• Management of symptomatic peripheral vascular disease (intermittent claudication).

Contraindicated in:

• Hypersensitivity
• Intolerance to other xanthine derivatives (caffeine and theophylline).

Use Cautiously in:

• Coronary artery or cerebrovascular disease
• Renal impairment (dose ↓ may be needed)
• Mild-to-moderate hepatic impairment
• Geri: ↑risk of adverse reactions
• OB: Lactation: Pedi: Safety not established.

CV: angina, arrhythmias, edema, flushing, hypotension.

EENT: blurred vision.

GI: abdominal discomfort, belching, bloating, diarrhea, dyspepsia, flatus, nausea, vomiting.

Neuro: agitation, dizziness, drowsiness, headache, insomnia, nervousness, tremor.

Resp: dyspnea.
Misc: ANAPHYLAXIS.

Drug-Drug:

• Additive hypotension may occur with nitrates.
• May ↑ the risk of bleeding with warfarin, heparin, aspirin, NSAIDs, cefotetan, valproic acid, clopidogrel, eptifibatide, tirofiban, or thrombolytic agents.
• May ↑ the risk of theophylline toxicity.
• Smoking may ↓ the effects.
• Strong CYP1A2 inhibitors, including ciprofloxacin and fluvoxamine may ↑ levels
• Cimetidine may ↑ levels.

Drug-Natural Products:

• ↑bleeding risk with anise, arnica, asafoetida, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, licorice.

(Generic available)

• Extended-release tablets: 400 mg;

• PO (Adults): 400 mg 3 times daily; if GI or CNS side effects occur, ↓ dose to 400 mg twice daily.

TRENtal

• Increases the flexibility of RBCs by increasing levels of cyclic adenosine monophosphate (cAMP).
• Decreases blood viscosity by inhibiting platelet aggregation and decreasing fibrinogen.

• Increased blood flow.

Therapeutic Classification: blood viscosity reducing agent

Absorption: Well absorbed following oral administration; food ↑ absorption.

Distribution: Bound to RBC membrane. Enters breast milk.

Metabolism/Excretion: Metabolized by RBCs and the liver.

Half-life: 25–50 min.

(improvement in blood flow)

• Instruct patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Consult health care professional before discontinuing medication, because several wk of therapy may be required before effects are seen.
• May cause dizziness and blurred vision. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Advise patient to avoid smoking, because nicotine constricts blood vessels.
• Instruct patient to notify health care professional if nausea, vomiting, GI upset, drowsiness, dizziness, or headache persists.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.

pen-tox-IF-i-lin