What is the treatment and dosage for Diosmine in chronic venous insufficiency and varicose veins?

Diosmin Treatment for Chronic Venous Insufficiency and Varicose Veins

The standard treatment regimen for diosmin in chronic venous insufficiency (CVI) and varicose veins is 600 mg twice daily, which has been shown to significantly improve clinical symptoms, quality of life, and CEAP staging. 1

Mechanism of Action and Efficacy

Diosmin works by:

• Improving venous tone and lymphatic drainage
• Reducing capillary hyperpermeability
• Protecting microcirculation from inflammatory processes 1

Clinical studies have demonstrated that diosmin therapy:

• Significantly decreases ankle and calf circumference
• Improves symptoms including pain, edema, heaviness, and tightness in the legs
• Enhances physical, social, and psychological quality of life 2
• Reduces the metabolism of noradrenaline in varicose veins, which may contribute to its therapeutic effect 3

Treatment Regimens

Standard Dosage

• For chronic venous insufficiency: 600 mg twice daily 1
• For acute hemorrhoids: 3 tablets of 500 mg twice daily for 4 days, then 2 tablets twice daily for 3 days 1
• For chronic hemorrhoids: 2 tablets of 500 mg daily for 60-83 days 1

Alternative Formulations

• A newer, more bioavailable formulation (μsmin® Plus) has shown efficacy at a lower dose of 450 mg once daily 4

Place in Therapy

Diosmin is indicated as:

1. First-line treatment for edema and symptoms of CVI in any disease stage
2. Adjunctive therapy with sclerotherapy, surgery, and/or compression therapy
3. Alternative treatment when surgery is not indicated or feasible 1

Comprehensive Management of CVI

While diosmin is effective, it should be part of a comprehensive approach to CVI management:

Diagnostic Evaluation

• Duplex ultrasound is the gold standard for diagnosing CVI
• Reflux duration >500 ms and vein size >4.5 mm support intervention 5

Treatment Options

1. First-line interventional treatment: Endovenous thermal ablation (radiofrequency or laser) for saphenous vein reflux 5
2. Adjunctive treatments:
   • Ultrasound-guided foam sclerotherapy for tributary veins and varicosities
   • Microphlebectomy for visible varicosities 5

Conservative Management

• Compression therapy (30-40 mmHg graduated compression stockings) for symptom relief and edema management
• Lifestyle modifications: weight management, regular exercise, leg elevation, and non-restrictive clothing 5

Monitoring and Follow-up

• Clinical improvement should be assessed after 4-8 weeks of treatment
• Parameters to monitor include:
  • Leg circumference
  • Pain (using visual analog scale)
  • Quality of life measures
  • CEAP classification 2, 4

Important Considerations

• Micronized purified flavonoid fraction (MPFF) consisting of 90% diosmin and 10% hesperidin (Daflon 500 mg) has better absorption due to micronization to particles <2 μm in diameter 1
• Diosmin has a tolerability profile similar to placebo, with the most common adverse events being mild gastrointestinal and autonomic symptoms 1
• Treatment may need to be continued long-term for chronic conditions, as symptoms often return after discontinuation

Treatment Duration

• For symptomatic relief: Minimum 30 days 2
• For venous ulcers: 2-6 months in conjunction with standard management (compression and local treatment) 1
• For maintenance therapy: Long-term use may be required, with periodic reassessment

By incorporating diosmin into a comprehensive treatment approach for CVI and varicose veins, patients can experience significant improvement in symptoms and quality of life.