The place of Trental (pentoxifylline) in the treatment program for chronic obliterating diseases of the arteries of the extremities and various vascular complications

pharmachologic effect

The drug Trental belongs to the group of vasodilating agents, including pentoxifylline. Has the following actions:

• reducing blood viscosity, improving its fluidity;
• reducing the adhesion of leukocytes to the walls of blood vessels, the adhesion of platelets and red blood cells;
• slight relaxation and expansion of the coronary vessels;
• weak improvement in the contractility of the heart muscle;
• improving cerebral circulation and reducing the severity of symptoms (Trental is better for the brain at a dosage of 400 mg);
• disappearance of pain at rest, elimination of night cramps and contraction of the calf muscles, lengthening of the walking distance in pathologies of the peripheral circulatory system.

A frequent question from patients is whether Trental thins the blood or not. Yes, it reduces blood viscosity and improves flow through veins and arteries. To prevent bleeding and adverse reactions when taken together with anticoagulants that perform a similar effect, regular monitoring of blood clotting parameters is necessary.

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.

Indications for use of Trental

The medicine improves peripheral and cerebral circulation, thins the blood, and dilates the coronary vessels. Used to treat the following diseases:

1. blockage or narrowing of the arteries of the leg or arm due to atherosclerosis, diabetes;
2. gangrene, trophic ulcers and other tissue nutritional disorders;
3. comprehensive treatment of the patient with ischemia and after a stroke;
4. impaired cerebral circulation, manifested by decreased concentration, memory loss, dizziness;
5. complex therapy of cerebral atherosclerosis;
6. circulatory disorders of the organ of vision;
7. hearing loss, pathologies of the inner ear, other degenerative changes.

Main properties of Trental

Trental is a drug based on pentoxifylline. Suitable for use by men and women. The active substance penetrates the systemic bloodstream and is distributed throughout the organs, including through the blood-brain barrier into the brain. The following effect on the body is formed:

• reducing blood viscosity, improving rheological properties;
• eliminating the clumping of red blood cells and platelets, which prevents blockage of blood vessels;
• reducing fibrinogen to reduce the risk of blood clots;
• suppression of the inflammatory response in blood vessels due to a decrease in the activity of leukocytes and their adhesion to the endothelium;
• slight myotropic effect;
• vasodilator effect with improved blood flow through the coronary vessels;
• stimulation of blood flow in areas of vascular damage, for example, the spine with osteochondrosis in the cervical region;
• improving the patient’s well-being after a cerebrovascular accident;
• suppression of neurological disorders, the patient walks better, cramps in the calves of the lower extremities stop, pain decreases.

The drug is used to slow blood flow due to the development of atherosclerosis and diabetes. It is applicable for trophic pathologies that cause gangrene and ulcers. The drug is often prescribed for decreased cerebral circulation after a stroke. The condition improves with degenerative changes in blood vessels in the inner ear with hearing loss.

Trental - instructions for use

The medication is available as an injection, administered intravenously infusion together with sodium chloride or Ringer's solution. To the question of how to drip Trental - quickly or slowly, the instructions contain the answer: 100 ml of the medicine should be administered over 60 minutes or more.

Tablets are prescribed in dosages of 100 and 400 mg 2-3 times a day. The dose is selected by a specialist depending on the patient’s condition, blood pressure, age, and the presence of liver and kidney pathologies.

The course of Trental is determined by the doctor: usually 5-10 intravenous infusions are prescribed 1-2 times a day, then tablets for 1-2 months.

How to take Trental - before or after meals

The medicine is taken orally during or immediately after meals. You should drink it with clean water; the tablets should not be broken, crushed or dissolved.

Popular Russian substitutes

Domestic substitutes for Trental have a fairly low cost with high efficiency.

Flexital

Flexital is an angioprotector that increases microcirculation in the bloodstream system. Used for blood flow disorders of various etiologies:

• diabetic type angiopathy;
• atherosclerotic genesis, impaired blood supply to the periphery;
• atherosclerotic encephalopathy;
• angioneuropathy and paresthesia;
• trophic ulcers, burns, frostbite;
• lack of blood flow to the eye;
• endarteritis;
• disturbance in the blood supply to the ear.

