*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

Widely known varicose disease is one of the forms of chronic venous insufficiency. In common parlance, it is called varicose veins, and phlebologists, or vascular surgeons, call it chronic venous insufficiency of the lower extremities. If back in Soviet times this disease was considered the suffering of the elderly, then in the first third of the XNUMXst century this pathology has become much younger, both in large cities and among the rural population.

And if in large cities the increase in the incidence is associated with a decrease in physical activity, physical inactivity, a sedentary lifestyle, and malnutrition, then in the villages the main role is played by the lack of specialized medical care, the low availability of ultrasound of the veins of the lower extremities and the consultation of a vascular surgeon. Bad habits and hard physical labor complete the unfavorable picture. What is chronic venous insufficiency of the lower extremities, and what is it associated with?

What are varicose veins and who suffers from them?

Man is the only living creature on the planet, the main mode of movement of which is upright walking on two legs, while maintaining the vertical position of the lower limbs. In particular, kangaroos also move on two legs, but at the same time, their hips and lower legs are located in a completely different way, and are not extended vertically in length.

If a person lived and swam in the sea, like his closest relatives – marine mammals, whales and dolphins, or like Ichthyander, then the issue of varicose veins would be removed. After all, the body would be located horizontally, and venous blood would not have to return to the right heart, overcoming a significant force of gravity. Therefore, human diseases associated with upright posture, or retribution for civilization and evolution, are osteochondrosis, or problems with intervertebral discs, and varicose veins, or problems with venous valves.

In the veins of the lower extremities there are valves that prevent the backflow of blood downwards, and muscles that, by their contraction, facilitate the passage of blood higher and higher. But in addition to the main vessels, there are also saphenous veins, and the so-called perforators, that is, mediator veins between the saphenous and deep venous vessels.

The expansion of these veins is associated with the degradation of smooth muscles and elastic fibers of the vascular wall. As a result, venous valve insufficiency develops. As a result, their valves stop closing, and a condition such as reflux occurs. This is the name of the reverse throwing of something, in this case, venous blood to where it is not needed.

For example, venous blood, instead of rushing up, begins to move in a horizontal direction, according to the principle “where it’s easier, it flows there.” This is due to the pathology of perforating vessels. Blood can rush back down, and this is the so-called vertical reflux. It is both superficial and deep. Both in that, and in another, and in the third case, characteristic complaints arise, and this condition and subsequent complications can be prevented by knowing about the risk factors. What are these risk factors, and what will a patient with varicose veins of the lower extremities complain about?

Risk factors and complaints

Withdrawal, we have already named some of the producing risk factors: this is the lack of physical activity, physical inactivity, or a sedentary, office lifestyle and work. These are malnutrition and bad habits, primarily smoking. If alcohol destroys the nervous system and liver, then nicotine mainly negatively affects the blood vessels. But there are other risk factors as well. These include:

1. standing work, which is perhaps no less harmful than prolonged sitting in one place;

2. the inability to change the way of activity during the day, moving from rest to activity;

3. on the contrary, overactive and excessive physical activity, for example, light and weightlifting without rest;

4. transfer of various weights and loads;

5. congenital, hereditary forms of weakening the tone of the vascular wall, which are less common;

6. various acquired vascular injuries, for example, due to numerous bites of poisonous snakes, smoking a large number of cigarettes;

7. The causes of varicose veins can be disorders of blood clotting, changes in its biological qualities, or fluidity, a decrease in oncotic pressure due to a drop in protein in the blood.

In addition, there is a physiological predisposition of the female to the development of varicose veins. This is due to an imbalance of sex hormones: an excess of estrogen and a deficiency of progesterone. What are the typical symptoms of varicose veins?

Symptoms and signs

Allocate early and late signs of chronic venous insufficiency. Early signs are considered to be those in which there are still no visible changes on examination. This is a feeling of fullness, heaviness in the legs, especially in the evening, paresthesia, a feeling of numbness, tingling, burning, a feeling of “crawling” after a long load. Night cramps are considered a characteristic harbinger of the progression of the disease. With their help, the body tries to at least somehow improve blood flow in the lower extremities, and eliminate stagnation, even in a painful way. There is a feeling of constant fatigue in the legs. These are complaints, but upon examination, the patient may be all right. In any case, the surgeon has not yet observed visible changes.

