Daflon (Micronized Purified Flavonoid Fraction) for Hemorrhoids
Dosing Regimen
For acute hemorrhoidal episodes, administer Daflon 500 mg as 3 tablets twice daily (total 3000 mg/day) for 4 days, then reduce to 2 tablets twice daily (total 2000 mg/day) for 3 days. 1 For chronic (recurrent) hemorrhoidal disease, use 2 tablets daily (1000 mg/day) for 60-83 days to reduce frequency, duration, and severity of symptoms. 1
Acute Hemorrhoid Crisis Dosing
- Initial intensive phase: 6 tablets daily (3 tablets twice daily) for 4 days provides rapid symptom control for grade 1-2 acute internal hemorrhoids. 1
- Tapering phase: 4 tablets daily (2 tablets twice daily) for 3 days completes the acute treatment course. 1
- This 7-day intensive regimen significantly improves duration and intensity of bleeding, pain, pruritus, and discharge compared to placebo. 1, 2
Chronic Disease Maintenance Dosing
- Standard maintenance: 2 tablets daily (1000 mg/day) for 2-3 months reduces recurrence frequency by 80% during active treatment. 1, 3
- Treatment duration of 60-83 days has demonstrated efficacy in reducing overall signs and symptoms of chronic hemorrhoids. 1
- Critical limitation: Symptom recurrence reaches 80% within 3-6 months after cessation, requiring either continuous therapy or transition to definitive treatment. 4
Post-Hemorrhoidectomy Use
- Administer 2 tablets daily starting preoperatively and continuing postoperatively to significantly reduce risk of secondary bleeding after elective hemorrhoidectomy. 1
Mechanism and Clinical Efficacy
Daflon works by improving venous tone, enhancing lymphatic drainage, and reducing capillary hyperpermeability through protection of microcirculation from inflammatory processes. 1 The micronization process (particles <2 micrometers) improves diosmin absorption by 77% compared to non-micronized formulations (57.9% vs 32.7% urinary excretion). 5
Evidence-Based Benefits
- Bleeding control: Meta-analysis demonstrates significant reduction (OR 0.082,95% CI 0.027-0.250; P < 0.001) across all hemorrhoid grades. 2
- Discharge/leakage: Significant improvement (OR 0.12,95% CI 0.04-0.42; P < 0.001) compared to placebo. 2
- Overall patient improvement: Strong effect (OR 5.25,95% CI 2.58-10.68; P < 0.001) for patient-reported outcomes. 2
- Pain relief: Trend toward improvement (OR 0.11,95% CI 0.01-1.11; P = 0.06), though not reaching statistical significance. 2
- Pruritus and tenesmus: Consistently reported benefits across multiple trials. 2
Common Adverse Effects
Daflon has a tolerability profile similar to placebo, with gastrointestinal and autonomic symptoms being the most frequently reported adverse events. 1 The medication is well-tolerated with minimal systemic side effects, making it suitable for prolonged use during the active treatment period. 1
Essential Non-Pharmacologic Adjuncts
Dietary Modifications (Mandatory First-Line)
- Fiber intake: Increase to 25-30 grams daily, achievable with 5-6 teaspoonfuls of psyllium husk mixed with 600 mL water daily. 6
- Hydration: Adequate water intake to soften stool and reduce straining during defecation. 6
- These dietary changes carry a strong recommendation (1B) and must accompany all pharmacologic therapy. 6
Lifestyle and Behavioral Modifications
- Avoid prolonged sitting on toilet: Limit time to prevent increased venous pressure in hemorrhoidal plexus. 6
- Eliminate straining: Critical to prevent exacerbation and recurrence of symptoms. 7, 4
- Sitz baths: Warm water soaks reduce inflammation and provide symptomatic relief. 6
Complementary Topical Therapy
- For thrombosed external hemorrhoids: Combine Daflon with topical 0.3% nifedipine plus 1.5% lidocaine ointment every 12 hours for 2 weeks (92% resolution rate). 8, 4
- For local inflammation: Short-term topical corticosteroids (≤7 days maximum) to avoid perianal tissue thinning. 8, 7, 4
- For pain relief: Topical lidocaine 1.5-2% provides symptomatic relief of local pain and itching. 7
Clinical Integration and Treatment Algorithm
Daflon should be integrated as first-line pharmacologic therapy alongside mandatory dietary and lifestyle modifications for all grades of symptomatic hemorrhoids. 6, 4 The World Society of Emergency Surgery recommends flavonoids to relieve symptoms in complicated hemorrhoids (weak recommendation, 2B based on moderate-quality evidence). 6
When to Use Daflon
- Grade 1-2 internal hemorrhoids: First-line pharmacologic option combined with conservative measures. 7, 4
- Acute hemorrhoidal crisis: Intensive 7-day regimen for rapid symptom control. 1
- Chronic recurrent disease: Maintenance therapy to reduce frequency and severity of episodes. 1, 3
- Post-procedural bleeding prevention: Adjunct to hemorrhoidectomy to reduce secondary bleeding risk. 1
When to Escalate Beyond Daflon
- Persistent symptoms after 1-2 weeks: Consider rubber band ligation (70.5-89% success rate for grades 1-3). 8
- Grade 3-4 hemorrhoids with complications: Surgical hemorrhoidectomy indicated (2-10% recurrence rate). 8
- Anemia from hemorrhoidal bleeding: Never attribute anemia to hemorrhoids without colonoscopy; definitive surgical treatment required. 4
Critical Pitfalls to Avoid
- Never use Daflon as monotherapy: Always combine with increased fiber (25-30 g/day) and adequate hydration. 6, 4
- Do not expect permanent cure: 80% symptom recurrence within 3-6 months after cessation requires ongoing management strategy. 4
- Never attribute anemia to hemorrhoids: Colonoscopy mandatory to rule out proximal colonic pathology before assuming hemorrhoidal source. 4
- Avoid prolonged topical corticosteroids: Limit to 7 days maximum when used alongside Daflon to prevent perianal tissue thinning. 8, 7, 4
- Do not delay definitive treatment: If symptoms persist despite 8 weeks of conservative therapy including Daflon, procedural or surgical intervention indicated. 8