The medication should not be prescribed in the following cases:

• heavy bleeding;
• heart attack and cerebral hemorrhage;
• porphyria;
• childhood;
• allergy to medicine.

The Trental analogue is used with great caution in patients with the following concomitant pathologies:

• hypotension and cardiac pathologies associated with myocardial rhythm;
• atherosclerosis of the coronary and cerebral arteries;
• liver and kidney dysfunction;
• after surgical intervention in the body.

The medication is administered intravenously in a single dosage of 100 mg, diluted in 200-250 ml of sodium chloride. The frequency of IV procedures per day is 3. When prescribing tablets, the initial dosage is 600 mg per day, which is halved after the symptoms of the disease disappear. Frequency of administration per day – 3 times. Adverse reactions of Flexital are identical to the negative effects of Trental.

Dipyridamole

The drug dilates the coronary arterioles and increases the speed of blood movement through the system. Dipyridamole is prescribed in the following cases:

• thromboembolism and thrombosis;
• encephalopathy and cerebral ischemia;
• heart attack and ischemic stroke;
• transient attacks in the brain;
• placental insufficiency during pregnancy;
• hypertension and impaired blood supply to the periphery;
• influenza and ARVI;
• DIC syndrome in children;
• glomerulonephritis (as part of combination therapy).

It is prohibited to prescribe for:

• hypersensitivity;
• decompensated stage of CHF and acute infarction;
• hypotension and hemorrhage;
• ulcerative destruction in the gastrointestinal tract;
• arrhythmias;
• tachycardia and angina pectoris;
• pathologies of the liver and kidneys;
• less than 12 years of age and lactation.

For the treatment of coronary insufficiency - 25-50 mg three times a day, with severe development of the disease - 75 mg 3 times a day. Dosage per day – 100-200 mg. For children, the dosage per day is 5 mg per 1 kg of weight, distributed over 3-4 tablet-taking procedures. Obliterating pathologies of the extremities – 75 mg three times a day for 2-3 months.

When using the medicine, the following negative effects may occur:

• increased blood flow can cause redness of the skin and lower blood pressure;
• tachycardia, arrhythmia and bradycardia;
• epigastric pain and diarrhea;
• increased bleeding;
• dizziness, sleep disturbance and headache;
• arthritis, rhinitis, myalgia.

Trental's analogs

If the drug is unavailable due to some factors, the doctor selects Trental analogues. Differences between different drugs in price, manufacturer, properties, indications, restrictions, adverse reactions. Trental substitutes are available with a doctor's prescription.

Drug analogues with release forms, price and country of origin

Betaserk

An analogue of Trental in tablets is the original drug Betaserc from France. Available in three dosages - 8, 16 and 24 mg. The analogue refers to drugs used for pathology of the vestibular apparatus to improve microcirculation of the labyrinth. The active substance is betahistine. Improves hearing when it is reduced, eliminates dizziness, tinnitus, headache due to dilation of cerebral blood vessels. Dispensed with a doctor's prescription.

Vinpocetine

The Russian analogue of the drug Trental is Vinpocetine. Sold in ampoules for intravenous infusion for acute conditions and tablets of 5 and 10 mg. Improves blood circulation and brain metabolism. The analogue is prescribed for cerebrovascular insufficiency, concomitant headache, dizziness, tinnitus, decreased memory and attention.

Mydocalm

An analogue of the drug Trental in tablets and ampoules for intramuscular administration is Mydocalm. Belongs to the group of centrally acting muscle relaxants and contains Tolperisone. The ampoules additionally contain lidocaine. The analogue is prescribed to relax muscles, improve peripheral blood flow, and reduce pain. Dispensed by prescription for osteochondrosis, atherosclerosis, cerebral stroke, types of arthrosis, diabetic angiopathy and other diseases of the musculoskeletal system and the central nervous system.

