Drug treatment of varicose veins, venous edema, and ulcers
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
This combination of flavonoid drugs has been used to manage the symptoms of chronic venous disease, including edema of the lower limbs, for many years. The use of this application has been summarized above. More recently, a number of clinical trials has been completed in which one flavonoid drug was used to treat patients with venous leg ulcers. Micronized purified flavonoid fraction (MPFF; Daflon 500 mg®, Servier, Gidy, France), which consists of 90% Diosmin and 10% flavonoids expressed as Hesperidin, has been shown to protect the microcirculation from damage secondary to raised ambulatory venous pressure.38 It decreases the interaction between leukocytes and endothelial cells by inhibiting expression of endothelial intercellular adhesion molecule 1 and vascular cell adhesion molecule, as well as the surface expression of some leukocyte adhesion molecules (monocyte or neutrophil CD62L and CD11B).39 There are few known side effects, and interactions with other drugs have not been reported.38
Pharmacology for venous and lymphatic diseases
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland in Manual of Venous and Lymphatic Diseases, 2017
Daflon or micronized purified flavonoid fraction (MPFF 90% diosmine and 10% other flavonoids expressed as hesperidin) is indicated for symptom relief and may also have possible benefit for healing ulcers. It acts to decrease leukocyte activation by inhibiting expression of endothelial intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule (VCAM), as well as surface expression of some leucocyte adhesion molecules. It affects platelet function, inhibits noradrenaline degradation and enhances lymphatic peristalsis to increase lymph flow.
Role of Medicinal Plants in the Treatment of Hemorrhoids
Megh R. Goyal, Preeti Birwal, Durgesh Nandini Chauhan in Herbs, Spices, and Medicinal Plants for Human Gastrointestinal Disorders, 2023
The major phytochemicals in Cissus quadrangularis are flavonoids. Bioflavonoids have been shown to exhibit phelotonic, vasculoprotective, and anti-inflammatory activities. Luteolin and ß-sitosterol from the crude extract of C. quadrangularis have been shown to produce its anti-inflammatorry effect. The venotonic effect of C. quadrangularis has been postulated to be due to the flavonoids present in its crude extract, which act in the same way as that of diosmin and hesperidin (found in Daflon).53
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
Lifestyle modifications (same as above).Avoiding constipation.Using MPFF (e.g., Daflon 500 mg) to decrease pain and recurrence.Using combined analgesia for 5 days of paracetamol, non-steroidal anti-inflammatory drugs, and opioids.Using laxatives to ensure a soft and regular bowel movement.Post-operative rehabilitation for wound healing and improving the quality of life of patients with defecation problems [25], starting with patient reeducation on muscular synergy (chest, abdomen, vertebral column, and perineum) [26].
Results of purified micronized flavonoid fraction in the treatment of categorized type III chronic pelvic pain syndrome: a randomized controlled trial
Published in The Aging Male, 2020
Aytac Sahin, Musab Ali Kutluhan, Caglar Yildirim, Ahmet Urkmez, Serkan Akan, Ayhan Verit
On the other hand, it is known that only the use of alpha-blockers, antibiotics, and anti-inflammatory drugs are highlighted in the European Association of Urology guidelines [25]. Similarly, in our study, the group receiving antibiotic + anti-inflammatory + alpha-blocker responded to treatment better than that receiving daflon treatment alone.
Evaluation of MTBH, a novel hesperetin derivative, on the activity of hepatic cytochrome P450 isoform in vitro and in vivo using a cocktail method by HPLC-MS/MS
Published in Xenobiotica, 2021
Yan Qin, Haijun Dong, Jiayin Sun, Yilong Zhang, Jun Li, Tianci Zhang, Guanjun Chen, Sheng Wang, Shuai Song, Wei Wang, Yuru Fan, Jie Wang, Xiaohui Huang, Chenlin Shen
Flavonoids are a class of plant polyphenols that confer a colourful appearance to flowers and fruits and protect them from the excess of solar ultraviolet (UV) radiation and against herbivores (Jaeger et al. 2018; Xu et al. 2020a). They are consumed in the human diet via fruits, grains, vegetables, herbs, and other plant-based products (Slamova et al. 2018). Hesperetin is a natural flavanone from the Citrus species that exhibit various biological properties, including antioxidant, anti-inflammatory, and anticancer activities. Various food supplements and Chinese herbal preparations containing flavonoids are becoming increasingly popular among the general population (Perez-Vizcaino and Fraga 2018). For example, daflon 500 mg, is a purified, micronized flavonoid fraction containing 450 mg diosmin and 50 mg hesperetin, which is currently used to treat chronic venous insufficiency and haemorrhoidal disease (Carballo-Villalobos et al. 2016; Ferraz et al. 2020). Owing to the wide consumption of flavonoids in daily life, the potential for food/herb-drug interactions has generated concerns. Therefore, to investigate the safety and effectiveness of co-administration of herb and drugs are urgently needed. The underlying mechanisms of drug interactions include: inhibition or induction of drug transporters or P-glycoprotein, alters the absorption, distribution, or excretion of the drug, and alters drug metabolism mediated by cytochrome P450 isoforms (CYP450s) (Volkova et al. 2013; Brantley et al. 2014; Chinni et al. 2014). Inhibition or induction of CYP450s by herbs or drugs can alter the pharmacokinetics of other therapeutic agents. A well-documented example of drug–drug interactions (DDI) involves flavonoids diosmin, which inhibited CYP2C9 enzymes. It is reported that oral administration of diosmin at 500 mg/d for 9 continuous days in healthy subjects altered the disposition kinetic behaviour of diclofenac (Rajnarayana et al. 2007), remarkably increased the area under the curve (AUC0–t) and half-life (t1/2) of diclofenac and decreased the drug’s oral clearance (CL).