Then begins the period of visible changes, or extended stage. There is excessive swelling in the ankles and legs, on the back of the foot. This indicates congestion, sweating of the liquid part of the blood, or plasma through the altered vascular wall in the tissue. Then telangiectasias, or spider veins, appear, and veins begin to appear on the legs in the form of knots and tortuous strands under the surface of the skin.

Then trophic disturbances appear. This is varicose dermatitis, hyperpigmentation and dry skin on the legs. As a result, the skin becomes thinner and, eventually, advanced complications develop. These are trophic ulcers, eczema, thrombophlebitis, which leads to septic complications, disability, and even pulmonary embolism, which very quickly leads to death. How to avoid the advanced stages of varicose veins, and what are the types and methods of its treatment?

Treatment of varicose veins

One of the simplest, most effective and inexpensive ways to treat venous insufficiency of the lower extremities can be considered compression therapy, or the use of elastic bandages (special medical knitwear). Tightly fitting the leg, it narrows the lumen in the superficial veins, and makes it difficult to reflux. In addition, the use of therapeutic knitwear significantly reduces the risk of venous thrombosis, especially after various surgical interventions. The use of compression underwear significantly improves the quality of life, reduces pain, relieves the feeling of heaviness in the legs.

There are several classes of compression garments, of which only #0, or the weakest in compression, can be used for prevention. Therapeutic types of underwear are prescribed by a phlebologist surgeon, and a special device is needed to put it on correctly. Compression underwear requires a certain mode of wearing and removing, but this is not the topic of the article.

Surgical treatment is mainly used in the advanced stages of the disease, but sometimes at the stage of advanced clinical signs as a means of preventing complications. This is the removal of superficial veins, sclerotherapy, when the lumen of the vein is “brewed” with the help of special preparations, and it stops absorbing blood. It is also possible to use laser “gluing” of the vein with the help of endovascular laser correction (ELK).

But still, the use of special drugs, or venotonics, is considered a conservative basis for the treatment of varicose veins. If you combine the use of these drugs with the observance of the rules of a healthy lifestyle, gymnastics, proper nutrition, giving up bad habits and wearing preventive compression underwear, then it is quite possible to get rid of varicose veins and prevent its progression in the initial stages.

The mechanism of action of venotonics

How do venotonics, or phlebotonics, work? They are a means of pathogenetic therapy, and affect not only the veins of the lower extremities, but also the vessels of the whole organism, when it comes to drugs that are taken orally. These are the so-called systemic phlebotonics. There are also local medicines that are applied to the skin of the legs in the form of ointments, gels and creams. They also affect the venous outflow, but only locally.

The main effect of these drugs is an increase in the muscle tone of the vascular wall, a decrease in the manifestation of reflux, and an improvement in valve function. The second effect of systemic venotonics is the capillary-protective effect, or the effect on microcirculation. This effect is a consequence of the first action. After it was possible to improve the venous outflow and lymphatic drainage, the condition of small capillaries and venules is also facilitated. The third effect is the effect on the rheological properties of blood and lymph, improving their viscosity and fluidity. Hemoconcentration, thickening of the blood, the tendency to thrombosis worsens the course of varicose veins, since the resistance in the vessels to the advancement of such blood will be higher than the more liquid one.

Venotonics, according to their classification, are in the middle between artificially created substances and food additives. The fact is that plant components, bioflavonoids, most actively affect the vessels. These are diosmin, rutin, quercetin, red grape and horse chestnut extract, and other means. They can be used for treatment as drugs in the form of monotherapy, and combined, the purpose of which is to enhance the effects of bioflavonoids, for example, using their combination and the addition of vitamins and antiplatelet agents.

In the advanced stage of varicose veins, it is advisable to combine venotonics with anti-inflammatory drugs from the NSAID group when there are symptoms of varicose dermatitis or phlebitis. Local preparations based on heparin are very popular, the task of which is to reduce blood viscosity and prevent thrombosis.

