Diosmin and Hesperidin: Recommended Dosing and Indications
For chronic venous disorders of the lower limbs, the recommended adult dose is diosmin 600 mg once daily, which is as effective as higher doses and does not require the addition of hesperidin. 1, 2
Standard Dosing for Chronic Venous Disease
The evidence strongly supports diosmin 600 mg once daily as the optimal dose for treating chronic venous disorders (CVD). 1, 2 Clinical trials demonstrate that non-micronized diosmin 600 mg daily achieves equivalent efficacy to micronized diosmin 900 mg plus hesperidin 100 mg, with no statistical differences in symptom reduction. 1, 2
Key Dosing Points:
- Diosmin 600 mg once daily is the recommended dose for CVD symptoms 1, 2
- No clinical benefit exists for doses exceeding 600 mg per day 2
- Micronization and hesperidin addition provide no additional therapeutic advantage 2
- Both formulations reduce CVD symptom intensity by approximately 50% over 1-6 months of treatment 2
Primary Indications
Chronic Venous Disorders (C0-C3 Grade)
Diosmin is indicated for symptomatic relief of chronic venous disease including:
The treatment typically shows significant symptom improvement within 1-6 months. 1, 2
Hemorrhoidal Disease
For acute hemorrhoidal crisis, flavonoid mixtures containing diosmin are effective:
- A combination of diosmin, troxerutin, and hesperidin significantly reduces pain, bleeding, edema, and thrombosis within 12 days 4
- For grades I-III hemorrhoidal disease with bleeding, diosmin-containing mixtures reduce bleeding in approximately 70-80% of patients at 6 months 5
- Faster control of edema and thrombosis occurs with flavonoid treatment compared to placebo 4
Lymphedema
Diosmin with hesperidin serves as effective supplementary treatment for lymphedema. 3
Post-Venous Intervention
The combination can be used as supplementary treatment for symptoms following venous interventions. 3
Administration Guidelines
- Take once daily 1, 2
- Non-micronized formulations offer greater ease of swallowing compared to micronized preparations 1
- Treatment duration typically ranges from 1-6 months depending on indication and response 1, 2
- Well tolerated with minimal adverse effects reported in clinical trials 2
Important Clinical Considerations
The current guideline classification undervalues pure diosmin 600 mg (rated 2C - weak recommendation, poor evidence quality) compared to micronized purified flavonoid fraction (MPFF) at 1000 mg (rated 1B - strong recommendation, moderate evidence quality), despite equivalent clinical efficacy. 2, 3 This discrepancy warrants reconsideration given that 600 mg daily of non-micronized diosmin achieves the same therapeutic outcomes. 2
For hemorrhoidal disease, flavonoid mixtures containing diosmin demonstrate safety and efficacy with minimal adverse events. 5, 4 The specific combinations studied include diosmin with troxerutin, rutin, hesperidin, and quercetin. 5, 4