What is the recommended dose of Daflon (micronized purified flavonoid fraction) for a patient with recurrent hemorrhoids?

Daflon Dosing for Recurrent Hemorrhoids

For recurrent hemorrhoids, administer Daflon 500 mg at a maintenance dose of 600 mg daily (one tablet once daily) to prevent acute flares and reduce symptom frequency. 1

Dosing Algorithm Based on Clinical Presentation

For Acute Hemorrhoidal Flare (Initial Attack Management)

• Days 1-4: Daflon 500 mg, 3 tablets twice daily (total 3000 mg/day) 1, 2, 3
• Days 5-13: Daflon 500 mg, 2 tablets twice daily (total 2000 mg/day) 1, 2
• This intensive regimen significantly reduces bleeding, pain, anal discomfort, and discharge compared to placebo, with symptom improvement visible as early as day 2 3

For Recurrent/Chronic Hemorrhoids (Maintenance Therapy)

• Long-term maintenance: Daflon 500 mg, 1 tablet daily (600 mg/day) 1
• This maintenance dose is specifically indicated for hemorrhoidal discomfort persisting after acute flare resolution or for recurrent hemorrhoidal flares 1
• Continue for at least 60-83 days to reduce frequency, duration, and severity of acute hemorrhoidal symptoms 2

Alternative Maintenance Regimen

• Standard maintenance: Daflon 500 mg, 1 tablet twice daily (1000 mg/day) for 2 months 2, 4
• This dosing reduced acute attack frequency from 70% to 40%, shortened attack duration from 4.6 to 2.6 days, and decreased severity scores from 1.6 to 1.1 4

Integration with Conservative Management

Daflon must be combined with dietary and lifestyle modifications as first-line therapy for all hemorrhoid grades. 5, 6

• Increase dietary fiber to 25-30 grams daily (5-6 teaspoonfuls psyllium husk with 600 mL water) 6
• Adequate water intake to soften stool and reduce straining 5, 6
• Avoid prolonged sitting and straining during defecation 6

Expected Outcomes and Timeline

• Symptom improvement: Noticeable within 4-8 weeks for chronic venous manifestations 1
• Acute flare resolution: Significant improvement by day 2-4 of intensive dosing 3
• Proctoscopic improvement: Visible reduction in inflammation, congestion, edema, and prolapse within 4 weeks 7
• Quality of life: Parallel improvement with symptom reduction over 6 months 2

Critical Limitation: Symptom Recurrence

Symptom recurrence reaches 80% within 3-6 months after cessation of flavonoid therapy. 8 This necessitates either:

• Continuous maintenance therapy at 600 mg daily 1
• Transition to definitive treatment (rubber band ligation for grade I-III or hemorrhoidectomy for grade III-IV) if symptoms remain uncontrolled 6

Adjunctive Topical Therapy for Enhanced Symptom Control

For thrombosed or acutely symptomatic hemorrhoids during maintenance therapy:

• Topical 0.3% nifedipine with 1.5% lidocaine ointment every 12 hours for 2 weeks (92% resolution rate) 6, 8
• Short-term topical corticosteroids (≤7 days maximum) for local inflammation 5, 8
• Never exceed 7 days of corticosteroid use to avoid perianal tissue thinning 5, 8

When to Escalate Beyond Medical Management

Consider procedural or surgical intervention if:

• Symptoms persist or worsen after 1-2 weeks of intensive Daflon therapy 6
• Anemia develops (hemoglobin drop, though rare at 0.5/100,000 population) 8
• Grade III-IV hemorrhoids with persistent prolapse despite medical management 6
• Patient experiences more than one acute flare per year despite maintenance therapy 6

Safety and Tolerability

• Daflon has a tolerability profile similar to placebo 2
• Most common adverse events are mild gastrointestinal and autonomic symptoms 2
• No systemic side effects reported with recommended dosing 6
• Safe for use during pregnancy (third trimester) with no adverse events versus placebo 6

Common Pitfalls to Avoid

• Never attribute anemia or positive fecal occult blood to hemorrhoids without colonoscopy to rule out proximal colonic pathology 8
• Do not use Daflon as monotherapy—always combine with dietary fiber, hydration, and lifestyle modifications 5, 6, 8
• Avoid assuming all anorectal symptoms are hemorrhoids—up to 20% have coexisting anal fissures 6
• Do not continue medical management indefinitely if symptoms recur frequently (>1 flare/year)—transition to definitive procedural treatment 6