Rating of the best venotonics

This drug review includes the most effective and popular phlebotonics. They are used worldwide for the treatment of chronic venous insufficiency of the lower extremities. It was decided to “dilute” them with some drugs for surgical treatment, namely, sclerosing agents, which, although they do not belong to venotonics, are widely used in conjunction with minor surgery methods.

First, the INN, or international non-proprietary name, is given, and then a list of drugs that are commercial analogues and contain precisely these active ingredients. As a rule, the first of these will be a drug from one of the world’s leading pharmaceutical companies, a highly purified and effective remedy. Further, other generics are listed, and the range of prices relevant for May 2020 for pharmacies of all forms of ownership in the Russian Federation is given. The inclusion of drugs in the list is dictated by national recommendations, and does not provide for any advertising or anti-advertising purposes.

Diosmin (Flebodia 600, Vasoket, Venolek)

Rating: 4.9

Diosmin is considered one of the most effective bioflavonoids, and Phlebodia 600 can be considered its characteristic medicinal representative. The name is clear: each capsule contains 600 mg of the active substance diosmin. There are 30 capsules in a package, the drug is produced by the French company Innotera and you can buy it at retail at prices from 980 to 1150 rubles. It is an active angioprotector, stabilizes capillary blood flow, and has an anti-inflammatory effect. The medicine is shown as part of complex therapy for the treatment of varicose veins on the legs, in the symptomatic treatment of acute hemorrhoids. It is necessary to apply diosmin one tablet a day in the morning on an empty stomach, the usual course is 2 months for varicose veins. In the case of hemorrhoids, drugs are used in a larger dosage, 2-3 tablets per day with meals for a week.

Advantages and disadvantages

Despite the fact that the drug diosmin is a natural compound, the drug is contraindicated for pregnant women in the first trimester, in childhood up to the age of eighteen, and during lactation due to lack of data. In rare cases, there is a side effect associated with heartburn, abdominal pain and headache. But at the same time, diosmin and hesperidin, which will be described below, are considered one of the most effective venotonics in terms of the strength of the three therapeutic effects.

Escin (Venoplant, Venitan, Aescusan)

Rating: 4.8

Escin i Venoplant is the next highly active bioflavonoid that is extracted from horse chestnut. Venoplant and Aescusan reduce capillary permeability, tone up the venous wall, fight edema, and have an anti-inflammatory and vascular protective effect. Escin reduces fragility and fragility of capillaries. As a result, the accumulation of fluid in the tissues of the lower extremities decreases, and if edema has already arisen, then against the background of the use of the drug it resolves faster, both by improving blood circulation and by improving lymph flow.

Aescin and its derivatives, such as Venoplant, are indicated for varicose veins, edema, cramps in the calf muscles and a feeling of heaviness in the legs. You need to use the medicine one tablet twice a day in the morning and in the evening on an empty stomach. The duration of the course should not exceed 4 months. Venoplant is produced by the German company Wilmar Schwabe, and a package of 20 tablets will retail for an average of 500 rubles.

Advantages and disadvantages

The big plus of escin will be high activity, but the minuses will be “continuations of the plus”. Venoplant and its analogues enhance the effect of indirect anticoagulants, such as warfarin, and therefore are not recommended for combined use. Side effects include allergic reactions, urticaria and a feeling of heat, nausea and dizziness. There are also contraindications: childhood and adolescence, pregnancy and lactation, but again, as a result of an elementary lack of research on this topic.

Diosmin + hesperedin (Detralex, Angiorus, Venarus, Venolife duo, Detravenol, Diovenges, Flebaven)

Rating: 4.8

What happens when you combine two highly active bioflavonoids, diosmin and hesperidin? One of the most powerful and active drugs for the treatment of chronic venous insufficiency, which is called Detralex, will appear. It is available in tablets, one g, 30 pieces per pack. It is produced by the well-known French company Servier, the cost of one package (monthly rate) ranges from 1250 to 1450 rubles. In addition, the medicine can be bought in the form of a suspension for oral administration. The same gram will already be packaged in 10 ml of suspension (single dose). There are exactly 30 such doses in the package, which is the same course for a month. The cost of the suspension is somewhat more expensive: from 1400 to 1650 rubles, the suspension is also produced by Servier.