Phlebodia

Trental substitute in tablets is a French analogue of Phlebodia. Refers to venotonic and venoprotective agents based on diosmin. Improves blood microcirculation, reduces platelet adhesion to venous walls, and relieves inflammation. It is used for varicose veins, impaired microcirculation, hemorrhoids and chronic lymphovenous insufficiency. Dispensed freely, without a doctor's prescription.

A nicotinic acid

An analogue of Trental in ampoules and tablets is the domestic drug Nicotinic acid. Vitamin B has a vasodilating or dilating effect on small blood vessels, a weak anticoagulant effect, and improves microcirculation. The specifics of the release depend on the form of release of the analogue: ampoules - with a prescription, tablets - freely, without a prescription.

Vasobral

An analogue of the drug Trental 400 is imported Vazobral tablets. Refers to vasodilating agents that improve cerebral and peripheral circulation. Reduces the permeability of vascular walls, the adhesion of red blood cells and leukocytes, increases the number of functioning capillaries, increases the resistance of brain cells and tissues to oxygen starvation.

Additionally, it has a diuretic effect, helps reduce drowsiness and fatigue, and improves mental and physical performance. It is a prescription analogue of Trental 400.

Duzopharm

An analogue in tablets that is cheaper than Trental is the Bulgarian drug Duzopharm. It has a similar vasodilating and microcirculation-improving effect. Taken for disorders of peripheral and cerebral circulation 2-3 times a day in courses. The cost of a package of 90 tablets is lower than 100 pieces of Trental 400.

Cardiomagnyl

The drug Cardiomagnyl contains acetylsalicylic acid to thin the blood and magnesium oxide to protect the gastric mucosa from the irritating effects of ASA. Used to prevent thrombosis and cardiovascular diseases. Sold freely in pharmacies.

Which is better, Trental or Cardiomagnyl, depends on the indications and condition of the patient. More often, the drugs are prescribed together. Monitoring coagulation parameters is important.

Cinnarizine

The analogue Cinnarizine is used for impaired peripheral and cerebral circulation: atherosclerosis, hearing pathologies, dizziness, residual complications of stroke and other conditions. Dispensed with a doctor's prescription.

Which is better – Cinnarizine or Trental, individually. Medicines from different groups have excellent therapeutic effects.

Wessel Due F

An imported drug from the group of direct anticoagulants, Wessel Due F, is used for disorders of cerebral and peripheral circulation. The analogue prevents thrombosis, improves blood properties, and protects blood vessels from damage. Used as prescribed by a doctor.

Sermion

The original drug Sermion is an analogue of Trental. Contains nicergoline. Available in bottles for the preparation of solution for injection and tablets. Used to improve peripheral and cerebral circulation. The analogue increases blood flow, improves the properties of blood cells and metabolism. Which is better, Sermion or Trental, depends on the patient’s condition. In general, the drugs have the same properties and indications.

Analogues in other dosage forms

Substitutes for Trental on the pharmacological market include medications that are produced in solution for injection. Very often, these analogs of Trental are used in intensive therapy for the treatment of cerebral ischemia and other complications in the bloodstream.

Latrain

The main component of Latren is pentoxifylline. The medication is manufactured in the form of a solution for injections (0.05%). This vasodilator medication is prescribed to improve microcirculation in the following pathologies:

• diabetic neuropathy;
• obliterating endarteritis and atherosclerosis;
• vascular spasms in Raynaud's syndrome;
• intermittent claudication;
• gangrene and trophic ulcer;
• thrombosis in the lower extremities;
• varicose veins and venous insufficiency;
• ischemic stroke;
• impaired blood flow to the inner ear and eye;
• decreased memory quality;
• sleep rhythm disturbance.

Do not use Latren in the treatment of:

• allergies to the composition;
• advanced atherosclerosis and acute infarction;
• hemorrhagic stroke and hemorrhage in the eye;
• pregnancy and breastfeeding;
• arrhythmias and hypotension;
• kidney and liver failure.

