Dawaa Reference

Clinical reference

Symptomatic Varicose Veins & Chronic Venous Insufficiency

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Cochrane Review CD003229 Phlebotonics for venous insufficiency (Martinez-Zapata 2020) · NICE Guideline CG168 Varicose Veins in Legs 2013 · No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020)

Verified against1 document
  • No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Heaviness in the affected leg
  • Itching over the veins [itching]
  • Cramping in the leg [muscle cramps]
  • Mild tenderness along the vein
  • Discoloration of the overlying skin
  • Reduced tolerance for exercise
  • Fatigue in the leg [fatigue]

Signs — what you find (3)

  • Visibly distended veins running from the thigh to the ankle
  • Discoloration is usually most marked around the ankle and calf
  • The Trendelenburg maneuver, releasing groin compression after leg elevation, tests deep valve competence

Tests (4)

  • Color duplex venous ultrasound assesses vein anatomy and valve function
  • Duplex ultrasound also checks for a deep vein thrombosis at the same time
  • A peak reflux velocity above about 27.4 cm/sec on ultrasound distinguishes diseased from normal limbs
  • Contrast venography is now rarely used

If not this — what else fits (4)

  • Lymphedema is on the differential for a swollen, symptomatic leg
  • Deep vein thrombosis must be excluded
  • Cellulitis is also considered
  • Stasis dermatitis is on the differential list

SourceStatPearls "Varicose Veins" - disease-level clinical article

Presentation findings are traced to the source above.

1

DIOSMIN + HESPERIDIN

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg (450 mg diosmin + 50 mg hesperidin) twice daily, or 1000 mg once daily, with meals x 2-3 months

Paediatric dose

Not applicable to children

Dose source

No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020)

Why

The micronised flavonoid fraction, and the one most studied. Cochrane 2020 (CD003229), moderate-certainty evidence: phlebotonics probably reduce swelling slightly, probably make little or no difference to quality of life, and probably cause slightly more side effects than placebo - mostly gastrointestinal. They do not heal ulcers. NICE does not recommend them at all; this is Egyptian practice, and the patient should know the benefit is modest.

Cautions
  • Micronized flavonoid fraction reduces venous distensibility and microvascular permeability.
  • The non-pharmacological mainstay is graduated compression stockings (Class 1 or 2) and leg elevation.
  • Refer to vascular surgery for duplex ultrasound evaluation, endothermal ablation, or sclerotherapy.
  • The treatment that fixes varicose veins is a referral - duplex ultrasound, then endothermal ablation or sclerotherapy. A tablet does not close an incompetent vein.
Egyptian brands
Egyptian brandManufacturerIndicative price
DIOSMIN PLUS 500 MG 30 F.C.TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)111.00 EGP (3.70/unit)
VASCUREST 500MG 30 F.C.TABS.D B K PHARMA > PHARMA THREE147.00 EGP (4.90/unit)
DAFLON 500 MG 30 F.C. TABS.SERVIER236.00 EGP (7.87/unit)
2

DIOSMIN

2nd line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg twice daily, or 1000 mg once daily, with meals x 2-3 months

Paediatric dose

Not applicable to children

Dose source

No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020)

Why

Single-ingredient alternative where the combination is unavailable or unaffordable. The same modest evidence applies.

Cautions
  • Helps alleviate heaviness, leg pain, and nocturnal cramps.
  • Inspect legs for venous eczema, lipodermatosclerosis, or active stasis ulceration.
  • The treatment that fixes varicose veins is a referral - duplex ultrasound, then endothermal ablation or sclerotherapy. A tablet does not close an incompetent vein.
  • Diosmin is a single-ingredient phlebotonic alternative.
Egyptian brands
Egyptian brandManufacturerIndicative price
DIFLORUTACINE 500 MG 30 F.C.TABS.ARAB DRUG COMPANY (ADCO)46.50 EGP (1.55/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.