The main ingredient will be a highly purified fraction of flavonoids, in terms of hesperidin. The medicine belongs to venotonics, reduces the extensibility of the venous wall, increases the resistance of capillaries. Detralex has clinical studies that have shown its high effectiveness on the influence of clinically significant venous parameters: venous capacity, compliance and emptying time.

The indications of the drug are the same, namely: symptoms of varicose veins, cramps, heaviness and pain in the legs, swelling and fatigue of the legs. The medicine is also used to treat manifestations of venous lymphatic insufficiency, symptomatic therapy of hemorrhoids and in the complex treatment of venous trophic ulcers. It is necessary to take the drug one tablet, or 10 ml per day of the suspension, washed down with water. It is this dosage that is considered optimal for treatment. The duration of treatment is quite long, up to 1 year, but only on the recommendation of a doctor.

Advantages and disadvantages

Detralex is a highly active combined drug, and has side effects, especially at high doses in the treatment of hemorrhoids, when several tablets must be taken per day. Most often it is nausea, diarrhea and abdominal discomfort. Rarely, a rash or itching occurs. The medicine is contraindicated for lactating and pregnant women, and in treatment it is desirable to combine the use of Detralex with a healthy lifestyle and wearing compression underwear. This mention exists in the official instructions, but this is a natural recommendation that is not even discussed.

Dihydroergocristin + esculin + rutoside (Anavenol)

Rating: 4.7

Anavenol is already a triple composition, while dihydroergocriptine belongs to ergot alkaloids, and from bioflavonoids that produce a phlebotonic effect, esculin and rutoside are included. This medicine, in addition to normalizing vascular reactivity, improving microcirculation and reducing edema due to dihydroergocriptine, also has an alpha-adrenergic blocking effect. Anavenol is indicated for the treatment of various forms of chronic venous insufficiency, in the initial stages of varicose veins, in the treatment of thrombosis and post-thrombotic syndrome, trophic ulcers of the lower extremities, and in microcirculation disorders associated with injuries. How to apply the medicine? Anavenol should be used two tablets 3 times a day, during the first week, and then 1 tablet 3 times a day.

Advantages and disadvantages

Side effects are related to the number of components, and it is generally believed that the more components in the preparation, the more side effects and more. Anavenol, in addition to the effects characteristic of venotonics, also has alpha-adrenergic blocking: this is swelling of the nasal mucosa. The rest is gastrointestinal dyspepsia, skin allergies, fatigue and dizziness. You can not use the drug for symptoms of hemorrhagic syndrome and bleeding, it is not recommended during pregnancy and its use during lactation. But this remedy is considered very popular, and the only one on the list that combines the phlebotonic effect and the action of an alpha-blocker, which is important for the pathogenetic treatment of vascular disorders.

Grape leaf extract (Antistax)

Rating: 4.7

Antistax can be considered the only grape leaf preparation widely known on the domestic market. It is produced by the Swiss company Pharmaton, and a package of 50 tablets of 180 mg capsules costs from 900 to 1800 rubles in pharmacies, that is, the price range is 100% of the cost of the drug. The composition of the capsules includes a dry extract of red grape leaves, and excipients. When opened, the gelatin red-brown capsule will contain a brownish-violet, reddish powder with an aromatic odor. Grape extract has a classic capillary-protective effect, and quercetin and hydroquercetin will act as bioflavonoids here. It protects the vascular endothelium, normalizes their permeability. This means that for blood plasma containing proteins, less fluid will flow into the surrounding tissue and less edema will form.

The indications for the appointment of Antistax are classic: this is a symptomatic treatment, prevention of chronic venous insufficiency and varicose veins, all symptoms of the initial stages. It is necessary to use the medicine 2 capsules per day, but not more than 4 capsules. The average duration of the course of treatment is 3 months, a second course is prescribed by a doctor. Prevention of exacerbations is taking 2 capsules once a day for a short course of 4 weeks, 2 times a year.

