Frampton J E, Brogden R N
Adis International Limited, Auckland, New Zealand.
Drugs Aging. 1995 Dec;7(6):480-503. doi: 10.2165/00002512-199507060-00007.
Pentoxifylline (oxpentifylline) has been used widely in the treatment of intermittent claudication, a prevalent condition in the elderly population. The exact mechanism(s) of action of the drug are unclear, but may be related to identified effects on white blood cell function and haemorrheological parameters. Clinical trials which conform best with European and North American guidelines have shown that 6 months' oral therapy with pentoxifylline 1200 mg/day significantly improves walking distances in patients with intermittent claudication. Patients most likely to benefit from treatment are those with an ankle/arm blood pressure ratio < or = 0.8 and a history of disease > 1 year. However, it remains unclear whether pentoxifylline or any other conservative treatment approach (including physical training) offers long term benefit, as studies comparing the development of intermittent claudication after several years of treatment with the natural course of the disease are still lacking. In patients with more severe vascular disease, intravenous administration of pentoxifylline (1200 mg/day for 21 days) decreased rest pain in patients with critical limb ischaemia. Oral administration (1200 g/day for up to 6 months) increased the healing of venous ulcers of the leg when used as an adjunct to standard compression bandaging. However, further studies are required to confirm these initial findings. The efficacy of pentoxifylline in the treatment of cerebrovascular disease has been evaluated in controlled clinical trials. Most notably, long term therapy (1200 mg/day) may slow the progression of dementia in patients who meet the clinical diagnostic criteria for 'multi-infarct' dementia and who also have clinical and neuroradiological evidence of cerebrovascular disease. The drug is effective in decreasing the risk of transient ischaemic attacks, but there are insufficient data to determine its value in the prevention and treatment of stroke. Pentoxifylline is well tolerated, with gastrointestinal effects reported in fewer than 3% of treated patients. However, the incidence of adverse events may be higher in elderly patients and/or those receiving concomitant medications. In summary, pentoxifylline is the most established agent when drug therapy is deemed appropriate in patients with intermittent claudication. Moreover, a promising new development for the drug is in the management of cerebrovascular dementia, an area where few therapeutic options are currently available.
己酮可可碱（氧代己酮可可碱）已被广泛用于治疗间歇性跛行，这是老年人群中的一种常见病症。该药物的确切作用机制尚不清楚，但可能与已确定的对白细胞功能和血液流变学参数的影响有关。最符合欧洲和北美指南的临床试验表明，每天服用1200毫克己酮可可碱进行6个月的口服治疗可显著改善间歇性跛行患者的行走距离。最有可能从治疗中受益的患者是那些踝/臂血压比值≤0.8且病程超过1年的患者。然而，由于仍缺乏将数年治疗后间歇性跛行的发展与疾病自然病程进行比较的研究，尚不清楚己酮可可碱或任何其他保守治疗方法（包括体育锻炼）是否能带来长期益处。在患有更严重血管疾病的患者中，静脉注射己酮可可碱（每天1200毫克，共21天）可减轻严重肢体缺血患者的静息痛。口服（每天1200毫克，最长6个月）作为标准压迫绷带的辅助治疗可促进腿部静脉溃疡的愈合。然而，需要进一步研究来证实这些初步发现。己酮可可碱在治疗脑血管疾病方面的疗效已在对照临床试验中进行了评估。最值得注意的是，长期治疗（每天1200毫克）可能会减缓符合“多发性梗死”痴呆临床诊断标准且同时有脑血管疾病临床和神经放射学证据的患者痴呆症的进展。该药物在降低短暂性脑缺血发作风险方面有效，但尚无足够数据确定其在预防和治疗中风方面的价值。己酮可可碱耐受性良好，接受治疗的患者中报告有胃肠道反应的不到3%。然而，老年患者和/或同时接受其他药物治疗的患者不良事件的发生率可能更高。总之，当认为药物治疗适用于间歇性跛行患者时，己酮可可碱是最常用的药物。此外，该药物在脑血管性痴呆管理方面有一个有前景的新进展，而目前该领域几乎没有治疗选择。
