Usage
Calcium Dobesilate is a vasoprotective agent primarily prescribed for chronic venous insufficiency (CVI), diabetic retinopathy, and hemorrhoids. It is also used to treat capillary fragility and permeability disorders.
Alternate Names
While “Calcium Dobesilate” is the most common name, it is also known as dobesilic acid calcium salt. Brand names include Doxium.
How It Works
Pharmacodynamics: Calcium Dobesilate normalizes capillary resistance and permeability, improves blood flow in veins, reduces capillary fragility and leakage, and inhibits platelet aggregation. It decreases blood viscosity and has anti-inflammatory and anti-edema effects. It may also enhance lymphatic drainage, optimizing microcirculatory function.
Pharmacokinetics:
- Absorption: Well-absorbed from the gastrointestinal tract after oral administration.
- Metabolism: Limited information available.
- Elimination: Primarily renal excretion.
Mode of Action: Calcium Dobesilate appears to act by multiple mechanisms impacting microcirculation. The drug is believed to:
- Stabilize capillary membranes, reducing their permeability and fragility.
- Inhibit the release of inflammatory mediators.
- Reduce platelet aggregation, thereby improving blood flow.
- Increase the production of nitric oxide, promoting vasodilation.
More research is needed to fully elucidate the precise molecular mechanisms and receptor targets involved.
Dosage
Standard Dosage
Adults:
The standard oral dosage is 500-1500 mg daily, divided into two or three doses, taken with meals. Doses up to 2000 mg/day have been used in some cases.
Children:
Not established. Generally avoided due to lack of safety and efficacy data. Some sources suggest avoiding use in children under 12.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required, but it’s advised to start with the lower end of the dosage range and monitor for side effects.
- Patients with Renal Impairment: Dose reduction may be necessary, especially in severe renal failure requiring dialysis.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustments may be needed based on liver function assessment.
- Patients with Comorbid Conditions: Monitor patients with heart dysfunction, seizures, electrolyte imbalance, liver problems, and other relevant conditions closely.
Clinical Use Cases
Dosage in these settings should be determined by the treating physician based on individual patient needs and the specific clinical context. No specific dosage guidelines are available for these clinical scenarios.
Dosage Adjustments
Dosage adjustments should be made on a case-by-case basis, considering renal/hepatic function, patient response, and the presence of other medical conditions.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Fever
- Headache
- Skin rash
- Gastrointestinal disorders
- Arthralgia (joint pain)
Rare but Serious Side Effects
- Agranulocytosis (low white blood cell count)
Long-Term Effects
Chronic complications from prolonged use are generally uncommon. Regular monitoring of blood counts and liver/kidney function is recommended during prolonged therapy.
Adverse Drug Reactions (ADR)
Agranulocytosis is a serious ADR that requires immediate discontinuation of the drug and appropriate medical management.
Contraindications
- Hypersensitivity to Calcium Dobesilate
- Pregnancy (Category C - use only if potential benefits outweigh risks)
- Breastfeeding (drug enters breast milk)
- Children under 12 years old (safety not established).
Drug Interactions
- Anticoagulants (e.g., warfarin): Close monitoring for bleeding is recommended.
- Creatinine assays: Calcium dobesilate might interfere, leading to falsely lower creatinine values.
- Other reported interactions: Interactions with aspirin, duloxetine, furosemide, insulin glargine, milk of magnesia, other antiplatelet agents like dipyridamole have been reported.
- Alcohol: Limit alcohol consumption while on Calcium Dobesilate.
Pregnancy and Breastfeeding
- Pregnancy: Category C - use only if benefits clearly outweigh the potential risks to the fetus. Data regarding safety in pregnancy is limited.
- Breastfeeding: The drug is excreted in breast milk. Discontinue breastfeeding or the drug.
Drug Profile Summary
- Mechanism of Action: Improves microcirculation by normalizing capillary permeability and resistance; reduces blood viscosity and inhibits platelet aggregation.
- Side Effects: Nausea, vomiting, diarrhea, fever, skin rash, arthralgia. Rarely, agranulocytosis.
- Contraindications: Hypersensitivity, pregnancy, breastfeeding.
- Drug Interactions: Anticoagulants, creatinine assays, alcohol.
- Pregnancy & Breastfeeding: Contraindicated or use with extreme caution.
- Dosage: 500-1500 mg/day orally, divided doses with meals.
- Monitoring Parameters: Blood counts (especially WBC), liver and kidney function tests during prolonged use.
Popular Combinations
Sometimes combined with Euphorbia prostrata for hemorrhoid treatment. This combination might offer synergistic effects due to the astringent and anti-inflammatory properties of Euphorbia prostrata.
Precautions
- General Precautions: Evaluate renal and hepatic function prior to and during treatment. Monitor for signs of infection, particularly agranulocytosis (fever, sore throat, etc.).
- Specific Populations: Use with caution in elderly patients and those with renal impairment. Avoid use during pregnancy and breastfeeding. Not recommended for children under 12.
- Lifestyle Considerations: Limit alcohol while taking this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Dobesilate?
A: 500-1500 mg/day, orally, divided into 2-3 doses taken with meals. Maximum dose up to 2000 mg/day.
Q2: How does Calcium Dobesilate work?
A: It improves microcirculation by normalizing capillary permeability and resistance, reducing blood viscosity, and inhibiting platelet aggregation.
Q3: What are the common side effects?
A: Nausea, vomiting, diarrhea, fever, skin rash, and joint pain.
Q4: Are there any serious side effects?
A: Rarely, agranulocytosis can occur. It is essential to monitor for signs of infection.
Q5: Can Calcium Dobesilate be used during pregnancy or breastfeeding?
A: No, it is generally contraindicated due to potential risks to the fetus/infant.
Q6: What are the contraindications for using this medication?
A: Hypersensitivity to Calcium Dobesilate, pregnancy, breastfeeding, children under 12.
Q7: Does Calcium Dobesilate interact with other medications?
A: Yes, it can interact with anticoagulants (e.g., warfarin) and might interfere with creatinine assays. Consult with a physician regarding potential interactions with other medications you are taking.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it is close to the time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not double the dose.
Q9: How should Calcium Dobesilate be taken?
A: Orally, with meals to minimize potential gastrointestinal discomfort.
Q10: What should patients be advised regarding lifestyle while taking Calcium Dobesilate?
A: Advise patients to limit alcohol consumption during treatment.
