Vasodilators for Sickle Cell Crises?

Hydroxyurea and oxygen therapy have been used to reduce the frequency of sickle cell crises. Can you tell me whether there is a role for vasodilators (eg, hydralazine and angiotensin-converting enzyme [ACE] inhibitors) and/or pentoxifylline in the treatment of affected patients?

— Higinio Fuentes, MD
  Miami

The role of these vasodilators needs to be more thoroughly investigated before they can be viewed as established therapies. There is evidence that enalapril reduces proteinuria in sickle cell disease; thus, ACE inhibitors should be considered in affected patients who also have proteinuria. However, the long-term impact of this intervention has not been documented. Pentoxifylline for sickle cell disease is an intriguing possibility, but its use in this setting is highly anecdotal and further investigation is needed.

—Gregory J. Kato, MD
  Director, Sickle Cell Vascular Disease Unit
  National Heart, Lung, and Blood Institute
  National Institutes of Health
  Bethesda, Md

FOR MORE INFORMATION:

• Aoki RY, Saad ST. Enalapril reduces the albuminuria of patients with sickle cell disease. Am J Med. 1995; 98:432-435.
• Falk RJ, Scheinman J, Phillips G, et al. Prevalence and pathologic features of sickle cell nephropathy and response to inhibition of angiotensin-converting enzyme. N Engl J Med. 1992;326:910-915.
• Sherer JT, Glover PH. Pentoxifylline for sickle-cell disease. Ann Pharmacother. 2000;34:1070-1074.