Varithena (Polidocanol) Dosage for Varicose Vein Sclerotherapy
For Varithena (polidocanol) sclerotherapy of varicose veins, the recommended dosage depends on vein size: 1% solution for veins 1-3 mm in diameter and 0.5% solution for veins ≤1 mm, with a maximum volume of 10 mL per treatment session. 1
Dosage Based on Vein Size
- For spider veins (varicose veins ≤1 mm in diameter): Use Varithena 0.5% solution 1
- For reticular veins (varicose veins 1-3 mm in diameter): Use Varithena 1% solution 1
- For each injection into a varicose vein, use 0.1 to 0.3 mL of the appropriate concentration 1
- The maximum recommended volume per treatment session is 10 mL 1
Clinical Considerations for Varithena Treatment
- Varithena is indicated for uncomplicated spider veins and reticular veins in the lower extremity 1
- Varithena has not been studied in varicose veins more than 3 mm in diameter according to FDA labeling 1
- The solution strength and volume injected depend on the size and extent of the varicose veins 1
- Extensive varicosities may require multiple treatment sessions 1
Treatment Algorithm for Varicose Veins
- First-line treatment for symptomatic varicose veins with documented valvular reflux is endovenous thermal ablation 2, 3
- Second-line treatment is sclerotherapy (including Varithena), particularly for small to medium-sized veins (1-5 mm) 3
- Third-line treatment is surgery, according to clinical guidelines 3
Efficacy and Outcomes
- Clinical trials of Varithena have demonstrated efficacy outcomes equivalent or better than physician-compounded foam 4
- A multicenter study showed that a single administration of up to 15 mL of polidocanol endovenous microfoam (PEM/Varithena) is effective for treating symptoms of superficial venous incompetence 5
- Doses of 0.5%, 1%, and 2% PEM appear to have an acceptable risk-benefit ratio 5
Safety Considerations and Contraindications
- Be prepared to treat anaphylaxis 1
- Monitor for potential complications such as venous thrombosis, pulmonary embolism, and arterial embolism 1
- Avoid intra-arterial injection to prevent tissue ischemia and necrosis 1
- Varithena is contraindicated in patients with known allergies to polidocanol and those with acute thromboembolic diseases 1