Advantages and disadvantages

As in the case of other venotonics, Antistax is not recommended for use before the age of eighteen, pregnant and lactating women due to the lack of the required volume of clinical studies. Side effects included itchy rash and urticaria, epigastric discomfort including nausea, and upset stools. But all these effects were observed in less than 1% of all patients. There were no cases of overdose. It should be borne in mind that one capsule contains about 9 mg of glucose, and the maximum daily dose is 35 milligrams. This is important for patients with insulin-dependent diabetes mellitus. Thus, Antistax is a good tool for the prevention and treatment of the initial stages of varicose veins, especially together with other types of therapy.

Ascorbic acid + rutoside (Ascorutin)

Rating: 4.6

The next few representatives of drugs are rutosides. The first of them is ascorutin, which is considered the cheapest and most affordable in the nomination of venotonics. Askorutin is a combination of rutoside bioflavonoids with ascorbic acid. This is indeed a very affordable drug, a pack of 50 tablets will cost no more than 50 rubles, but it is quite possible to find it for 30 rubles, moreover, in any pharmacy. This is a domestic medicine produced by Pharmstandard at the Ufa vitamin plant. Each tablet contains equally ascorbic acid and rutin, 50 mg each.

It is believed that Askorutin eliminates increased capillary permeability and strengthens the vascular wall, so doctors prescribe it in complex therapy, primarily for frequent bruises, hematomas, and various types of bleeding as manifestations of hemorrhagic syndrome. It helps in the treatment of vitamin C vitamin deficiency. But for the treatment of varicose veins, it is indicated as part of complex therapy. You can even combine it with Detralex, Antistax, or Anavenol. In itself, the action of ascorutin is rather weak, so it is necessary to help him. Ascorutin is preferably taken one tablet two or three times a day for 2-3 weeks. For preventive purposes, 1-2 tablets per day are enough.

Advantages and disadvantages

The advantages of ascorutin are in its wide distribution and low cost, the ability to prevent vitamin C deficiency, and the disadvantages are in a rather weak effect on the vessels of the lower extremities. In addition, it should be borne in mind that it is desirable not to use the drug in case of a tendency to thrombosis, with thrombophlebitis and with increased blood clotting. Ascorutin is not taken in the first trimester of pregnancy because it contains rutin. Askorutin can be used in the second and third trimester of pregnancy, but always taking into account the minimum daily requirement of a pregnant woman for ascorbic acid – about 60 mg. It should be remembered that the fetus can get used to high doses of ascorbic acid in a pregnant woman, and after birth, the baby sometimes develops a withdrawal syndrome, therefore, without the appointment of an obstetrician-gynecologist, it is better not to take ascorbic acid on your own. During lactation, the need for ascorbic acid is even higher, from 80 mg. The drug sometimes causes side effects, such as allergic and dyspeptic effects, headache attacks. During the use of the drug, it should be borne in mind that Askorutin increases the absorption of iron, but reduces the effect of anticoagulants and heparin.

Troxevazin (Troxerutin, Phlebopress)

Rating: 4.5

Another representative of rutosides is the well-known Troxevasin, which can be produced in local form, and in capsules for oral administration. A package of 50 capsules of 300 mg, produced by Balkanpharma, will cost from 400 to 500 rubles. This is a Bulgarian medicine. Each capsule contains 300 mg of troxerutin, and this agent has the activity of vitamin P. In addition to the venotonic, angioprotective and anti-edematous effect, the drug suppresses inflammation, has an anticoagulant and antioxidant effect. The drug increases the tone of the capillaries, the vascular wall increases its density, which reduces diapedesis and edema.

Troxevasin is indicated for symptomatic varicose veins, thrombophlebitis, periphlebitis and varicose dermatitis. We should not forget about the local preparation in the form of a gel. It can be applied to the affected area and signs of varicose veins twice a day, morning and evening until completely absorbed, and even under elastic, compression underwear. It is much better if you combine taking Troxevasin capsules with the application of its own gel. Patients notice a significant improvement, on average, after a week of use.

