From the Guidelines
There are no medications specifically approved to treat lymphedema directly, and the primary treatments focus on physical approaches rather than pharmaceutical interventions. The management of lymphedema typically involves complete decongestive therapy (CDT), which combines manual lymphatic drainage, compression garments, exercise, and skin care 1. While diuretics like furosemide might temporarily reduce swelling, they are generally not recommended for long-term lymphedema management as they don't address the underlying lymphatic dysfunction and can lead to electrolyte imbalances and dehydration.
Some key points to consider in the management of lymphedema include:
- The risk of developing lymphedema is higher in patients who undergo breast surgery and/or radiation, with an estimated incidence of over 40% among breast cancer survivors 1.
- Obesity is a risk factor for lymphedema, and maintaining a normal weight is recommended 1.
- Supervised, slowly progressive resistance training may be safe and effective for breast cancer survivors with regard to lymphedema development 1.
- Antibiotics such as penicillin or cephalosporins are only used when lymphedema is complicated by infection (cellulitis), typically at standard doses for 7-14 days.
- Anti-inflammatory medications might help with discomfort but don't treat the underlying condition.
- Research into targeted lymphatic medications continues, but currently, physical management remains the cornerstone of lymphedema treatment, with medications playing only a supportive role for complications.
Physical management, including complete decongestive therapy, remains the primary approach to treating lymphedema, with medications used only to address complications such as infection or discomfort. It's essential to note that low-level laser therapy, manual lymphatic drainage, and compression bandaging can be considered for improving lymphedema, as suggested by the ASCO endorsement of the SIO clinical practice guideline 1.
From the Research
Medications Used to Treat Lymphedema
- Diuretics: although their use for pure lymphedema is physiologically unsound, they may be of use in edema of mixed origin and in palliative (cancer) circumstances 2
- Coumarin/flavonoid group of drugs: have been shown to reduce swelling in all types of lymphedema 2, 3, 4
- Benzopyrones: have been tested and shown encouraging but conflicting results, with some studies suggesting they can reduce oedema, symptoms, and inflammation 5, 4
- Rutosides: do not have hepatotoxic effects and can be used in conjunction with complex physical therapy to treat lymphedema 3
Key Findings
- The use of pharmacogenomics could significantly lower the risk of coumarin-associated hepatotoxicity, by targeting the use of coumarin to those with functional CYP2A6 3
- Oral benzo-pyrones can reduce oedema, symptoms, and inflammation, with significant and clinically important results 4
- Topical coumarin can also reduce oedema and symptoms, with minimal side-effects 4
Treatment Approaches
- Complete decongestive therapy (CDT) is effective in reducing lymphedema, although the contribution of each individual CDT component has not been determined 6
- Complex physical therapy, including compression, exercise, and massage, can help reduce swelling and improve drainage of interstitial fluid and macromolecules 2