VASCUREST® Film-Coated Tablets

Diosmin 450 mg + Hesperidin 50 mg

Medical Description

VASCUREST® contains micronized purified flavonoid fraction (MPFF) consisting of diosmin 450 mg and hesperidin 50 mg, a well-established venoactive therapy used to improve venous tone, reduce inflammation, and protect the microcirculation. It is indicated for the management of chronic venous disease (CVD), including varicose veins, leg heaviness, edema, pain, and venous ulcers, as well as for the symptomatic treatment of acute and chronic hemorrhoidal disease.

MPFF enhances venous return by reducing venous capacitance and distensibility, improving lymphatic drainage, decreasing capillary permeability, and limiting leukocyte activation and inflammatory damage within the venous wall. These mechanisms contribute to improved venous function and symptom relief.

International guidelines from the European Society for Vascular Surgery (ESVS) and the International Union of Phlebology recognize MPFF as one of the most extensively studied and recommended oral venoactive medications for chronic venous disease.

Therapeutic Indications

VASCUREST® is indicated for:

• Chronic venous insufficiency (CVI)
• Chronic venous disease (CVD)
• Varicose veins
• Leg heaviness and fatigue
• Leg pain associated with venous disease
• Lower limb edema
• Nocturnal leg cramps related to venous insufficiency
• Venous ulcers (as an adjunct to compression therapy)
• Acute hemorrhoidal attacks
• Chronic hemorrhoidal disease

Mechanism of Action

Diosmin and hesperidin exert multiple complementary effects:

• Increases venous tone and reduces venous distensibility.
• Improves venous return to the heart.
• Enhances lymphatic drainage.
• Reduces capillary permeability and capillary fragility.
• Improves microcirculatory blood flow.
• Inhibits inflammatory mediators and leukocyte adhesion.
• Protects vascular endothelium from oxidative stress.
• Reduces tissue edema.

Clinical Benefits

Clinical studies have demonstrated that MPFF may:

• Reduce leg pain and discomfort.
• Decrease lower limb swelling.
• Improve sensations of heaviness and fatigue.
• Reduce nocturnal cramps.
• Improve quality of life in chronic venous disease.
• Accelerate healing of venous leg ulcers when combined with compression therapy.
• Shorten the duration and severity of acute hemorrhoidal episodes.
• Reduce bleeding, pain, itching, and swelling associated with hemorrhoids.

Adult Dosage

→Chronic Venous Disease

• One tablet twice daily, preferably with meals.

Some treatment regimens may later be adjusted according to physician recommendation and clinical response.

→Acute Hemorrhoidal Attack

Common regimen:

• 6 tablets daily for the first 4 days
• followed by 4 tablets daily for the next 3 days

Maintenance therapy may then continue with 2 tablets daily, depending on physician assessment.

Pediatric Use

• Not routinely recommended in children or adolescents, as adequate safety and efficacy data are limited.
• Use only if specifically prescribed by a healthcare professional.

Use During Pregnancy

• Available clinical data have not demonstrated an increased risk of congenital malformations.
• May be considered during pregnancy only when clearly needed and under physician supervision.
• Routine self-medication during pregnancy is not recommended.

Breastfeeding

Because data regarding excretion into breast milk remain limited:

• Use during breastfeeding should only occur after consultation with a healthcare provider.

Contraindications

Do not use in patients with:

• Hypersensitivity to diosmin, hesperidin, or any excipient.

Warnings and Precautions

• Compression stockings, regular walking, leg elevation, weight management, and avoidance of prolonged standing remain the cornerstone of chronic venous disease management.
• Drug therapy should complement—not replace—lifestyle measures.
• Acute hemorrhoidal symptoms that persist or worsen should be evaluated to exclude other anorectal disorders.
• Seek medical evaluation if symptoms fail to improve after appropriate treatment.
• Not intended for emergency treatment of severe venous thrombosis.

Possible Side Effects

Most adverse effects are mild and transient.

Common:

• Nausea
• Dyspepsia
• Diarrhea
• Abdominal discomfort

Less common:

• Headache
• Dizziness
• Skin rash
• Pruritus
• Urticaria

Rare:

• Allergic reactions including angioedema.

Seek immediate medical attention if severe allergic reactions occur.

Drug Interactions

Clinically significant drug interactions are uncommon.

Patients should nevertheless inform their healthcare provider about all prescription medicines, over-the-counter medications, herbal products, and dietary supplements.

Storage

• Store below 30°C.
• Protect from moisture and direct sunlight.
• Keep in the original package.
• Keep out of the reach of children.

Evidence Summary

High-quality evidence from randomized controlled trials and systematic reviews supports the use of micronized purified flavonoid fraction (MPFF) for reducing symptoms of chronic venous disease, improving quality of life, and enhancing venous ulcer healing when combined with compression therapy. Clinical trials have also demonstrated significant reductions in pain, bleeding, edema, and symptom duration during acute hemorrhoidal attacks. International vascular guidelines consistently recommend MPFF as a first-line venoactive agent for symptomatic chronic venous disease due to its favorable efficacy and safety profile.

Key Counseling Points

• Take with meals to reduce gastrointestinal discomfort.
• Continue lifestyle measures such as regular walking and leg elevation.
• Wear compression stockings if recommended.
• Maintain adequate hydration and physical activity.
• Complete the prescribed treatment course even if symptoms improve.
• Consult your physician if symptoms persist or worsen.

Patient Disclaimer

This information is intended for educational purposes only and should not replace professional medical advice. Always use VASCUREST® exactly as prescribed by your physician or pharmacist. Seek immediate medical attention if you experience severe allergic reactions, sudden leg swelling with pain, chest pain, or persistent rectal bleeding.

References

• European Society for Vascular Surgery (ESVS). 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease.
• International Union of Phlebology (UIP). Global Guidelines for Chronic Venous Disease.
• American Venous Forum (AVF) Guidelines.
• Cochrane Database of Systematic Reviews. Interventions for chronic venous insufficiency and venous leg ulcers.
• Martinez-Zapata MJ, et al. Micronized purified flavonoid fraction for chronic venous disease. Cochrane Database Syst Rev.
• Jantet G. Chronic Venous Insufficiency Study Group. MPFF in chronic venous insufficiency. Angiology.
• Guilhou JJ, et al. MPFF as adjunctive therapy in venous leg ulcer healing. Phlebology.
• Nicolaides AN. Investigation and management of chronic venous disorders. Int Angiol.
• Rabe E, et al. Management of chronic venous disease. Phlebology.
• UpToDate. Chronic venous disease and varicose veins in adults.
• Merck Manual Professional Edition. Chronic Venous Insufficiency.
• Medscape. Chronic Venous Insufficiency Treatment Review.
• U.S. National Library of Medicine (PubMed/NIH).
• National Center for Biotechnology Information (NCBI).
• University vascular medicine educational resources.

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