Advantages and disadvantages

Like all rutosides, Troxevasin may have gastrointestinal side effects, and application of the gel may cause hives, eczema, or dermatitis. The gel must not be applied to damaged skin and open wounds. If, together with signs of varicose veins, there are symptoms of hemorrhagic diathesis and increased vascular permeability, then you need to combine the medicine with taking ascorbic acid. Troxevasin, when properly used in the complex treatment of varicose veins, is an active and inexpensive drug.

Rutoside (Venoruton)

Rating: 4.5

The last of the presented, but far from the last rutoside on the market, is the drug Venoruton. It can be bought at a price of 930 to 1500 rubles. That is how much a package of 50 capsules of 300 mg, produced by the famous pharmaceutical company Novartis Pharma, costs. Inside the capsules, there is either a yellow or light brown powder that does not smell of anything. These are hydroxyethyl rutosides, derivatives of rutin, acting on veins and capillaries. They affect the contacts between vascular endothelial cells and reduce the pores between them. The change in the fibrous matrix between endothelial cells helps in this.

The use of Venoruton reduces inflammation, erythrocyte aggregation, and increases their resistance to deformation. The indication for use is the clinical signs of varicose veins. These are pain and cramps, swelling and trophic disorders, varicose ulcers. Venoruton is also used for hemorrhoids. Even in the complex treatment of diabetic retinopathy, Venoruton is prescribed for the prevention of retinal vascular thrombosis. Venoruton is prescribed by obstetricians-gynecologists for pregnant women with venous insufficiency and hemorrhoids, but only from the second semester.

Take it one capsule 3 times a day with meals. Improvement of the condition begins in a few days, and reaches its maximum effect in a month. The duration of the course is determined by the doctor, after its completion the effect persists for a month. Capsules should be taken with a sufficient amount of water, in case of lymphostasis, the number of capsules increases to 10 capsules per day.

Advantages and disadvantages

The drug has both advantages and disadvantages. Joint reception with ascorbic acid enhances the effect, but it can not be used in case of hypersensitivity to rutosides, in the 1st trimester of pregnancy. There may be nausea, heartburn or diarrhoea, skin rash or flushing, which are dose dependent and disappear quickly after discontinuation of the drug. As for breastfeeding, it is better to refrain from taking Venoruton during this period. In general, we can say that this is an excellent drug produced by one of the leaders in modern pharmaceuticals.

Heparin (Lyoton 1000 Trombless, Trombogel)

Rating: 4.5

We present Lyoton 1000 in the form of a transparent gel containing heparin at a dose of 1000 units per 1 g. In total, the tube contains 50 g of the drug, it is produced by the Italian Menarini group, and the tube of the corresponding volume will cost from 450 to 550 rubles. Lyoton 1000 has a pleasant smell, slightly viscous consistency, almost transparent. The action of this agent is antithrombotic, it is an anticoagulant, and in essence it does not apply to venotonic drugs. But its appointment together with venotonics greatly enhances their effectiveness due to anti-inflammatory and anti-exudative action. It activates fibrinolysis, prevents thrombosis, and ultimately accelerates the process of resorption not only of hematomas and various blood clots, but also reduces swelling. The indication is varicose veins and classic chronic venous insufficiency, thrombophlebitis. Apply the product to the skin 1 to 3 times a day, daily, in a short course of 3 to 7 days.

Advantages and disadvantages

The drug is well tolerated, but it is not used for ulcerative necrotic processes, hemorrhagic syndrome and bleeding, low platelet count. Side effects include itching and redness of the skin, which is not common. Heparin does not cross the placenta and into milk, and the drug can be prescribed if necessary to pregnant and lactating mothers, but only as directed by a doctor. The drug should not be applied to wounds, and with deep vein thrombosis, heparin is sometimes not effective enough. It cannot be combined with NSAIDs, antihistamines, coagulants, such as Warfarin. But supporting venotonics with topical heparin is a powerful remedy for the symptoms of varicose veins.

Heparin sodium + dexpanthenol + dimethyl sulfoxide (Dolobene, Heparidex, Dolonit)

Rating: 4.4

Gel Dolobene is another representative of local preparations containing heparin and additional components. We already know about the function of sodium heparin. This is an anticoagulant, its effects are described above when we talked about Lioton-1000. What do additional components do? Dimethyl sulfoxide, aka Dimexide, reduces swelling, reduces inflammation and relieves pain. It reduces the conduction of pain impulses by reducing their speed. The effect on edema is associated with the inactivation of free radical oxidation. It is able to penetrate deep into the skin.

