Diosmin Explained

Diosmin (diosmetin 7-O-rutinoside), a flavone glycoside of diosmetin, is manufactured from citrus fruit peels as a phlebotonic non-prescription dietary supplement used to aid treatment of hemorrhoids or chronic venous diseases, mainly of the legs.

Uses

Diosmin is a dietary supplement used to aid treatment of hemorrhoids and venous diseases, i.e., chronic venous insufficiency including spider and varicose veins, leg swelling (edema), stasis dermatitis and venous ulcers.[1] The mechanism of action of Diosmin and other phlebotonics is undefined,[1] and clinical evidence of benefit is limited.[1] Diosmin is not recommended for treating the rectal mucosa, skin irritations, or wounds, and should not be used to treat dermatitis, eczema, or urticaria.[1] Diosmin is not recommended for use in children or women during pregnancy.[1] There is moderate-quality evidence that diosmin or other phlebotonics improved leg and ankle swelling and lower leg pain,[2] and low-quality evidence for treating hemorrhoids.[3]

Phlebotonics

Diosmin is included among a small class of agents called "phlebotonics" having heterogeneous composition and consisting partly of citrus peel extracts (flavonoids, such as hesperidin) and synthetic compounds, which are used to treat chronic venous insufficiency or hemorrhoids.[1]

In 2017, the American Working Group in Chronic Venous Disease recommended use of micronized purified flavonoid fraction (diosmiplex) as a medical food for chronic venous disease symptoms and venous ulcers, having "beneficial outcomes without serious adverse events", alone or combined with compression therapy, concurring with the previous guidance of the International European Society for Vascular Surgery.[4] The German Dermatological Society indicated that Diosmin may be used with other treatments for symptoms of chronic venous diseases.[5]

The American Society of Colon and Rectal Surgeons mentions phlebotonics as a possible treatment for symptoms of hemorrhoid grades I to II, as there is only moderate-quality evidence of effectiveness with "expectations of minimal harm", while having no evidence of long-term benefit.[6] French,[7] [8] Indian,[9] Portuguese,[10] and Italian[11] professional societies of coloproctology issued similar recommendations regarding phlebotonics for hemorrhoids.

Adverse effects

In some 10% of users, diosmin causes mild gastrointestinal disorders or skin irritations (hives, itching), stomach pain, nausea, heart arrhythmias, or anemia.[1] Preliminary research indicates no evidence of toxicity.[1] The US Food and Drug Administration (FDA) concluded in 2001 that there was inadequate evidence on which to base an expectation of safety.[12], the FDA did not revise this position.[13]

Regulatory status

Diosmin is distributed in the U.S. as a dietary supplement called Daflon.[1] Diosmin is not approved as a prescription drug in the United States,[1] although it is available as over-the-counter or prescription-only drug in Europe sold under name Detralex[14] among others. Phlebotonics are not approved in Germany, and are restricted in Spain only for the treatment of chronic venous diseases.[15]

