What are the uses of Daflon (diosmin and hesperidin)?

Uses of Daflon (Diosmin and Hesperidin)

Daflon (micronized purified flavonoid fraction containing 90% diosmin and 10% hesperidin) is primarily used for treating hemorrhoids, chronic venous insufficiency, and venous ulcers due to its ability to improve venous tone, reduce inflammation, and enhance lymphatic drainage.

Primary Uses

1. Hemorrhoids

• Effectiveness for hemorrhoids:
  • Significantly improves symptoms of grade 1 and 2 hemorrhoids (83% and 62% response rates, respectively) 1
  • Less effective for grade 3 hemorrhoids (23% response rate) 1
  • Reduces acute hemorrhoidal symptoms including discomfort, edema, and bleeding 1
  • Decreases duration and intensity of symptoms in acute internal hemorrhoids compared to placebo 2
  • Reduces risk of secondary bleeding after elective hemorrhoidectomy 2

2. Chronic Venous Insufficiency (CVI)

• Benefits for CVI:
  • Decreases ankle/calf circumference in patients with edema 2
  • Improves venous tone and reduces venous distensibility 3
  • Decreases venous emptying time (p<0.001) 3
  • Improves clinical symptoms and quality of life 2, 4
  • Addresses venous trophic disorders like gravitational dermatitis and dermatofibrosclerosis 4
  • Received 1B recommendation (highest) in guidelines for venous disease therapy 5

3. Venous Ulcers

• Efficacy for venous ulcers:
  • Accelerates healing of venous ulcers ≤10 cm in diameter when combined with standard management 2
  • More effective for smaller ulcers (<3 cm: ~70% resolution vs 50% with standard care alone) 1
  • Less effective for larger ulcers (>10 cm) 1
  • Cost-effective when added to standard management 2

Mechanism of Action

Daflon works through several mechanisms:

1. Vascular effects:

   • Increases venous tone by enhancing smooth muscle contractibility 1
   • Prolongs post-synaptic response to norepinephrine 1
   • Increases sensitivity of vascular smooth muscle to norepinephrine and calcium 1

2. Anti-inflammatory effects:

   • Acts as a scavenger of reactive oxygen species (ROS) 1
   • Inhibits 5-lipoxygenase and production of prostaglandins E2 and thromboxane B2 1, 6
   • Protects endothelial cells from inflammatory damage 1

3. Lymphatic effects:

   • Increases lymphatic contractility and drainage 1
   • Reduces edema by improving lymphatic function 1, 6

4. Microcirculation effects:

   • Decreases capillary hyperpermeability 2, 4
   • Protects microcirculation from inflammatory processes 2

Dosing Considerations

• For hemorrhoids:

  • Acute episodes: 3 tablets twice daily for 4 days, then 2 tablets twice daily for 3 days 2
  • Chronic/recurrent hemorrhoids: 2 tablets daily for 60-83 days 2

• For chronic venous insufficiency:

  • Standard dose: 500 mg twice daily 2, 3
  • Treatment duration: 2-6 months or longer depending on severity 2

• For venous ulcers:

  • 500 mg twice daily in addition to standard management (compression and local treatment) 2
  • Continue for 2-6 months or until ulcer healing 2

Safety Profile

• Generally well-tolerated with a safety profile similar to placebo 2
• Most common adverse events are gastrointestinal and autonomic in nature 2
• Rare side effects leading to treatment withdrawal (only 3 patients in a study of 183) 3
• May interact with certain medications through CYP450 enzyme system effects 1
• Potential interactions with diltiazem, chlorzoxazone, diclofenac, and metronidazole 1

Clinical Considerations

• Daflon is not FDA-approved in the United States 7
• More effective when used early in disease progression
• Can be used as first-line treatment for CVI symptoms or in conjunction with other therapies for advanced disease 4
• Consider as adjunctive therapy after venous interventions 5
• Most beneficial when started promptly for acute hemorrhoidal episodes (within 48 hours) 1

Daflon represents an effective pharmacological option for managing venous disorders, with strongest evidence supporting its use in hemorrhoids and chronic venous insufficiency.