Pharmacological Agents in the Treatment of Venous Disease: An Update of the Available Evidence

Abstract

Varicose veins and the complications of venous disease are thought to affect over a quarter of the adult population and the management of these conditions are a major cause of health service expense. Advances in the understanding of venous pathophysiology have highlighted numerous potential targets for pharmacotherapy. This review considers the evidence for pharmacological agents used for the treatment of chronic venous disease. A literature search using Pubmed, Embase and Cinahl databases was performed. The initial search terms 'varicose vein', 'venous ulcer' and 'venous disease' were used with appropriate search limits to identify prospective studies of pharmacotherapy in venous disease. A wide range of venoactive and non-venoactive drugs have been studied in patients with venous disease. The use of micronized purified flavonoid fraction (Daflon) can reduce symptoms of pain, heaviness and oedema in patients with venous reflux and a recent meta-analysis concluded that Daflon improves healing in patients with venous ulceration treated with compression. Pentoxifylline may be a useful adjunct to compression therapy for patients with venous ulceration. Oxerutins and calcium dobesilate may be of benefit in reducing oedema and rutosides may help to relieve the symptoms of varicose veins in pregnancy. The clinical benefits of other medications remain unproven. Although numerous pharmacological agents have been proposed and studied, Daflon has demonstrated the greatest clinical benefits in patients with venous disease. Further research is needed to define the role of venoactive drugs in clinical care and improve our understanding of the pathophysiology of venous disease to help identify new therapeutic avenues.

Clinical and pharmacological aspects of bath salt use: A review of the literature and case reports

“…MPFF has been successfully used for treatment of venous leg ulcers caused by microcirculation damage induced by increased ambulatory venous pressure [146,147,149,150] and seems to have the highest clinical benefit among various pharmacological agents in patients with venous diseases [151]. In a meta-analysis of 5…”

“…Among these compounds, trihydroxyethylrutoside (troxerutin) has been studied more for its phlebotropic effects [155]. Hydroxyethylrutosides have been successfully used for management of venous diseases [151,156] and they are presumed to act on the microvascular endothelium and decrease hyperpermeability and edema [157]. Commercially available approved drugs in Europe including Venoruton®, Paroven® and Relvène® are mixtures of hydroxyethylrutosides and are prescribed for chronic venous insufficiency.…”

Development of technology of the soft medicinal form based on the extract of common hazel leaves

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Rapid Screening of Permeation of Rutin through Skin Using Alaptide Enantiomers

“…drugs for the treatment of chronic venous insufficiency, superficial thrombophlebitis and haemorrhoids. They can be applied locally for the treatment of dermatomicroangiopathy, periphlebitis, haematomas and traumatic oedema [28]. …”