Micronized Diosmin and Flavonoid Fraction – What Do They Have in Common?
Micronized diosmin and micronized purified flavonoid fraction are medications from the flavonoid group that are used as venopharmaceuticals/venoprotectives in the treatment of chronic venous insufficiency and hemorrhoidal disease. Both have many common properties, which we discuss in the following text. Their differences will be covered in a follow-up article on this topic.
Introduction
Chronic venous insufficiency represents a serious global problem with very high prevalence. Causal therapy does not yet exist, but conservative approaches are successful in the initial stages of symptomatic treatment. These include physical therapy, such as the use of compression bandages and elastic stockings, as well as the administration of venopharmaceuticals. Venopharmaceuticals act at the level of veins and microcirculation: they reduce venous distensibility and venostasis, influence the activation and adhesion of leukocytes, decrease the production of inflammatory mediators, increased capillary permeability and fragility, prevent inflammatory changes, and primarily have antiedematous effects. Flavonoids are also intended for the treatment of symptoms associated with chronic venous insufficiency.
Flavonoid Venopharmaceuticals
Micronized diosmin and micronized purified flavonoid fraction are of natural origin. The two most significant representatives of this group, micronized diosmin and micronized purified flavonoid fraction, are very similar in many respects. Their production is based on the extraction of hesperidin from citrus peels. This flavonoid is then semi-synthetically processed to produce diosmin and other flavonoids. In the case of micronized diosmin, the proportion of other flavonoids in the mixture is precisely defined by the pharmacopoeia. Pharmacological effects are exhibited by diosmin, hesperidin, and other components of the mixture.
Hesperidin and other components are not listed in the SPC of products containing micronized diosmin precisely to meet pharmacopoeial purity. According to this specification of the European Pharmacopoeia, micronized diosmin contains more active substance − diosmin − compared to micronized purified flavonoid fraction.
Venotonic flavonoids are micronized to improve bioavailability. Micronization adjusts the particle size to micrometer units, which allows for an increased surface area and promotes the solubility of the drug, and thus its absorption in the body.
Indications
Both named medications are intended for the treatment of symptoms and manifestations of chronic venous insufficiency of the lower limbs, whether functional or organic: the feeling of heaviness, pain, nocturnal cramps, edema, and trophic changes, including venous ulcers. They can also be used for the treatment of acute attacks of hemorrhoidal disease and as the primary therapy for subjective symptoms and functional objective manifestations of hemorrhoidal disease.
Contraindications include hypersensitivity to the active substance or any of the excipients. The most common adverse effects are gastrointestinal intolerance signs, while other adverse effects are rare.
Insurance Reimbursement
Micronized diosmin and micronized purified flavonoid fraction have the status of medicinal products, not dietary supplements, and thus fall under the competence of the State Institute for Drug Control (SÚKL), which approves their quality, safety, and efficacy.
Both medications are covered by health insurance. They are reimbursed for the symptomatic treatment of chronic venous disease with objective signs of the disease, such as visible varicose veins, edema, skin changes, or in the case of proven reflux and venous hypertension by ultrasound examination of the vessels. Reimbursement of treatment is terminated if no clinically significant improvement is achieved within 2–3 months. Reimbursement is also provided for the treatment of venous ulcers − in this case, improvement must be observed within six months. Reimbursement for lymphedema is not officially established, as it is formally considered off-label treatment, although flavonoid venopharmaceuticals have shown beneficial effects in this indication and are widely prescribed.
Conclusion
Medications with micronized diosmin and micronized purified flavonoid fraction are considered effective venopharmaceuticals used in the treatment of chronic venous insufficiency and the manifestations of hemorrhoidal disease. Both share many essential properties, from the method of obtaining to the mechanism of action on the venous wall, indications, and contraindications. They are also approached similarly from the perspective of health care payers.
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Sources:
1. Slíva J., Karetová D. Comments on the analysis of the composition of the flavonoid mixture in Diozen 500 mg tablets using UHPLC. Internal Medicine 2021; 67 (1): 85.
2. Diozen. The strength of diosmin. Zentiva, 2019.
3. SPC Diozen. Available at: www.sukl.cz/modules/medication/detail.php?code=0243066&tab=texts
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