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Pharmacological Treatment of Lymph Stasis
Published in Waldemar L. Olszewski, Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
A number of important experimental trials are in progress, one of which is an investigation of the substance calcium dobesilate which has many properties similar to the benzopyrones. Casley-Smith and Casley-Smith56 have shown it to reduce acute lymphedema while Piller57 showed it to increase thoracic duct flow of lymph both in mobile and anesthetized animals. This is of particular importance in the survival of tissues during ischemic assault.
Drug treatment of varicose veins, venous edema, and ulcers
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
In some countries drugs are widely prescribed, but in others few drugs are used in the treatment of varicose veins. A range of phlebotonic drugs is used (Table 32.1). The origin of these is from plants or synthetic sources. Little new evidence regarding the efficacy of these drugs on symptoms arising from varicose veins has been published in recent years. A Cochrane review of the efficacy of these drugs was published in 20051 and has not been updated subsequently. In all, 110 studies were considered for inclusion in the analysis; however, valid methodology and data were only present in 44 studies, covering a range of commonly prescribed drugs. The scope of this review included the following flavonoids: rutoside, French maritime pine bark extract, grape seed extract, Diosmin and Hesperidin, disodium flavonate, and the saponside centella asiatica. The synthetic products included were calcium dobesilate, fantazone, aminaftone, and chromocarbe. The overall findings were that there appeared to be an effect on edema, but amongst the symptoms mentioned above, only restless legs were moderated. For the more frequently prescribed drugs, the following effects were observed: calcium dobesilate reduced cramps and restless legs; Diosmin and Hesperidin benefitted trophic disorders as well as cramps and swelling; and rutosides were found to benefit edema. On the basis of their review, the authors concluded that there is insufficient evidence to support the global use of phlebotonics in the management of the signs and symptoms described above. Fortunately, few side effects of this treatment have been reported.
Investigation of therapeutic effects of calcium dobesilate in cerebral hypoxia/ reperfusion injury in rats
Published in Neurological Research, 2023
Alemiddin Ozdemir, Mustafa Ogden, Bahar Kartal, Asli Fahriye Ceylan, Ulas Yuksel, Bulent Bakar
Calcium dobesilate is a synthetic pharmacological agent used in the treatment of chronic venous stasis, and hemorrhoidal diseases due to its vasoprotective and antioxidant properties [2–4]. These properties are revealed through the following mechanisms: it decreases blood viscosity by reducing fibrinogen concentration and platelet aggregation via nitric oxide synthase. It reduces capillary hyperpermeability by selectively increasing resistance, inhibits the effect of vasoactive substances, and corrects the impaired collagen biosynthesis of the basal membrane. In addition, it reduces the release of some cytokines (such as histamine, serotonin, bradykinin, hyaluronidase, and prostaglandins) and free oxygen radicals that activate endothelial damage and lipid peroxidation [5–8]. In many studies, it has been suggested that calcium dobesilate can be used to improve the devastating effects of ischemia/reperfusion injury in various organs such as the heart, lungs, and intestines [9–11]. However, despite the vasoprotective and antioxidant properties, no study in the literature has investigated the possible therapeutic effects of calcium dobesilate on cerebral stroke.
Deletion of discoidin domain receptor 2 attenuates renal interstitial fibrosis in a murine unilateral ureteral obstruction model
Published in Renal Failure, 2019
Xi’an Li, Xin Bu, Fei Yan, Fuli Wang, Di Wei, Jiarui Yuan, Wanxiang Zheng, Jin Su, Jianlin Yuan
There is no ideal drug for the treatment of renal interstitial fibrosis. Takahiro Uchida et al. showed that the various protective effects of dipeptidyl peptidase 4 inhibition in nondiabetic mice with UUO [26]. Jin Liang et al. suggest that resveratrol treatment inhibits oxidative stress, Smad3 acetylation, and renal interstitial fibrosis [27]. And Cui Zhang et al. showed that resveratrol can reduce the expression of eIF2a and ATF4 protein and subsequently prevents the excessive apoptosis of renal tubular epithelial cells and delays the renal fibrosis development [28]. Calcium dobesilate can reduce the permeability of capillary, inhibit platelet aggregation, and reduce the blood viscosity. Calcium dobesilate is mainly used in treatment of microvascular disease in clinical, which is widely used in varicose veins, diabetic retinopathy, diabetic nephropathy and other disease treatment. Our research shows that Calcium dobesilate can affect the expression of DDR2 and improve the renal interstitial fibrosis in mice. which provides a theoretical basis for delaying the progression of renal interstitial fibrosis. However, the mechanism is not clear. Our ongoing research is focusing on the regulative mechanism of calcium dobesilate.
Recommendations and best practice on the management of hemorrhoidal disease in Saudi Arabia
Published in Hospital Practice, 2022
Mohamed Zaki El-Kelani, Raouf Kerdahi, Samir Raghib, Mohamed Ashraf Shawkat, Naser Abdelnazer, Ishag Mudawi, Magdy Mahmoud, Wassim Abi Hussein, Mohamed Tawfik, Waleed Wahdan
Topical preparations such as creams, ointments and suppositories should be limited as the published literature lacks strong evidence supporting the true efficacy of topical treatment for symptomatic hemorrhoidal disease.For an oral preparation, micronized purified flavonoid fraction (MPFF) are the most common phlebotonic agent used for treating non-complicated Grade I and II hemorrhoidal disease. MPFF has proven to improve venous tone, reduce capillary fragility, decrease capillary permeability, facilitate lymphatic drainage, and has anti‐inflammatory effects. In the Cochrane review of 24 randomized controlled trials enrolling a total of 2,334 participants, phlebotonics particularly MPFF demonstrated a statistically significant beneficial effect for the outcomes of pruritus, bleeding, discharge and leakage and overall symptom improvement [16].MPFF also serves as an effective adjuvant to surgery and other procedures (during the pre- and post-operative periods).Flavonoids should be considered during the referral period from GPs to specialist especially in public hospitals, which might be for one month.Other existing venoactive drugs like calcium dobesilate, heparan sulfate, Euphorbia prostrata, and ginkgo biloba have a low level of evidence in the management of hemorrhoidal disease. Calcium dobesilate has been associated with an increased risk of agranulocytosis [16].Stool softeners must be used [17–19].