Latren is prescribed intravenously in 200 ml (100 mg) of solution using a dropper. If necessary, double the dosage - 400-500 ml. Duration of treatment is 5-7 days. For children, the dosage is 5 mg per kg of child weight. Therapy also continues for 5-7 days.

Pentilin

Pentilin is a vasodilator drug, a generic version of Trental, which improves cerebral microcirculation and coronary blood flow. The main component in the medicine is pentoxifylline in solution (2%) for injections. Pentilin is used in the treatment of such blood flow disorders:

• encephalopathy of discirculatory and atherosclerotic type;
• stroke and cerebral ischemia;
• impaired blood flow in the periphery due to the progression of atherosclerosis, angiopathy of diabetic origin, inflammation in the venous and muscular apparatus of the legs;
• trophic destruction in the limbs and gangrene;
• angioneuropathy;
• impaired blood flow in the retina and visual organ;
• endarteritis of obliterating origin;
• disturbance in the inner ear due to the development of vascular diseases.

Pentilin is not prescribed to patients for the following reasons:

• allergy to medication;
• hemorrhage in the eye and brain, as well as internal bleeding;
• hemorrhages;
• ulcers in the digestive organs and heart attack in the acute phase;
• pregnancy, childhood and breastfeeding.

The drug is administered intravenously using the drip method - 100-600 mg per 100-500 ml of sodium chloride solution, Ringer or glucose solution with a dropper speed of 100 mg per 1 hour. The frequency of administration procedures per day is 1-2 times. The maximum volume of the main component per day is 1200 mg.

Mexicor

Mexicor is a membrane protector, which, along with its vasodilating properties, also cleanses the bloodstream of free radical particles. With the help of Mexicor, you can remove toxins after intoxication with alcohol and drugs, smoke and pesticides and prevent neuronal hypoxia, ischemia and stroke. The main component in the medicine is ethylmethylhydroxypyridine succinate.

Mexicor is used in the treatment of the following pathologies:

• encephalopathy due to the progression of systemic atherosclerosis;
• ischemia and hypoxia of the brain;
• cardiopsychoneurosis;
• trophic ulcerative disorders in the legs;
• Raynaud's disease;
• injury to the brain and visual organ;
• heart attack and peritonitis;
• anxiety and neuroses;
• withdrawal syndrome;
• intoxication of the body of various etiologies;
• primary stage of glaucoma;
• necrotizing pancreatitis.

It is prohibited to prescribe medicine for:

• allergies to components in the medication;
• pathologies of the kidneys and liver;
• pregnancy and pregnancy;
• in pediatrics.

Mexicor can be administered by IV injection or drip:

1. The initial dosage is 50-100 mg one to three times a day. The maximum daily volume is 800 mg.
2. For disturbances of cerebral blood flow in the acute phase - 200-300 mg once a day intravenously (2-4 days), and then 100 mg intramuscularly for 10-14 days.
3. For encephalopathy – 100 mg for 14 days (twice or three times a day), and after that switch to intramuscular injections (100 mg/1 time per day).
4. Open coal glaucoma – 100-300 mg (1 time per day) for 14 days.
5. To relieve withdrawal symptoms - 100-200 mg IM three times a day for 5-7 days.

After using the medication, the following negative symptoms may appear:

• pressure fluctuations and tachycardia;
• headache, lack of coordination and nervousness;
• allergic reactions;
• hand tremors and swelling in the periphery.

Pentoxifylline or Trental - which is better, doctors' reviews

Pentoxifylline is a domestic analogue of Trental in tablets and ampoules. Used for disorders of cerebral and peripheral circulation. Tablet dosages are 100 and 400 mg. The first is used in older people and with low blood pressure. The second is for all other patients.

The cost of Pentoxifylline and Trental differs significantly: the former is several times cheaper.

Patients are interested in the question of what is more effective - Trental or Pentoxifylline. If you have financial resources, it is recommended to choose the first medicine, since it is produced by an imported manufacturer, has excellent reviews from doctors, and is manufactured using high-quality, purified raw materials. Undesirable side effects have been reported less frequently.

