Usage
- Calcium Dobesilate + Troxerutin is prescribed for conditions related to venous insufficiency and microcirculation disorders. These include:
- Chronic Venous Insufficiency (CVI): This encompasses symptoms like leg pain, swelling, cramps, and varicose veins.
- Hemorrhoids (Piles): Swollen veins in the anus and rectum causing pain, bleeding, and itching.
- Diabetic Retinopathy: Damage to blood vessels in the retina due to diabetes.
- Pharmacological Classification: Vasoprotective agent, Venotonic.
- Mechanism of Action: This combination drug works through the synergistic effects of its components:
- Calcium Dobesilate: Stabilizes capillary walls, reduces capillary permeability and fragility, lowers blood viscosity, and may improve blood flow by enhancing nitric oxide production.
- Troxerutin: A bioflavonoid that strengthens capillary walls, reduces capillary permeability, and improves lymphatic drainage, mitigating edema and inflammation.
Alternate Names
- Doxium (common brand name for Calcium Dobesilate)
- There are a variety of brand names for the combination of Calcium Dobesilate and Troxerutin, which vary regionally. Some examples from India include:
- Osil Plus
- Rutin
How It Works
- Pharmacodynamics: Calcium Dobesilate reduces capillary fragility and permeability, decreases blood viscosity, and improves microcirculation. Troxerutin strengthens capillary walls, reduces edema and inflammation, and improves lymphatic drainage. Together, they alleviate symptoms of venous insufficiency and related conditions.
- Pharmacokinetics:
- Absorption: Calcium Dobesilate is absorbed from the gastrointestinal tract. Troxerutin absorption varies depending on the formulation.
- Metabolism: The metabolic pathways of both drugs are not fully elucidated.
- Elimination: Information on elimination pathways for both drugs is limited. It’s known that some Calcium Dobesilate is excreted renally.
- Mode of Action: Calcium Dobesilate may increase prostacyclin (PGI2) synthesis and reduce thromboxane A2 (TXA2) production. It is believed to inhibit certain glycosidases, impacting capillary wall structure. Troxerutin primarily acts by protecting capillary endothelium from oxidative stress and reducing inflammatory mediators.
- Receptor binding, enzyme inhibition, or neurotransmitter modulation: Information is limited. The effects observed suggest involvement of enzyme modulation and interference with inflammatory pathways, but specific receptors or neurotransmitters have not been clearly identified.
Dosage
Standard Dosage
Adults:
- Calcium Dobesilate: 500-1000 mg daily, divided into two or three doses, taken with meals.
- Troxerutin: Often combined in fixed-dose preparations with Calcium Dobesilate, typically 200-300 mg per dose.
- Treatment duration varies depending on the condition and severity but generally extends for several weeks.
Children: Safety and efficacy have not been established in children. Use is generally not recommended.
Special Cases:
- Elderly Patients: Dosage adjustments may be needed based on renal function.
- Patients with Renal Impairment: Dose reduction is required in patients with severe renal impairment.
- Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustment may be necessary.
- Patients with Comorbid Conditions: Consider individual patient factors and adjust dosage as needed.
Clinical Use Cases
The combination of Calcium Dobesilate and Troxerutin is not typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary use is in the long-term management of chronic venous disorders.
Dosage Adjustments
Dose adjustments should be based on patient-specific factors like renal and hepatic function, other medical conditions, and concomitant medications.
Side Effects
Common Side Effects:
- Nausea, diarrhea, stomach pain
- Skin rash, itching
- Fever, headache, vertigo
- Flushing
Rare but Serious Side Effects:
- Agranulocytosis (low white blood cell count)
- Allergic reactions
Long-Term Effects:
- Potential for skin thinning with topical formulations containing corticosteroids (like hydrocortisone, if combined in a cream).
Adverse Drug Reactions (ADR):
- Severe allergic reactions (anaphylaxis) require immediate attention.
Contraindications
- Hypersensitivity to Calcium Dobesilate, Troxerutin, or any component of the formulation.
- Pregnancy (unless benefits outweigh risks).
