Drug list
BLOOD FORMATION AND COAGULATION › HEMORRHEOLOGIC AGENTS

PENTOXIFYLLINE (Apo-Pentoxifylline SR · Jamp Pentoxifylline SR · Trental)

400mgSR Tab
LU76
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For the treatment of patients with critical limb ischemia (with arterial ulcers, gangrene and/or rest pain) and documented arterial vascular disease.

LU Authorization Period: Indefinite
Complete Ontario criteria

For the treatment of patients with critical limb ischemia (with arterial ulcers, gangrene and/or rest pain) and documented arterial vascular disease. Limited Use form must specify if arterial ulcers, gangrene and/or rest pain are present.

LU529
QUICK SCAN

For the treatment of patients with venous ulcers lasting, or expected to last, more than 8 weeks.

LU Authorization Period: 1 year
Complete Ontario criteria

For the treatment of patients with venous ulcers lasting, or expected to last, more than 8 weeks. Treatment should be discontinued after 3 months if there is no indication of objective benefit. The duration of therapy with pentoxifylline should not exceed 12 months. Pentoxifylline should be used in combination with compression therapy.

Clinical verification required

Quick summaries support scanning only. Confirm eligibility against the complete Ontario criteria and current Ontario e-Formulary before billing.

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