Dexpanthenol is a provitamin that is converted into pantothenic acid in the skin. It is integrated into catabolic and anabolic processes, improves granulation and epithelization, which contributes to the regeneration of affected areas.

Therefore, indications are various inflammatory lesions of the musculoskeletal system, injuries and bruises, sprains and acute neuralgia, but hematomas and especially edema, which occur in the classical course of varicose veins. It is necessary to apply the medicine by gently rubbing it into the skin 2 to 4 times a day. The drug is used under a bandage, with iontophoresis as a conductor in ultrasound therapy (with phonophoresis). The medicine is produced by the German company Merkle, and a Gel tube weighing 50 g will cost from 430 to 520 rubles in pharmacies.

Advantages and disadvantages

Contraindication is asthma, severe disorders of the liver and kidneys, cardiovascular system. Do not use the drug for pregnant and lactating women, children under the age of 5 years. It should not be applied to open wounds. The medicine also has side effects, usually redness and itching, a slight burning sensation. Dimethyl sulfoxide can cause garlic breath or taste changes. It should be remembered that the medicine can increase the skin’s reaction to ultraviolet radiation, so during treatment it is better not to sunbathe or go to the solarium. It is also desirable to use Dolobene separately from other ointments and gels.

Calcium dobesilate (Doxy-Chem)

Rating: 4.3

Doxy-Hem is a drug that can also be added to joint therapy along with venotonics. This is calcium dobesilate, which is produced by the Serbian company Hemofarm in capsules. A package of 30 capsules of 500 mg will cost from 220 to 340 rubles, which is a relatively inexpensive price. The capsules contain a white or yellowish powder. Calcium dobesilate is an angioprotector, a drug that improves microcirculation and reduces high vascular permeability. Calcium dobesilate improves lymph flow, reduces platelet aggregation and blood viscosity. Along the way, it improves the resistance of erythrocyte membranes to physical deformations.

A remedy is indicated for various vascular disorders in which there is a high permeability and fragility of the capillaries. The second indication is various types of chronic venous insufficiency, and first of all, prevaricosis and varicose veins, with the complaints that were described above. Also, these are phlebitis, paresthesia, tissue swelling, and even trophic ulcers. You need to take the medicine 500 mg 3 times a day for 3 weeks, and then once a day. The course of treatment is from a month to several months at the discretion of the doctor, depending on the effect.

Advantages and disadvantages

This drug also has contraindications. These are hypersensitivity to the active substance, exacerbation of peptic ulcer, other variants of bleeding from the gastrointestinal tract, chronic diseases of parenchymal organs, an overdose of anticoagulants and the bleeding caused by them, age up to 13 years and the first trimester of pregnancy. There are also side effects, including nausea and diarrhea, allergic itching, fever and joint pain. Very rarely, reversible agranulocytosis occurs. It is not recommended to use this medicine for nursing mothers, and if there is progressive liver or kidney failure, then the drug is prohibited. On the other hand, Doxy-Hem can be taken prophylactically, in the form of monotherapy against the background of compression underwear and the implementation of the rules of a healthy lifestyle.

Lauromacrogol 400 (Ethoxysclerol)

Rating: 4.2

In this drug review, it was decided to include a couple of drugs that are used by vascular surgeons for sclerotherapy, that is, turning off certain veins from the bloodstream. One of these drugs is Ethoxysclerol, and 5 bottles of 2 ml each (one package, 3%) will cost from 1800 to 2640 rubles. Produced by the German company Kreussler.

When used, the drug damages the endothelial cells of the venous vessels, protein denaturation occurs, a strong thrombus is formed, and within 7 days it is organized, and therefore the blood flow in the veins stops. The drug reduces the excitability of nerve endings and reduces the conduction of a pain impulse, as a result of which sclerotherapy will be painless. In addition to chronic venous insufficiency, the drug is used for sclerotherapy for hemorrhoids, varicose veins of the esophagus and stomach, portal vein thrombosis, and other similar conditions.

