Diosmin and Hesperidin Content in Alermor (MPFF)
The 2026 study referenced in the Praxis Medical Insights guideline used Alermor (micronized purified flavonoid fraction), which contains 450 mg of diosmin and 50 mg of hesperidin per tablet, administered as 2 tablets daily for a total daily dose of 900 mg diosmin and 100 mg hesperidin. 1
Standard MPFF Formulation
Each tablet of micronized purified flavonoid fraction (MPFF) contains 450 mg diosmin and 50 mg hesperidin, representing a 90%/10% ratio of diosmin to flavonoids expressed as hesperidin 2, 3
The standard therapeutic regimen is 2 tablets daily (1000 mg total: 900 mg diosmin + 100 mg hesperidin), which was the dosing used in the hemorrhoid studies cited in the 2026 Praxis guideline 1, 2
Micronization Advantage
Micronization reduces diosmin particle diameter to <2 micrometers, which significantly improves gastrointestinal absorption compared to non-micronized formulations 2
Micronized diosmin at 1000 mg daily (as MPFF) demonstrates superior clinical efficacy compared to 900 mg of non-micronized diosmin, with greater improvements in venous symptoms and plethysmographic parameters in chronic venous insufficiency 4, 3
The micronization process provides better pharmacodynamic activity and higher patient satisfaction (95% vs 80%) compared to equivalent doses of non-micronized diosmin 3
Clinical Context for Hemorrhoids
For hemorrhoidal disease, the World Society of Emergency Surgery recommends flavonoid therapy (specifically MPFF formulations like Alermor) to relieve symptoms in complicated hemorrhoids, based on moderate-quality evidence (Grade 2B recommendation) 1
The standard MPFF dose of 1000 mg daily (2 tablets) must be combined with dietary fiber (25-30 g daily) and adequate hydration, as flavonoid monotherapy is ineffective for sustained symptom control 1