Pentoxifylline and Tocopherol (Vitamin E) for Osteradionecrosis
You have been prescribed, or are being considered for, pentoxifylline and tocopherol (vitamin E). These medications are prescribed to manage osteoradionecrosis (ORN) of the jaw. This is a condition caused by reduced blood supply to the bone which leads to bone tissue damage or poor healing. The medications can be used to treat active ORN or to reduce the risk of developing ORN in patients who have previously had radiotherapy and now need dental extractions. This page will outline further information about these medications, how to take them and the possible side effects.
Pentoxifylline
| Dose |
400mg, twice daily with food |
| Indication/benefit |
Improves blood flow, reduces inflammation and may reverse tissue fibrosis (scarring) |
|
Side effects |
Nausea, dizziness, headache, flushing |
|
Rare significant side effects |
Bleeding, allergic reaction, low blood pressure. Please stop the medication immediately if you are experiencing any of these and discuss with a medical professional |
Tocopherol (Vitamin E)
| Dose |
1000iu, once daily with food |
| Indication/benefit |
Acts as an antioxidant to protect tissues. May help reduce inflammation and fibrosis |
|
Side effects |
Mild stomach upset, headache, fatigue |
|
Rare significant side effects |
Increased bleeding, diarrhoea |
Please stop the medication immediately if you are experiencing any of these and discuss with a medical professional
What does the evidence say about these medications?
This treatment is considered experimental as there are currently no published randomised controlled trials (RCTs) to date. However, published cases have shown promising results in using these medications to treat osteoradionecrosis.
A large study called the ‘RAPTOR’ trial is currently in progress to further investigate the treatment’s effectiveness.
More information about the trial can be found by entering the website address below into your internet search:
Dosing regimen prior to a dental extraction
You may have been prescribed pentoxifylline and vitamin E to take on a short-term basis (usually 4 to 12 weeks), alongside an antibiotic before and after your dental extraction. The combination of these medications will reduce the risk of ORN. You will be informed by your medical team if this applies to you.
- Start your Pentoxifylline 400 mg (twice daily) and Vitamin E 1,000 IU (once daily) 7 days before the date of your scheduled dental surgery.
- Take the prescribed antibiotic starting 2 days before your dental extraction. You will then continue to take the antibiotics until the course is completed.
Additional information
Before you are prescribed the pentoxifylline or vitamin E, you will be asked to have a blood test taken (either within the hospital or with your GP), to check your liver and kidney function.
It is most likely that you will be asked to arrange further blood tests with your GP to monitor your liver and kidney function every 8 to 12 weeks, while taking these medications.
Patients who have had a recent heart attack, history of bleeds on the brain or eyes, severe heart conditions or significant liver or kidney disease are not suitable to take these medications.
Contact information
If you have any questions or concerns, please contact your clinical team to discuss.
Oral Maxillofacial Surgery (OMFS) outpatient department, Gloucestershire Royal Hospital, Great Western Road GL1 3NN
Tel: 0300 422 3197
Monday to Friday, 09.00 am to 5.00 pm