The Trental analogue Pentoxifylline is often purchased through government procurement, sponsored by the state and used in an outpatient or hospital setting.

Cheap similar products

There are analogues cheaper than Trental, which at a budget price are no less effective than the original drug.

Pentoxifylline

An analogue of Trental 400 - Pentoxifylline is produced in tablets and solution for injections based on the component - pentoxifylline. This cheap substitute for Trental is used in the treatment of the following pathologies:

• impaired blood flow in the periphery;
• ischemic attacks;
• encephalopathy of various origins;
• paresthesia and Raynaud's disease;
• gangrene and ulcers, as well as frostbite and thrombophilic syndrome;
• lack of blood circulation in the eyes and inner ear.

Pentoxifylline is not used in the following cases:

• allergies to medication ingredients;
• hemophthalmos, excessive internal blood loss;
• heart attack in the acute stage;
• hemorrhages;
• cerebral atherosclerosis;
• abnormal heart rhythm and coronary insufficiency;
• pregnancy;
• breastfeeding and childhood.

The drug in solution is prescribed for violations of cerebral and peripheral microcirculation, 100 mg intramuscularly or intravenously, diluted in 250-500 ml of sodium chloride solution (drip) once a day. If necessary, the same dosage is used 2-3 times in 24 hours. The duration of the therapeutic course is 2-3 weeks. Tablets should be taken after meals, 2-3 times a day, 200 mg. An individual course of treatment is prescribed by the doctor, where he indicates its duration and the exact dosage of the medication.

Xanthinol nicotinate

A medication based on xanthinol nicotinate improves peripheral and cerebral microcirculation, prevents the development of hypoxia and tissue ischemia in organs. The medication also improves metabolism in the bloodstream, brain, and myocardium.

The medication is used to treat the following disorders in the patient’s body:

• atherosclerotic disorders in the microcirculation of the brain;
• endarteritis in the extremities;
• Raynaud's disease;
• thrombosis and thrombophlebitis;
• eye retinopathy due to diabetes mellitus;
• trophic ulcers;
• Meniere's syndrome;
• hypoxia of brain cells and ischemia.

It is forbidden to take the medicine if you are allergic to its composition, in the 1st trimester of pregnancy, as well as with myocardial insufficiency of the 2nd and 3rd step and heart blockades.

The dosage is calculated as follows:

1. Tablets are prescribed at 150 mg 3 times a day, and if there is a need, then the dosage can be increased to 300-600 mg per day.
2. 300 mg (2 ml of solution) is administered intramuscularly 1-3 times a day. The dosage can be increased to 600-900 mg (4-6 ml of solution). Therapy lasts 15-20 days.
3. With slow intravenous administration - 300 mg, 1-2 times a day. You can use the drip method - dilute 10 ml of solution in 200-500 ml of Ringer's solution. The frequency of prescribing droppers per day is 3-4 times.

Curantil or Trental - which is better?

Analogue Curantil is an imported medicine from the group of vasodilating, antiplatelet drugs. It is used as prescribed by a doctor and is dispensed from pharmacies according to a specially issued prescription. Contains the substance dipyridamole, which has the following therapeutic effects:

• improvement of microcirculation;
• inhibition of platelet adhesion and adhesion to the walls of blood vessels;
• dilatation of arterioles;
• increasing resistance to viral infections;
• improvement of decreased interferon production.

It is impossible to say for sure which is better for atherosclerosis - Trental or Curantil. Medicines have a similar effect. Can be prescribed together according to indications.

Actovegin or Trental

Actovegin is a drug in ampoules (for intravenous and intramuscular administration) and tablets. Improves trophic nutrition, activates metabolic processes in tissues, stimulates regeneration. Normalizes the absorption and supply of oxygen to tissues. Used to treat impaired peripheral circulation and complications, cognitive disorders, diabetic polyneuropathy.

Trental is also produced in tablets and ampoules. Used to treat diseases of peripheral and cerebral circulation. Dilates blood vessels, improves the properties of blood cells, cerebral circulation.

Which is better, Actovegin or Trental, depends on the indications and is determined by the attending physician.

