZdravCity

Trental tablets p.p.o. prolonged action 400 mg 60 pcs. Aventis Pharma/Sanofi India
RUB 1,574 order
Trental tab. p.p.o ksh/sol 100 mg n60 Sanofi India Limited IN
RUR 527 order
Trental tablets p.p.o. prolonged action 400 mg 20 pcs. Sanofi India Limited
RUB 755 order

Pharmacy Dialogue

Trental (tab.p/v.400mg No. 20)Sanofi Aventis
RUR 717 order
Trental (tab.p/v.400mg No. 20)Aventis Pharma
RUR 705 order
Trental (tablet p/o 100 mg No. 60)Aventis Pharma
600 rub. order
Trental (p/o long-acting tablet 400 mg No. 20) Zentiva Private Limited
RUR 795 order
Trental (tab.prolonged.p.pl/vol.400mg No. 60)Sanofi Aventis
RUB 1,588 order

Pharmacy24

Trental 5 ml N5 solution for injection Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
209 UAH order
Trental 400 mg No. 20 tablets Sanofi India Limited, India
215 UAH order

PaniPharmacy

Trental tablets Trental tablets 400 mg No. 20 India, Sanofi India
219 UAH. order
Trental ampoule Trental injection solution 100 mg ampoules 5 ml No. 5 Hungary, Chinoin
220 UAH order