See also

Notes and References

  1. Web site: Diosmin . Drugs.com . 7 November 2019 . 1 January 2019.
  2. Martinez-Zapata MJ, Vernooij RW, Simancas-Racines D, Uriona Tuma SM, Stein AT, Moreno Carriles RM, Vargas E, Bonfill Cosp X . 6 . Phlebotonics for venous insufficiency . The Cochrane Database of Systematic Reviews . 2020 . 11 . CD003229 . November 2020 . 33141449 . 8094625 . 10.1002/14651858.CD003229.pub4 .
  3. Perera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, Ukaegbu O, van Issum C . 6 . Phlebotonics for haemorrhoids . The Cochrane Database of Systematic Reviews . 8 . CD004322 . August 2012 . 22895941 . 10.1002/14651858.CD004322.pub3 . 28445593 .
  4. Bush R, Comerota A, Meissner M, Raffetto JD, Hahn SR, Freeman K . 24389276 . Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF) . Phlebology . 32 . 1_suppl . 3–19 . April 2017 . 28211296 . 10.1177/0268355517692221 . Professional society guidelines . Only recently has a standardized formulation MPFF been available in the United States (Vasculera—Primus Pharmaceuticals, Inc.). .
  5. Stücker M, Debus ES, Hoffmann J, Jünger M, Kröger K, Mumme A, Ramelet AA, Rabe E . 6 . Consensus statement on the symptom-based treatment of chronic venous diseases . Journal of the German Society of Dermatology . 14 . 6 . 575–83 . June 2016 . 27240062 . 10.1111/ddg.13006 . Professional society guidelines . free .
  6. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR . 4198610 . The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids . Diseases of the Colon and Rectum . 61 . 3 . 284–292 . March 2018 . 29420423 . 10.1097/DCR.0000000000001030 . Professional society guidelines .
  7. Higuero T, Abramowitz L, Castinel A, Fathallah N, Hemery P, Laclotte Duhoux C, Pigot F, Pillant-Le Moult H, Senéjoux A, Siproudhis L, Staumont G, Suduca JM, Vinson-Bonnet B . 6 . Guidelines for the treatment of hemorrhoids (short report) . Journal of Visceral Surgery . 153 . 3 . 213–8 . June 2016 . 27209079 . 10.1016/j.jviscsurg.2016.03.004 . Professional society guidelines . free .
  8. Higuero T . Treatment of hemorroïdal disease: new french guidelines . La Revue du Praticien . 67 . 10 . 1059–1062 . December 2017 . 30512599 . fr .
  9. Agarwal N, Singh K, Sheikh P, Mittal K, Mathai V, Kumar A . Executive Summary - The Association of Colon & Rectal Surgeons of India (ACRSI) Practice Guidelines for the Management of Haemorrhoids-2016 . The Indian Journal of Surgery . 79 . 1 . 58–61 . February 2017 . 28331268 . 5346092 . 10.1007/s12262-016-1578-7 . Professional society guidelines .
  10. Salgueiro P, Caetano AC, Oliveira AM, Rosa B, Mascarenhas-Saraiva M, Ministro P, Amaro P, Godinho R, Coelho R, Gaio R, Fernandes S . 6 . Portuguese Society of Gastroenterology Consensus on the Diagnosis and Management of Hemorrhoidal Disease . GE - Portuguese Journal of Gastroenterology . 27 . 2 . 90–102 . 10.1159/000502260 . Professional society guidelines. 2020 . 32266306 . 7113592 . free .
  11. Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C . 30827065 . 6 . Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement . Techniques in Coloproctology . 19 . 10 . 567–75 . October 2015 . 26403234 . 10.1007/s10151-015-1371-9 . 10447/208054 . free .
  12. New Dietary Ingredients in Dietary Supplements, U. S. Food and Drug Administration Center for Food Safety and Applied Nutrition Office of Nutritional Products, Labeling, and Dietary Supplements February 2001 (Updated September 10, 2001) https://www.fda.gov/Food/DietarySupplements/ucm109764.htm, Memorandum https://www.fda.gov/ohrms/dockets/dockets/95s0316/rpt0083_01.pdf
  13. Book: Garg N, Gloviczki P . 55 - Chronic Venous Insufficiency . Vascular Medicine: A Companion to Braunwald's Heart Disease . 2013 . Elsevier Health Sciences . 9781437729306 . 652–666 . 10.1016/B978-1-4377-2930-6.00055-0 . Second .
  14. Web site: Detralex . Štátny ústav pre kontrolu liečiv . 1 April 2024.
  15. Web site: Consolidated List of Products - Whose Consumption and/or Sale Have Been Banned, Withdrawn, Severely Restricted or Not Approved by Governments, Twelfth Issue - Pharmaceuticals. United Nations - New York, 2005 . https://web.archive.org/web/20141108234228/http://apps.who.int/medicinedocs/en/m/abstract/Js16780e/ . dead . November 8, 2014 . apps.who.int . 7 November 2019 . 2005.

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