Is Diosmin effective for treating hemorrhoids?

Diosmin for Hemorrhoids

Diosmin is effective for treating hemorrhoids and should be used as part of conservative management, particularly for acute hemorrhoidal episodes, where it significantly reduces symptoms including pain, bleeding, edema, and inflammation, with resolution times shortened from 8 days to 4-5 days. 1

Evidence for Efficacy

Symptom Relief and Resolution Time

• Diosmin reduces discomfort, swelling, inflammation, and time to resolution when compared to standard care alone, with acute flare resolution shortened from 8 days to 4-5 days 1
• A double-blind, placebo-controlled study (n=120) demonstrated statistically significant improvement in pain, pruritus, discharge, edema, erythema, and bleeding 1
• In patients with grade I-II acute hemorrhoids, diosmin achieved early resolution of pain, discomfort, itching, and bleeding within 7 days, with 73% showing reduction in hemorrhoid size 2

Specific Clinical Outcomes

• Topical diosmin ointment produced 75% improvement in edema and 73% improvement in erythema over three consecutive weekly visits in patients with grades 1-4 hemorrhoids featuring strangulation and thrombosis 3
• Oral diosmin (450 mg tablets, two tablets twice daily for 7 days, then one tablet twice daily for up to 2 months) achieved 79% reduction in pain and 67% reduction in bleeding within the first week, increasing to 98% and 86% respectively by the second week 4

Recommended Treatment Regimen

Dosing Strategy

• Initial phase: 600 mg daily (or 900 mg twice daily for acute episodes) for the first 7 days 1, 2
• Maintenance phase: Continue for 35-40 days total to achieve optimal outcomes and prevent recurrence 2
• The micronized form is superior to unmicronized diosmin for reducing edema and clinical symptoms 1

Integration with Standard Care

• Diosmin should always be combined with dietary modifications (increased fiber and water intake) and avoidance of straining during defecation 5, 6
• When combined with infrared photocoagulation (IRP) for grades I-III internal hemorrhoids, the combination achieved 75% bleeding cessation at 5 days versus 60% with diosmin alone or 56% with IRP alone 1
• Patients with grades I-II hemorrhoids respond significantly better (83% and 62% respectively) than those with grade III hemorrhoids (23%) 1

Comparison with Other Treatments

Versus Sclerotherapy

• A 2-year follow-up study comparing diosmin to sclerotherapy showed that both Average Symptoms Score (ASS) and Average Anoscopy Scores (AAS) decreased significantly in the diosmin group by the second visit, with both groups reaching nadir levels by 26 weeks 1

Position in Treatment Algorithm

• Diosmin is recommended as first-line pharmacological therapy alongside conservative measures (fiber, fluids, lifestyle modifications) for all grades of hemorrhoids 6
• For thrombosed or strangulated hemorrhoids, diosmin can be combined with topical muscle relaxants for additional pain relief 6
• If symptoms persist despite 1-2 weeks of conservative management including diosmin, procedural interventions like rubber band ligation should be considered 5, 6

Safety Profile

Tolerability

• No cases of intolerance or adverse reactions were identified in a multicenter study of 220 patients, indicating a high safety profile 2
• The drug is very well tolerated and produces no unwanted side effects when properly used 3
• Excellent tolerability makes diosmin easy to handle by general practitioners and useful for proctologists in preparing patients for further treatments 4

Drug Interactions

• Diosmin may increase bioavailability of diltiazem through CYP450 3A4 inhibition 1
• Single-dose pharmacokinetic studies show diosmin significantly delayed the half-life and increased AUC of chlorzoxazone (CYP2E1 metabolism), diclofenac, and metronidazole (both CYP2C9 metabolism) 1

Critical Pitfalls to Avoid

• Do not use diosmin as monotherapy—it must be combined with dietary modifications, increased fiber/water intake, and avoidance of straining 5, 6
• Do not expect equal efficacy across all hemorrhoid grades—grades I-II respond significantly better than grade III 1
• Do not discontinue therapy prematurely—optimal outcomes require 35-40 days of continuous treatment, not just symptom resolution 2
• Do not attribute all anorectal symptoms to hemorrhoids without proper evaluation—up to 20% of patients have concomitant anal fissures 5

When to Escalate Treatment

• If symptoms worsen or fail to improve within 1-2 weeks despite diosmin and conservative measures, further evaluation and procedural interventions are necessary 5
• For grade III-IV hemorrhoids with persistent symptoms, or when anemia develops from hemorrhoidal bleeding, surgical hemorrhoidectomy should be considered 5
• Rubber band ligation (success rates 70-89%) should be the first procedural intervention for persistent grade I-III internal hemorrhoids after conservative management with diosmin fails 5