- Breastfeeding (generally avoided).
- Severe renal impairment.
- Use with caution in children, as safety and efficacy are not established.
Drug Interactions
- Anticoagulants (e.g., warfarin): Increased risk of bleeding.
- Consult a drug interaction database for specific interactions. The combination of Calcium Dobesilate and Troxerutin can have interactions with several medications.
- Alcohol should be avoided as it may exacerbate certain side effects.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C (Consult with a physician if pregnancy is suspected or confirmed).
- Fetal risks are not well-established, but caution is recommended.
- Drug excretion in breast milk is unknown. Avoid use during breastfeeding.
Drug Profile Summary
- Mechanism of Action: Calcium Dobesilate improves microcirculation by stabilizing capillaries and reducing blood viscosity. Troxerutin strengthens capillaries, reduces edema, and exerts anti-inflammatory effects.
- Side Effects: Nausea, diarrhea, skin rash, headache, vertigo. Rare but serious: agranulocytosis.
- Contraindications: Hypersensitivity, pregnancy, breastfeeding, severe renal impairment.
- Drug Interactions: Anticoagulants, alcohol.
- Pregnancy & Breastfeeding: Avoid unless benefits clearly outweigh risks.
- Dosage: Adults: 500-1000 mg Calcium Dobesilate/day; Troxerutin 200-300 mg/dose. Adjust based on the patient’s condition.
- Monitoring Parameters: Monitor for signs of agranulocytosis (e.g., fever, sore throat), renal function in patients with renal impairment, and liver function if necessary.
Popular Combinations
Calcium Dobesilate is sometimes combined with other medications, such as hydrocortisone, lidocaine, and zinc oxide, in topical preparations for hemorrhoids. It may also be used with other systemic medications targeting venous insufficiency, but these combinations should be carefully considered based on individual patient needs.
Precautions
- General Precautions: Pre-screening for allergies, renal and hepatic function.
- Specific Populations: Avoid in pregnancy and breastfeeding. Caution in children and the elderly.
- Lifestyle Considerations: Avoid alcohol.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Dobesilate + Troxerutin?
A: The standard adult dosage is 500-1000 mg of Calcium Dobesilate per day, often given in two or three divided doses with meals. Troxerutin is frequently co-formulated with Calcium Dobesilate, typically containing 200-300 mg per dose. The exact dose and duration depend on the specific condition and should be determined by a physician.
Q2: What are the common side effects of this combination?
A: Common side effects include nausea, diarrhea, skin rash, fever, headache, and vertigo.
Q3: Is this combination safe during pregnancy and breastfeeding?
A: It is generally not recommended during pregnancy and breastfeeding unless the potential benefits clearly outweigh the risks. Consult with a physician.
Q4: Are there any drug interactions I should be aware of?
A: Yes, this medication can interact with anticoagulants, increasing the risk of bleeding. Alcohol should also be avoided as it may exacerbate certain side effects. Always inform your doctor about all other medications you are taking.
Q5: How does this medication work to treat hemorrhoids?
A: The combined action of Calcium Dobesilate and Troxerutin strengthens the blood vessels, reduces inflammation, and improves blood flow in the affected area, relieving pain, swelling, and itching associated with hemorrhoids.
Q6: What is the difference between Calcium Dobesilate and Troxerutin?
A: While both drugs are vasoprotective, Calcium Dobesilate primarily works on capillary permeability and blood viscosity, while Troxerutin strengthens capillary walls, reduces edema, and has anti-inflammatory properties.
Q7: Can this medication be used for diabetic retinopathy?
A: Yes, it has shown some benefit in improving microcirculation in the retina, potentially benefiting patients with diabetic retinopathy.
Q8: Are there any contraindications for this combination?
A: Yes, contraindications include hypersensitivity to either drug, pregnancy, breastfeeding, and severe renal impairment. It’s also generally avoided in children due to a lack of safety and efficacy data.
Q9: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to catch up.
Q10: How should this medication be stored?
A: Store the medication at room temperature in a cool, dry place away from direct sunlight and moisture. Keep it out of the reach of children.
