Abstract
The modern aspects of pharmacotherapy of chronic venous insufficiency (CVI) of the lower extremities are presented in the article. Phlebotropic drugs are medications for basic pharmacotherapy of CVI. A common characteristic of pharmacodynamics of these drugs is the ability to increase the venous tone, and reduce severity of specific symptoms and syndromes of CVI. The efficiency of the most widespread venotonic drugs has been analyzed. The largest number of preclinical and clinical research among all groups of veno-active drugs has been devoted to the study of Micronized Purified Flavonoid Fraction (MPFF). It has been determined that the therapeutic effect of MPFF is higher compared to the therapeutic effect of non-micronised Diosmin. An important feature of the action of MPFF is a rapid onset of the venotonic effect, the effect is shown already from the first hour after administration and lasts during the day. This action is successfully complemented by improved rheological properties of the blood, reduction in blood viscosity, stimulation of the drainage function of lymphatic vessels. Treatment should be given by courses, which duration depends on disease severity, and is for 2-3 months, but not less than twice a year. The continuous therapeutic scheme can be used in the case of refractory forms of CVI. MPFF is characterized by a high clinical efficacy, high bioavailability and safety. It does not cause serious adverse reactions, well tolerated and can be used as a drug of the first choice.
Highlights
Synthetic compoundsActive component Coumarin Hydroxyethyl rutoside Troxerutin Diosmin Procyanidolic oligomers (grape seed extract) Escin (horse chestnut extract) Centella asiatica (“clever herb”) Ginkgo biloba Ruscus aculeatus Dihydroergotamine Dihydroergocristine Tribenoside Calcium dobesilate
Chronic venous insufficiency (CVI) of the lower extremities is a syndrome characterized by disorders of the venous outflow on the macrohemodynamic level, it leads to disorganization of the regional microcirculation system [6, 16]
chronic venous insufficiency (CVI) of the lower extremities is primarily characterized by stagnation or redistribution of the venous blood flow in the venous system
Summary
Active component Coumarin Hydroxyethyl rutoside Troxerutin Diosmin Procyanidolic oligomers (grape seed extract) Escin (horse chestnut extract) Centella asiatica (“clever herb”) Ginkgo biloba Ruscus aculeatus Dihydroergotamine Dihydroergocristine Tribenoside Calcium dobesilate. Most PHD increase the tone of peripheral veins and lymphatic vessels due to the effect on the norepinephrine-dependent mechanism, and due to some specific effects of individual drugs [8]. The results of numerous clinical studies suggest that at early stages of the disease all PHD have a good therapeutic effect on subjective symptoms of CVI, but not the objective symptoms of CVI such as telangiectasia, varicose reticular and subcutaneous veins [10, 13]. Hydroxyethyl rutosides (Venoruton) and the extract of Ruscus aculeatus (Cyclo 3 fort) reduce the chronic venous edema and can be the second line drugs. To assess the efficiency of other phlebotropic drugs in the chronic venous edema it is necessary to conduct numerous randomized clinical studies according to standardized protocols [11, 29]. Results of certain clinical research indicate that in some clinical situations
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