Role of Diosmin in Chronic Venous Disease

Leg cramps, swelling, bulging veins or unsightly veins are issues commonly found in many middle aged women and often men as well.  These swollen blood vessels called Varicose Veins not only make your legs look unattractive, but they also indicate a serious circulatory problem leading to a disease called Chronic Venous Insufficiency or CVI.  At our clinic, The Vein & Vascular Clinic of Texas, our main focus is screening and early detection of varicose veins.  We have a full spectrum of treatment options for advanced disease as well.

Although CVI is not a major life threatening issue, it can have a severe impact on both an individual’s life and the healthcare system.  It is estimated that more than 50 percent of women in America develop varicose veins by the age of 50.  Along with pain and disfiguration, CVI adds to the expense of the medical system.  The cost of treating CVI has been estimated to be $750 million to $1 billion per year. The average cost of treatment for a single patient can exceed $40000.  Estimates of 2 million work days are lost due to medical conditions and around $3 million are lost in health care costs.

The treatment methods currently available include compression stockings or bandages, sclerotherapy, laser or radiofrequency ablation and surgical intervention.  However, these methods are cumbersome and come with financial and biological issues.  Surgical remedies are expensive and comprehensive bandages are time consuming as well as difficult to apply.  We reserve surgical intervention for advanced disease.  The least invasive and least painful treatment is radio frequency ablation, RFA, for varicose veins which is offered at our clinic and done within the office setting.

Phlebotonics are drugs or nutrients functioned to improve vein health.  Out of various phlebotonics, Diosmin has been labelled as especially useful in countering CVI.

Diosmin is a naturally occurring hesperidin bioflavonoid, first identified in 1925.  It is prescribed as a standard pharmaceutical intervention in Europe for CVI and hemorrhoids.  Many women in the US have been using this European drug available without prescription, as a food supplement.  Micronized Diosmin has been clinically proven to produce healthier looking legs by healing swollen ankles, spider and varicose veins and leg ulcers.

Before getting into detail about Diosmin, First we must know what chronic venous disease is and how it affects an individual’s life.

What is CVI?

CVI occurs when veins in the legs don’t allow blood to travel back to the heart due to incompetent venous valves.  This leads to venous hypertension and improper circulation of blood in the leg.  CVI is a common cause of leg pain and swelling, associated with varicose veins.

Normally, each pump in the heart pushes blood around the body.  This pump works well for outgoing blood coursing around the arteries.  By the time blood hits and returns through the veins, much of the propulsion generated by the heart is gone.  In addition to this challenge, returning blood travelling from the legs has to fight against gravity.

Our body has a complicated system set up to perform this operation.  This system includes venous muscle pump, a series of flap valve and perforating veins to allow communication of the superficial and deep venous system.  Dysfunction of any of the normal structures, specifically the venous valve may lead to venous hypertension and development of CVI.

Venous valves are a series of one-way valves that prevent blood from returning to the feet.  As these valves become incompetent they allow retrograded flow of blood towards the feet and build up pressure in lower veins.  This pressure in turn weakens the valve further down.  Engorged with blood, the vein walls weaken, turning them into varicose and spider veins.  This vicious cycle develops blood that seeps through weakened vein walls and pools in the calves of the legs.  The buildup of lymph fluid and blood causes swelling and discoloration which can get worse with the development of painful and stubborn ulcers.

Even though CVI is not life threatening, it can affect quality of life if left untreated.  CVI can lead to serious medical conditions including phlebitis and DVT.  Risk factors of CVI include work environments that involve standing or sitting for a long period, women over the age of 50, tall height, pregnancy, physical activity, smoking, obesity and family history of varicose veins.

What is Diosmin?

Diosmin is a naturally occurring hesperidin bioflavonoid extracted from the rind of sweet oranges.

The most clinically effective Diosmin is micronized, which means it has undergone a scientifically controlled process to reduce the size of standard particles in order to increase its bio-availability and rapid relief of symptoms that accelerate healing.

How does it work?

