Venotonic (venotropics) – varicose veins


Venotonics, also known as venotropics or phlebotropics, are a class of medicinals that have effect on veins and are used to alleviate venous diseases and disorders and particularly venous insufficiency.

No venotonic has been shown to cure venous insufficiency or to be as effective as surgical ablation to improve the symptoms of venous insufficiency, but several have been shown to reduce the symptoms of venous insufficiency to a clinically significant degree.

Venotonic criogel Gel with plant extracts of Cypress, Rusco and Centella asiatica. It Contains Diosmin, Escin and menthol, refreshing and invigorating activities. Useful for the maintenance of physiological lightness of the lower limbs.

Venotonics flavonoidsVenotonic me dications (primarily plantderived and synthetic flavonoids, such as horse chestnut seed extract, that improve venous tone) provide symptom relief.

A meta – analysis studied the effectiveness of venotonic medications (such as rutoside, flunarizine, and dihydroergotamine) in chronic venous insufficiency. Thes e ag ents significantly reduced pain, leg heaviness, cramps, and paresthesias.

Butcher’s broomextract (BBE)appears to reducethe diameter ofvaricose veinsin vitro. BBEis availablein the UnitedStates withouta prescriptionas an herbalsupplement.

It ishypothesized thatthe mechanism ofaction for BBE may be via increasingcyclic adenosineonophosphate (cAMP)levels within the veins.2Because of itsability to increase vein tone, it mayhave some benefit as a treatment fororthostatic hypotension.

Symptomaticimprovement in heaviness, fatigue andaltered sensations in patients takingbutcher’s broom for venous insufficiencyis correlated with reduced volume ofblood within the varicosities.

Horse Chestnut Seed ExtractHorse chestnut seed extract (HCSE) hasbeen used in traditional medicine asa treatment for varicose veins. In their2002 systematic review of previousstudies for the Cochrane Collaboration,Pittler and Ernst found that there wasevidence, basedon placebocontrolledstudies, thatHCSE reducedthe symptomsof venousinsufficiency andthat HSCSE isa reasonable,short-termtreatmentfor venousinsufficiency. By Robert C. Kiser, DO, MSPH

For most patients, venotonics can be a useful adjunct to more definite surgical ablation of incompetent veins.

Diosmiplex is classified as a “medical food.” The classification of “medical foods” was established by the 1988 Orphan Drug Act and is defined as “a food which is formulated to be consumed or administered enterally under the supervision of a physician, and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.” (source: 21 U.S.C. sec. 360ee(b)(3). — [from the Orphan Drug Act, 1988]). Because the constituents are derived from commonly eaten foods, the medicine is Generally Recognized as Safe (GRAS). The most common side effect of diosmin is dyspepsia, and this is likely another reason for the addition of the Alka4-complex to the product.

The medicine is currently FDA approved for chronic venous insufficiency presenting as hemorrhoids and varicose veins. For acute hemorrhoids, diosmiplex is given three times a day for 4 days and twice daily for 9 days. For varicose veins, edema, stasis dermatitis and venous ulcers, diosmiplex is given once daily as a 630mg dose (600mg of diosmin is combined with 30mg of alka4-complex in each tablet). Although improvement may occur within the first week of treatment, 4-8 weeks may be necessary to see clinical improvement. The mechanism of action for diosmiplex is at several areas of the pathophysiology of venous insufficiency, varicose veins, venous hypertension and the microscopic pathways that lead to the skin changes associated with venous disease.

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Venotonic (venotropics) – varicose veins