Diosmin is a dietary supplement used to aid treatment ofhemorrhoids and venous diseases, i.e.,chronic venous insufficiency including spider and varicose veins, leg swelling (edema),stasis dermatitis andvenous ulcers.[1] The mechanism of action of Diosmin and other phlebotonics is undefined,[1] andclinical evidence of benefit is limited.[1] Diosmin is not recommended for treating therectal mucosa, skin irritations, or wounds, and should not be used to treatdermatitis,eczema, orurticaria.[1] Diosmin is not recommended for use in children or women duringpregnancy.[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 treatinghemorrhoids.[1][3]
In 2017, the American Working Group in Chronic Venous Disease recommended use of micronized purified flavonoid fraction (diosmiplex) as amedical food for chronic venous disease symptoms andvenous ulcers, having "beneficial outcomes without serious adverse events", alone or combined withcompression therapy, concurring with the previous guidance of the International European Society for Vascular Surgery.[4] TheGerman Dermatological Society indicated that Diosmin may be used with other treatments for symptoms ofchronic venous diseases.[5]
TheAmerican 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.[3][6] French,[7][8] Indian,[9] Portuguese,[10] and Italian[11] professional societies ofcoloproctology issued similar recommendations regarding phlebotonics for hemorrhoids.
In some 10% of users, diosmin causes mildgastrointestinal disorders or skin irritations (hives, itching), stomach pain, nausea, heartarrhythmias, oranemia.[1] Preliminary research indicates no evidence oftoxicity.[1] The USFood and Drug Administration (FDA) concluded in 2001 that there was inadequate evidence on which to base an expectation of safety.[12] As of 2013[update], the FDA did not revise this position.[13]
Diosmin is distributed in the U.S. as a dietary supplement calledDaflon.[1] Diosmin is not approved as aprescription 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,[5] and are restricted in Spain only for the treatment of chronic venous diseases.[15]
^Bush R, Comerota A, Meissner M, Raffetto JD, Hahn SR, Freeman K (April 2017). "Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF)".Phlebology (Professional society guidelines).32 (1_suppl):3–19.doi:10.1177/0268355517692221.PMID28211296.S2CID24389276.Only recently has a standardized formulation MPFF been available in the United States (Vasculera—Primus Pharmaceuticals, Inc.).
^Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR (March 2018). "The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids".Diseases of the Colon and Rectum (Professional society guidelines).61 (3):284–292.doi:10.1097/DCR.0000000000001030.PMID29420423.S2CID4198610.
^Higuero T (December 2017). "Treatment of hemorroïdal disease: new french guidelines".La Revue du Praticien (in French).67 (10):1059–1062.PMID30512599.
^Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, et al. (October 2015). "Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement".Techniques in Coloproctology.19 (10):567–75.doi:10.1007/s10151-015-1371-9.hdl:10447/208054.PMID26403234.S2CID30827065.
^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)[1], Memorandum[2]
^Garg N, Gloviczki P (2013). "55 - Chronic Venous Insufficiency".Vascular Medicine: A Companion to Braunwald's Heart Disease (Second ed.). Elsevier Health Sciences. pp. 652–666.doi:10.1016/B978-1-4377-2930-6.00055-0.ISBN9781437729306.
^"Detralex". Štátny ústav pre kontrolu liečiv. Retrieved1 April 2024.
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