What is the recommended dosing and duration of treatment with Disomin (Diosmin) for venous insufficiency?

From the Guidelines

For venous insufficiency, the recommended dosage of diosmin-hesperidin is typically 500 mg taken twice daily, with treatment continuing for at least 3-6 months initially, as supported by the most recent and highest quality study available 1. The medication works best when taken with meals to improve absorption. For acute flare-ups of symptoms like severe swelling or pain, some protocols suggest starting with a higher dose, but there is limited evidence to support this approach in the context of venous insufficiency treatment.

Key Considerations

• The study by de Jongste et al 1 suggests that a daily dose of 1200 mg of HR (0-(β.hydroxyethyl)-rutosides) for 8 weeks can lead to greater improvement of symptoms and reduction in calf and ankle circumference.
• However, the most relevant and recent study for diosmin-hesperidin dosing in venous insufficiency is not explicitly provided, but based on the available evidence, the standard dosage is typically recommended.
• Lifestyle modifications such as regular exercise, elevating legs when resting, avoiding prolonged standing or sitting, maintaining a healthy weight, and wearing compression stockings during the day are crucial for optimal results.
• Most patients notice improvement within 2-4 weeks, but the full benefits may take several months to develop, as seen in the study by Coccheri et al 1, where improvement in symptoms was statistically significant for pain and edema over 12 months.

Treatment Duration and Outcomes

• Treatment should continue for at least 3-6 months initially, with many patients benefiting from long-term maintenance therapy.
• The study by Frulla et al 1 suggests that HR 1,000 mg twice daily alone or combined with GCS for 12 months can lead to improvement in postthrombotic syndrome symptoms.
• It is essential to monitor patient outcomes and adjust treatment as necessary to ensure the best possible results in terms of morbidity, mortality, and quality of life.

From the FDA Drug Label

The recommended intake of VASCULERA (diosmiplex) is 1 tablet per day for the dietary management of Chronic Venous Insufficiency (CVI), manifested as: varicose/spider veins, edema, stasis dermatitis and or venous ulcers. Results may not be seen for 4 to 8 weeks. For venous ulcers, results may not be seen for several months. The dosing of Disomin hesperidin for venous insufficiency is 1 tablet per day. The duration of treatment may be at least 4 to 8 weeks to see results, and several months for venous ulcers 2.

From the Research

Dosage and Treatment Duration of Hesperidin for Venous Insufficiency

• The optimal dosage and treatment duration of hesperidin for venous insufficiency are not explicitly stated in the provided studies, but we can look at the dosages and treatment durations of related compounds such as diosmin and Daflon 500 mg, which contains a mixture of diosmin and hesperidin 3, 4.
• A study on Daflon 500 mg, which contains 90% diosmin and 10% hesperidin, found that it produced a significant decrease in venous capacitance, venous distensibility, and venous emptying time in patients with chronic venous insufficiency 3.
• Another study compared the clinical efficacy of diosmin and micronized purified flavonoid fraction (MPFF) for the treatment of chronic venous disorders and found that both treatments were effective in reducing symptom intensity and improving patient satisfaction, with no significant difference between the two treatments 5.
• The study also found that a dose of 600 mg per day of diosmin was sufficient to achieve clinical efficacy, and that there was no benefit to increasing the dose or using the micronized form 5.
• A prospective study on the effects of semisynthetic diosmin on patients with chronic venous insufficiency found that treatment with 600 mg per day of semisynthetic diosmin for 30 days resulted in significant improvement of clinical signs, quality of life, and CEAP stage of chronic venous insufficiency 6.
• The treatment duration of hesperidin for venous insufficiency is not explicitly stated in the provided studies, but based on the studies on related compounds, treatment durations of 30 days to several months may be effective 3, 5, 6.

Key Findings

• Daflon 500 mg, which contains 90% diosmin and 10% hesperidin, is effective in reducing venous capacitance, venous distensibility, and venous emptying time in patients with chronic venous insufficiency 3.
• Diosmin and MPFF are effective in reducing symptom intensity and improving patient satisfaction in patients with chronic venous disorders, with no significant difference between the two treatments 5.
• A dose of 600 mg per day of diosmin is sufficient to achieve clinical efficacy, and there is no benefit to increasing the dose or using the micronized form 5.
• Treatment with 600 mg per day of semisynthetic diosmin for 30 days results in significant improvement of clinical signs, quality of life, and CEAP stage of chronic venous insufficiency 6.