Usage
Euphorbia Prostrata extract is primarily prescribed for the treatment of hemorrhoids (piles), particularly grades 1 and 2. It is also used to provide symptomatic relief after hemorrhoidectomy in patients with grade 3 and 4 hemorrhoids. Additionally, it’s indicated for other anorectal and colonic diseases. It has been used traditionally, alongside other agents, to manage diabetes. While it has shown some effects on blood glucose levels in studies, it’s not classified as an anti-diabetic drug.
It is classified as an herbal remedy with anti-inflammatory, antioxidant, hemostatic, astringent, and wound-healing properties. When combined with calcium dobesilate, it acts as a vasoprotective and venotonic agent.
Its mechanism of action involves reducing inflammation by modulating inflammatory pathways, protecting cells from free radical damage with its antioxidant properties, shrinking engorged veins, and controlling bleeding by enhancing blood flow. Furthermore, it decreases blood viscosity and reduces leakage from blood vessels, thus promoting healing. It has also been suggested it blocks pain-causing nerves, though limited information about this is available.
Alternate Names
While no official alternate names exist, it is sometimes referred to as just Euphorbia prostrata. It is available in combination with other drugs, such as Calcium Dobesilate. Brand names in India include “Thank OD” and combination products containing it such as “Sitcom”.
How It Works
Pharmacodynamics: Euphorbia Prostrata extract exhibits anti-inflammatory, antioxidant, astringent, and hemostatic properties. Flavonoids (apigenin, apigenin-7 glucoside, luteolin, and luteolin-7 glucoside), phenolic acids (ellagic and gallic acids), and tannins contribute to these actions. It reduces inflammation, promotes wound healing, and strengthens blood vessel walls. When used in combination with calcium dobesilate, the synergistic effect enhances vasoprotective and venotonic actions, normalising capillary permeability and inhibiting inflammatory processes.
Pharmacokinetics: Limited detailed information is available on the pharmacokinetics of Euphorbia Prostrata extract. Studies suggest it’s absorbed orally and can be applied topically. More research is needed to fully elucidate its absorption, distribution, metabolism, and excretion pathways. Studies show that there are high MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) values for the crude extracts.
Mode of Action:
The extract’s flavonoids and phenolic compounds exert anti-inflammatory, analgesic, antioxidant, hemostatic, antithrombotic, wound healing, and vasoprotective effects. Tannins provide astringent and hemostatic properties. It modulates the body’s inflammatory pathways, reducing inflammatory cytokines like IL-1 and IL-6. It also inhibits the activity of NF-κB, a protein complex that controls transcription of DNA and cytokine production. Research suggests it may interact with or alter coagulation pathways, necessitating caution when co-administered with anticoagulants.
Dosage
Standard Dosage
Adults:
- Hemorrhoids: 100 mg orally once daily for 14 days.
- Post-Hemorrhoidectomy (Grades 3 and 4): 100 mg orally twice daily for 14 days.
- Topical: As directed by the physician.
Children:
The safety and efficacy in children and adolescents below 18 years haven’t been established and are generally not recommended unless specifically directed by a doctor.
Special Cases:
- Elderly Patients: Exercise caution due to the potential for increased risk of adverse effects.
- Patients with Renal Impairment: Use with caution. Dosage adjustment may be required.
- Patients with Hepatic Dysfunction: Use with caution. Dosage adjustment may be required.
- Patients with Comorbid Conditions: Bleeding disorders should be carefully evaluated before use. Patients with inflammatory bowel disease, intestinal disorders, or known hypersensitivity disorders should use it with caution.
Clinical Use Cases
Dosage recommendations for specific clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, and emergencies have not been established in the available literature.
Dosage Adjustments
Dose adjustments may be needed for patients with renal or hepatic impairment, based on individual assessment. Monitor patients with bleeding disorders closely.
