What is the recommended dose of Diosmin (flavonoid) + Hesperidin (flavonoid) for treating hemorrhoids?

Recommended Dosage of Diosmin + Hesperidin for Hemorrhoids

The recommended dosage of Diosmin + Hesperidin for treating hemorrhoids is 1000 mg (900 mg diosmin + 100 mg hesperidin) twice daily for the first 4 days, followed by 1000 mg once daily for 3 days, and then maintenance therapy of 500-600 mg daily for up to 2 months. 1, 2

Dosing Regimen Based on Hemorrhoid Stage

Acute Hemorrhoidal Episode

• Initial loading dose: 1000 mg (900 mg diosmin + 100 mg hesperidin) twice daily for 4 days 1, 2
• Step-down dose: 1000 mg once daily for 3 days 2
• This regimen is particularly effective for controlling acute bleeding in all grades of hemorrhoids 1

Maintenance Therapy

• 500-600 mg once daily for up to 2 months 2
• This dosage is effective for preventing recurrence and maintaining symptom relief 1, 2

Efficacy of Diosmin + Hesperidin

• Flavonoids like diosmin and hesperidin improve venous tone and reduce hemorrhoidal symptoms by:
  • Decreasing venous stasis 3
  • Suppressing local inflammation 3
  • Improving lymphatic drainage 3, 4
• Clinical improvement is typically observed within the first week of treatment:
  • 79% reduction in pain within the first week 2
  • 67% reduction in bleeding within the first week 2
  • By the second week, pain reduction reaches 98% and bleeding reduction reaches 86% 2

Evidence Supporting This Dosage

• Meta-analyses of 14 trials comparing flavonoids with placebo in 1514 patients with hemorrhoids have confirmed their efficacy 3
• A Cochrane review of 24 randomized controlled trials (2,334 participants) supports the use of flavonoids for hemorrhoid treatment 3
• A double-blind multicenter prospective comparative study showed significant improvement in bleeding (79.5% after 1 month) with a flavonoid mixture containing diosmin and hesperidin 5

Important Considerations

• There is no conclusive evidence supporting the superiority of higher daily dosages (3000 mg) compared to standard dosages (1800 mg) for acute hemorrhoids 3
• Diosmin + hesperidin should be used as part of a comprehensive treatment approach that includes:
  • Increased dietary fiber and water intake 1, 6
  • Avoidance of straining during defecation 1, 6
  • Sitz baths for symptomatic relief 1
• For persistent symptoms despite pharmacological treatment with diosmin + hesperidin, procedural interventions like rubber band ligation should be considered 1, 6

Formulations and Administration

• Oral tablets are the most common formulation for systemic effects 2
• Topical preparations (ointments) are also available and effective for local symptoms:
  • Particularly effective for reducing edema (75% improvement) and erythema (73% improvement) 7
  • Well-tolerated with no significant side effects when properly used 7

Safety Profile

• Diosmin + hesperidin has an excellent tolerability profile with minimal adverse events reported 5, 2
• This favorable safety profile makes it easy to manage by general practitioners and useful for proctologists in preparing patients for further treatments if needed 2