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Polidocanol
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Sixteen patients with positive patch test reactions to polidocanol were observed in Germany. The majority suffered from chronic dermatitis and had further contact sensitizations to antibiotics and to vehicle constituents. The clinical relevance of positive reactions to polidocanol remained unclear in many cases. A positive reaction was reproduced in only two of six patients at a follow-up examination (2).
The VANISH-2 Study: A Randomized, Blinded, Multicenter Study to Evaluate the Efficacy and Safety of Polidocanol Endovenous Microfoam 0.5% and 1.0% Compared with Placebo for the Treatment of Saphenofemoral Junction Incompetence
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Study Impact The VANISH-2 trial was a pivotal phase 3 study which helped gain Food and Drug Administration (FDA) approval for Varithena® (Smith and Nephew, Andover, MA, USA). This trial demonstrated an excellent safety profile for this novel, commercially manufactured chemical formulation for polidocanol for treating larger superficial varicose veins. Prior to the availability of Varithena, endovenous liquid sclerosants (i.e., polidocanol, sodium tetradecyl sulfate, etc.) were mixed with room air using the Tessari method.2 This is commonly referred to as “physician compounded foam” (PCF) and served to treat a larger luminal surface area for varicose veins. FDA-approved usage of polidocanol is limited to spider and reticular veins, thus PCF sclerotherapy of larger varicose veins (≥3 mm) is not a formally approved indication. This method results in sclerosant foam with inconsistent bubble size and high nitrogen content. Transient ischemic symptoms and stroke have been reported following administration of physician compounded foam sclerotherapy likely due to patients with patent foramen ovale.3 The incidence of patent foramen ovale in the general population has been reported as high as 26%–59%.4,5 The commercial processing of Varithena results in a 1% polidocanol foam with a 65:35 O2 to CO2 ratio with a nitrogen content less than 0.8%. The more rapidly absorbed bubbles in Varithena result in less risk of clinically significant systemic embolization and this was demonstrated by Regan and Gibson in a recent study.6
Palliation of malignant lower gastrointestinal disease
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Another reported option is injection of polidocanol. This is a sclerosing rather than a necrosing agent, and so it is not clear why its injection leads to debulking, though this effect has been described. In five patients with inoperable rectal cancers causing bowel obstruction and treated with intratumoral injection of polidocanol, the obstruction was relieved in all cases, with no major complications [27].
Is aspiration and sclerotherapy treatment for hydroceles in the aging male an evidence-based treatment?
Published in The Aging Male, 2019
W. St. J. Taylor, J. Cobley, W. Mahmalji
Polidocanol is used as a sclerosant for varicose veins. Lund et al. [19] performed a double blind, randomised controlled trial comparing polidocanol to placebo. Polidocanol was injected, 1 ml for hydrocele less than 100 ml, 2 ml for hydrocele 200–400 ml, 4 ml for hydrocele greater than 400 ml. This was then massaged into the scrotum. Recurrence was seen in 44% of patients compared to 78% in just the aspiration alone group. This result was statistically significant. Cure rates after multiple aspirations and injections were 89%. There were no significant complications. It is worth noting that in this study nine of 41 (21.9%) were cured after aspiration and placebo injection. This finding is comparable with the Agrawal study [18]. The cure rates of phenol were better than polidocanol.
Current pharmacological approaches to the treatment of tendinopathy
Published in Expert Opinion on Pharmacotherapy, 2020
Rocco Aicale, Rocco Domenico Bisaccia, Antonio Oliviero, Francesco Oliva, Nicola Maffulli
Sclerosing agents that selectively targets the abnormal neovascularity may cause thrombosis of the vessels destroying the local neonerves, implicated in pain generation and adjacent to the neovessels, and may decrease pain [75], and induce fibroblast proliferation and synthesis of collagen, producing a stronger and more organized tendon [125]. Early reports of polidocanol injected under Doppler US guidance demonstrated significant improvements in pain and function [126,127]. However, as conflicting results have been published, high-quality evidence to formulate a recommendation for sclerosing injections is needed. A double-blind RCT showed the potential benefits of polidocanol injection on chronic AT, reporting an improvement in VAS scale and patient satisfaction when compared to anesthetic substances injection [128,129]. The same research group performed a further trial testing whether a higher concentration of polidocanol (10 mg/ml) produced better results with a lesser number of injections; at the final evaluation at 14 months, no significant differences regarding patient’s satisfaction between the two groups were found [126]. Another study from an independent center did not confirm the high beneficial value of sclerosing neovascularization in a cohort of 113 patients with midportion Achilles tendinopathy treated with sclerosing ethoxysclerol (i.e. polidocanol) injections [130]. Two studies, conducted by the same author, using polidocanol sclerotherapy injection for the management of PT reported modest improvements in VISA scores after 12 and 24 months’ follow-up, with the administration of up to five US-guided polidocanol injections [131,132]. The use of sclerosis agents, such as polidocanol, injected under US guidance, has been widely promoted both in Achilles and Patellar tendinopathy. However, independent studies have shown less favorable results [131], and its use remains questionable.
Safety considerations when using drugs to treat pruritus
Published in Expert Opinion on Drug Safety, 2020
Kayla Fourzali, Gil Yosipovitch
Polidocanol is used medically as a sclerosing agent and has anesthetic and antipruritic properties. In an observational study of patients with AD, psoriasis, and pruritus, resolution of itching and signs of xerosis were noted in nearly half of patients by the end of 2 weeks [30]. The clinical data for its use as a topical anti-pruritic suggest that topical polidocanol is generally well tolerated with reports of minor irritation associated with application in a small percentage of patients [30,31].