Side Effects
Common Side Effects
Nausea, dyspepsia, abdominal pain, diarrhea, constipation, dry mouth, rash, local burning or stinging sensation (topical application), redness at the application site, stomach ache, headache, itching, joint pain.
Rare but Serious Side Effects
Severe allergic reactions.
Long-Term Effects
Data on long-term effects are limited.
Adverse Drug Reactions (ADR)
Severe nausea, vomiting, diarrhea, skin rashes in case of overdose. Immediate medical attention is required in such cases.
Contraindications
- Hypersensitivity to Euphorbia Prostrata, flavonoids, or any component of the formulation.
- Bleeding disorders.
- Pregnancy and breastfeeding (except under strict medical supervision).
Drug Interactions
- Anticoagulants (e.g., warfarin, heparin): Potential for altered coagulation profile.
- Corticosteroids (e.g., prednisone): Potential interactions.
- Immunosuppressants (e.g., cyclosporine): Potential interactions.
- Alcohol: Interaction is unknown. It’s advised to avoid alcohol during treatment.
Interactions with OTC drugs, supplements, and other commonly prescribed medications need further investigation.
Pregnancy and Breastfeeding
Contraindicated during pregnancy and breastfeeding due to insufficient safety data and potential risks.
Drug Profile Summary
- Mechanism of Action: Anti-inflammatory, antioxidant, astringent, hemostatic; vasoprotective and venotonic when combined with calcium dobesilate.
- Side Effects: Nausea, diarrhea, abdominal pain, rash, constipation, dry mouth. Rarely, severe allergic reactions.
- Contraindications: Hypersensitivity, bleeding disorders, pregnancy, breastfeeding.
- Drug Interactions: Anticoagulants, corticosteroids, immunosuppressants. Alcohol should be avoided.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: 100 mg once daily (hemorrhoids) or twice daily (post-hemorrhoidectomy) for 14 days. Topical: As directed.
- Monitoring Parameters: Monitor for allergic reactions and any unusual side effects. Assess hemorrhoid symptoms.
Popular Combinations
- Calcium dobesilate: For enhanced vasoprotective and venotonic effects in hemorrhoid treatment.
- Topical lidocaine: For added local anesthetic action.
Precautions
- General Precautions: Screen for allergies, metabolic disorders, and organ dysfunction, particularly liver and kidney disorders.
- Pregnant Women: Contraindicated.
- Breastfeeding Mothers: Contraindicated.
- Children & Elderly: Not recommended for children under 18. Exercise caution in the elderly.
- Lifestyle Considerations: Avoid alcohol. Driving is generally safe unless dizziness or fatigue occurs.
FAQs (Frequently Asked Questions)
A: For adults with hemorrhoids, 100 mg once daily for 14 days. For post-hemorrhoidectomy care (grades 3 and 4), 100 mg twice daily for 14 days. Topical application as directed by the physician.
A: No, it’s contraindicated during pregnancy due to potential risks and insufficient safety data.
A: Common side effects include nausea, diarrhea, abdominal pain, constipation, dry mouth, rash, and local reactions (burning, stinging, redness) with topical use.
A: It reduces inflammation, strengthens vein walls, decreases blood viscosity, controls bleeding, and promotes wound healing.
A: Use with caution in patients with liver or kidney impairment, and adjust dosage accordingly. Consult with a nephrologist or hepatologist as needed.
A: It may interact with anticoagulants, corticosteroids, and immunosuppressants. Alcohol should be avoided.
A: While traditionally it’s been used for similar conditions, its primary indication is hemorrhoids. Consult a physician for appropriate treatment of anal fissures.
A: It’s recommended to complete the full course of treatment as prescribed by your physician, even if symptoms improve earlier.
A: No specific dietary restrictions are known unless otherwise advised by your physician. However, a high-fiber diet and ample hydration are generally recommended for hemorrhoid management.
Q10: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it’s close to the next scheduled dose. Do not double the dose.
