What is the recommended dosage of diosmin (flavonoid) for the treatment of hemorrhoids?

Diosmin Dosage for Hemorrhoids

For acute hemorrhoids, use diosmin 1800 mg daily (3 tablets of 600 mg twice daily) for 4 days, then reduce to 1200 mg daily (2 tablets of 600 mg twice daily) for 3 additional days; for chronic hemorrhoids, use 1000 mg daily (2 tablets of 500 mg) for 2-3 months. 1, 2

Acute Hemorrhoid Treatment Protocol

High-dose regimen for acute symptoms:

• Days 1-4: 1800 mg daily (3 tablets of 600 mg twice daily or 6 tablets of 500 mg in divided doses) 2
• Days 5-7: 1200 mg daily (2 tablets of 600 mg twice daily or 4 tablets of 500 mg in divided doses) 2
• This intensive regimen significantly improves bleeding, pain, and swelling in grade 1-2 internal hemorrhoids within the first week 1, 2

For acute bleeding specifically:

• Diosmin 1800 mg daily (divided into 3 doses) for 5 days stops hemorrhoidal bleeding in an average of 3.2 days 3
• Must be combined with bulk-forming agents (psyllium 3.26g twice daily) for optimal results 3

Chronic (Recurrent) Hemorrhoid Management

Standard maintenance dosing:

• 1000 mg daily (2 tablets of 500 mg) for 60-83 days 2
• This regimen reduces frequency, duration, and severity of recurrent hemorrhoidal symptoms 2
• Symptom recurrence reaches 80% within 3-6 months after cessation, so consider extended courses for patients with frequent flares 4

Important Clinical Considerations

Formulation matters for efficacy:

• Micronized purified flavonoid fraction (MPFF) containing 90% diosmin and 10% hesperidin is the most studied formulation 2
• Micronization to particles <2 micrometers significantly improves absorption compared to non-micronized forms 2
• No conclusive evidence shows that 3000 mg daily of micronized flavonoid fraction is superior to 1800 mg daily of purified diosmin for acute hemorrhoids 5

Expected timeline for symptom improvement:

• Objective improvement (reduced bleeding, edema) occurs by day 4 of treatment 6
• Subjective symptom relief may lag behind objective findings 6
• By day 14, most patients show both objective and subjective improvement 6

Diosmin must be part of comprehensive conservative management:

• Always combine with increased dietary fiber (25-30g daily) and adequate water intake 4, 1
• Add topical treatments as needed: lidocaine for pain, short-term corticosteroids (≤7 days) for inflammation 1
• For thrombosed external hemorrhoids, topical nifedipine 0.3% with lidocaine 1.5% every 12 hours is more effective than diosmin alone 4

Critical Pitfalls to Avoid

Do not use diosmin as monotherapy:

• Flavonoids relieve symptoms but do not replace dietary modifications and lifestyle changes 4, 1
• For grade 3-4 hemorrhoids or those unresponsive to medical management, procedural interventions (rubber band ligation) or surgery are indicated 4

Do not attribute all bleeding to hemorrhoids:

• Hemorrhoids alone do not cause positive fecal occult blood tests 4
• Anemia from hemorrhoids is rare (0.5 per 100,000 population) and requires colonoscopy to rule out other causes 4
• Complete colonic evaluation is mandatory when bleeding is atypical or patient has risk factors for neoplasia 4

Safety profile:

• Diosmin is well tolerated with adverse events similar to placebo 6, 2
• Most common side effects are mild gastrointestinal and autonomic symptoms 2
• No significant drug interactions or contraindications reported in clinical trials 6, 2