Diosmin reduces the sensation of pain, swelling, tension and heaviness in the legs associated with chronic venous disease.  Micronized Diosmin prolongs the vasoconstrictor effect of noradrenaline on the vein wall and by doing so, increases venous tone, and thereby reduces pooling that can lead to swollen veins.  It has anti-inflammatory effects on vessel walls as well.

Clinical Data

In a study of 245 patients with varicose vein disease who underwent surgical removal of an affected vein, those given micronized Diosmin pre- and post-operative therapy (two weeks before and for 30 consecutive days after surgery) achieved a measurable reduction in postoperative hematoma, pain severity and limb heaviness, as well as ease of exercise and improved quality of life.

Diosmin’s clinical efficacy has been tested in more than 40 clinical trials comprising of more than 15,000 patients.  The largest published clinical trial for CVI was a two year trial which enrolled 5,052 patients in 23 countries.  After six months, there were significant reductions in edema and improved quality of life (QOL).  Objective endpoints like decrease in venous reflux, increase in venous flow and reduction in venous pressure was also statistically significant in the Diosmin treated group.

Studies showed that micronized Diosmin protects the one way venous valves from leukocyte induced inflammation and destruction.  Micronized Diosmin also increases venous tone and reduces venous stretching and blood pooling.  This increases blood flow towards the heart and reduces venous high blood pressure present in suffering from chronic venous disease.

Other Benefits

Venous Leg Ulcers. Unhealed leg ulcers are a major consequence of chronic venous disease and major health issues.

Studies show that micronized Diosmin helps heal leg ulcerations by inhibiting the synthesis of inflammatory prostaglandin and free radicals.  Micronized Diosmin also decreases microvascular leakage and inhibits white blood cell trapping and migration.  One study found that treatment with micronized Diosmin led to complete healing of infected leg ulcers.

A multicenter, randomized, controlled trial tested micronized Diosmin in addition to standard compression stocking therapy versus placebo for two months in patients with leg ulcers.  A complete healing of leg ulcers is seen in patients who use Diosmin and compression stockings.

Lymphedema. Lymphedema is an abnormal swelling due to blockage of the lymphatic system.

Micronized Diosmin has been shown to improve lyphatic drainage by promoting lymphatic contraction by increasing the number of functional lymphatic capillaries and by decreasing the diameter of lymphatic capillaries and the intralymphatic pressure.

One study analyzed micronized Diosmin as a treatment of upper limb lymphedema secondary to conventional therapy for breast cancer.  Results showed improvement of the lymphedema but no significant reduction of arm swelling and no effect on cancer.

Diosmin may also bring relief to people suffering from secondary restless leg syndrome.

Micronized Diosmin alleviates acute and chronic pain and swelling of hemorrhoids.


There are multiple ways to treat chronic venous insufficiency including compression bandages, sclerotherapy and surgery but nothing has come closer to the inexpensive and effective treatment with micronized Diosmin.

Micronized Diosmin is the only oral treatment shown to be effective with the earliest symptoms of chronic venous insufficiency up to the most severe stage.

Because of unique and clinically proven mode of action which deals with all the clinical aspects of venous disease it should be used as a first line treatment for edema and symptoms of CVI at any stage of the disease along with other conservative therapy.

Micronized Diosmin enjoys an outstanding safety record unrivaled by any other drug used to treat venous disorders.  The majority of published studies, including the ones involving pregnancy, show that Diosmin is generally nontoxic at recommended doses.  However, those who are pregnant or take any prescription medications should check with a physician before taking micronized Diosmin.

Now a prescription formulation is also available in the US known as Vasculera (Diosmiplex).  It consists of a proprietary blend of micronized and highly purified Diosmin glycotides in combination with alkaline granules, alka4 complex.  It is the only FDA approved formulation in the US.

For further information and to schedule a free vein screening please contact our office at 972-529-6939.  Our physicians, Dr. M. Akram Khan and Dr. Ambreen Ashfaque have many years of experience in varicose vein care and are both certified by the American Board of Venous and Lymphatic Medicine.