Trental or Detralex – which is better?

Detralex is a combined analogue based on diosmin and hesperidin. Refers to venotonic and venoprotective agents. The drug eliminates leg cramps, pain, a feeling of “fatigue,” bloating and heaviness of the lower extremities. Prescribed for varicose veins, venous trophic ulcers, swelling of the legs. Dispensed without a doctor's prescription.

Trental has a less pronounced effect on trophic ulcers and varicose veins. Can be prescribed together with Detralex.

It is difficult to determine which of the two drugs is better. The drugs belong to different groups and have different therapeutic effects.

Trental or Cavinton

Cavinton is a drug that improves cerebral blood flow and metabolism in the brain. Available in ampoules and three forms of tablets - regular, enhanced with the prefix forte (10 mg) and dispersible (Comforte). Prescribed to eliminate tinnitus, dizziness, headache, unsteadiness in gait associated with vascular disorders, and atherosclerosis.

Trental is used for the same purposes, and for other indications - circulatory disorders in the extremities.

Both drugs are prescription drugs produced by imported manufacturers. Improve blood flow and metabolism in tissues. Which is better depends on the desired therapeutic effects and indications.

Side effects and contraindications

There are many side effects. They were identified during clinical trials. The following negative effects on the body are identified:

• neurological disorders such as dizziness, headache, convulsions, non-infectious meningitis;
• anxiety, insomnia;
• cardiovascular pathologies - arrhythmia, increased heart rate, hypotension, angina pectoris, hot flashes;

• dyspeptic disorders, impaired stool formation, hypersalivation;
• cholestasis, increased transaminase activity;
• deterioration of hematopoietic function with a decrease in blood sprouts;
• benign neoplasm in the eyeball, decreased vision;
• local allergic reactions in the form of itching, burning, rash, erythema, redness;
• systemic allergic reactions, manifested by urticaria, angioedema, anaphylactic shock, angioedema, bronchospasm.

The drug is contraindicated in patients who have excessive bleeding from external or internal organs, including the brain. It is not used for heart attack, stroke in the acute period, pregnancy and lactation, and minors. Since the composition contains auxiliary components, it is not recommended for use in cases of enzyme deficiency. It is not prescribed when individual intolerance to one of the components of the drug is observed.

Trental or Vasonite

Vazonit is a medicine based on pentoxifylline in tablets containing 400 mg of active substance. The price of the cheap analogue of Trental 100 and 400 ranges from 400 to 550 rubles for 20 tablets. This is 15–20% lower.

Otherwise, Trental and Vazonit are similar: composition, indications, contraindications, side effects and interactions with other medications. They differ in the country of origin and price. The quality of the drugs does not differ, according to doctors.

Trental or Mexidol - which is better for blood vessels

Mexidol is an original domestic drug in ampoules and tablets. Belongs to the group of antioxidant agents. Improves cerebral metabolism, blood supply to the brain, reduces platelet adhesion to the walls of blood vessels, reduces cholesterol levels, increases the body's resistance to stress factors (oxygen starvation, exposure to alcohol, ischemia, shock, etc.).

Trental is prescribed to improve cerebral and peripheral blood supply and prevent platelet aggregation.

Which is better – Trental or Mexidol – is determined individually. Medicines have common characteristics, however, they belong to different pharmacological groups and have different effects.

The choice of a Trental substitute must be agreed with your doctor by filling out a special prescription form. Before purchasing, it is advisable to read the instructions for use and ask a specialist any questions you may have.

Answers to frequently asked questions

Answers to the most pressing and common questions from patients are given.

1. Is Trental an antibiotic or not?
   

   No, the drug belongs to the group of drugs for improving cerebral and peripheral circulation (vasodilating agents).

2. What is the difference between Trental 100 or 400?
   

   Both drugs belong to the same group and have similar effects. They differ in the amount of the active substance - pentoxifylline: in the first case it contains 100 mg, in the second - 4 times more. A low-dose drug is more often prescribed to patients with low blood pressure or a risk of low blood pressure during treatment.