It is necessary to use Ethoxysclerol at a dose of not more than 2 mg / kg / day, and as a result, up to 70 mg can be administered for a patient weighing 140 kg. This is 4,6 ml of a 3% solution. The drug is also produced in lower concentrations: 0,5% and 1%. For one injection for sclerosing saphenous varicose veins, a 0,5% solution is usually used in an amount of 0,1 to 0,3 ml. Medicines are withdrawn strictly into the necessary vein with a horizontal, or elevated 45 ° position of the leg. The dosage and concentration of the solution is chosen by the vascular surgeon depending on the caliber of the vein and the development of the vascular nodes.

Advantages and disadvantages

The drug is strictly contraindicated in hypersensitivity, arterial thrombosis, and inflammation in the area of ​​sclerosis. Diseases include fever, bronchial asthma, endocarditis and myocarditis. The drug is contraindicated in the first trimester of pregnancy and after 36 weeks, while breastfeeding. Of the side effects, subsequently, hyperpigmentation of the skin develops at the site of intravenous injection. The drug should not be administered intra-arterially. After the injection of the drug, a compression bandage must be applied, and then the patient must walk for thirty minutes. This is necessary so that the bandage squeezes the venous walls, a good fibrous scar forms, and there is no recanalization of the thrombosed vessel.

Sodium tetradecyl sulfate (Fibro-Vane)

Rating: 4.2

Fibrovein is a similar drug, but already made in England, with a fundamentally different mechanism of action. This is also an injection solution, also 3% or less, in the same package (2 ml No. 5), for 2000 rubles. The drug also causes coagulation of endothelial and smooth muscle proteins. As a result, the diameter of the vessel is reduced, its lumen is closed and the outcome is transformation into connective tissue or fibrosis. The main difference, and moreover cardinal from the previous medication, is the anticoagulant effect and prevention of blood clot formation. If the action of Ethoxysclerol was based on vascular thrombosis, then in this case thrombosis does not occur, but fibrosis occurs immediately. The drug has a higher density than blood, so it does not enter the systemic circulation. Even administration in high doses does not affect the acid-base state of the blood, since two buffer systems are specially introduced into the composition of the drug: bicarbonate and phosphate.

The drug is used strictly for varicose veins of the lower extremities. Fibro-Vane is injected after the isolation of a segment of the vein, when it becomes empty. After the introduction, immediate compression should be carried out, that is, a compression bandage should be applied. The usual dosage is 1 ml for one injection in one place, and the maximum single dose is 4 ml for a 3% solution. If necessary, repeat sclerosing therapy is performed after 2 weeks.

Advantages and disadvantages

The drug does not create blood clots, and therefore the occurrence of pulmonary embolism is excluded, and this is very important. Contraindication is acute thrombophlebitis, acute thrombosis, hemorrhagic diathesis and infection. The drug is not administered to pregnant and lactating women, it is necessary to administer the drug very carefully near the arteries and nerves, and side effects may cause skin hyperemia or slight soreness.

Evidence-based medicine on phlebotonics

The 2016st century is the era of evidence-based medicine, when data on the safety and efficacy of drugs are tested in large, randomized trials. But such studies are not always possible, they require high costs. Therefore, it is often resorted to studying a large number of small studies on small groups of patients. So, scientific data on the use of venotonics were obtained in 53. 6000 follow-ups were studied, per 28 patients. There were 10 studies on rutosides, 9 on diosmin, and XNUMX on calcium dobesylate.

As a result of the analysis of these studies, it was found that phlebotonics are recommended as a means of eliminating symptoms, and only secondarily are they effective as a means of prevention. The drugs have been shown to be safe, but only over short follow-up periods. They do have side effects that were higher compared to placebo. First of all, these are gastrointestinal disorders, and most often they were detected while taking rutosides.

It also turned out that if the patient does not yet have symptoms of chronic venous diseases, then these drugs should not be taken. The undesirability of taking venotonics during pregnancy and breastfeeding has been confirmed.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.