{
  "schema_version": 1,
  "kind": "condition",
  "id": "varicose-veins-symptomatic",
  "name": "Symptomatic Varicose Veins & Chronic Venous Insufficiency",
  "category": "chronic",
  "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)",
  "review_status": "reviewed",
  "verified_against": "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_date": "2026-08",
  "treatments": [
    {
      "id": 1936,
      "generic": "Diosmin + Hesperidin",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 500.0,
      "adult_dose": "500 mg (450 mg diosmin + 50 mg hesperidin) twice daily, or 1000 mg once daily, with meals",
      "adult_duration": "2-3 months",
      "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)",
      "rationale": "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Not applicable to children",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "DIOSMIN PLUS 500 MG 30 F.C.TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)",
          "price_egp": 111.0,
          "pack_count": 30,
          "unit_price": 3.7,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "VASCUREST 500MG 30 F.C.TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "D B K PHARMA > PHARMA THREE",
          "price_egp": 147.0,
          "pack_count": 30,
          "unit_price": 4.9,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "DAFLON 500 MG 30 F.C. TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "SERVIER",
          "price_egp": 236.0,
          "pack_count": 30,
          "unit_price": 7.87,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "varicose-veins-symptomatic"
    },
    {
      "id": 1937,
      "generic": "Diosmin",
      "line": 2,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 500.0,
      "adult_dose": "500 mg twice daily, or 1000 mg once daily, with meals",
      "adult_duration": "2-3 months",
      "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)",
      "rationale": "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."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Not applicable to children",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "DIFLORUTACINE 500 MG 30 F.C.TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ARAB DRUG COMPANY (ADCO)",
          "price_egp": 46.5,
          "pack_count": 30,
          "unit_price": 1.55,
          "strength_mg": 500.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "varicose-veins-symptomatic"
    }
  ]
}