Usage
- Medical Conditions: Micronised Purified Flavonoid Fraction (MPFF) is primarily prescribed for Chronic Venous Insufficiency (CVI) and acute hemorrhoidal attacks. CVI encompasses symptoms like leg heaviness, pain, swelling, and nocturnal leg cramps. MPFF is also employed in managing lymphedema, venous ulcers, and varicose veins. It has secondary uses in conditions like diabetic retinopathy, superficial vein thrombosis, rosacea, and melasma.
- Pharmacological Classification: MPFF is categorized as a venotonic, vasculoprotective agent, and a capillary stabilizing agent. It falls under the bioflavonoid class.
- Mechanism of Action: MPFF enhances venous tone by reducing venous distensibility and stasis. At the microcirculatory level, it normalizes and reinforces capillary permeability, reducing capillary fragility. It achieves this by inhibiting the breakdown and prolonging the activity of norepinephrine.
Alternate Names
- MPFF is a combination of diosmin (90%) and hesperidin (10%).
- Brand Names: Daflon 500, Detralex.
How It Works
- Pharmacodynamics: MPFF exhibits venotonic and vasculoprotective effects. It increases venous tone, reduces venous capacitance and distensibility, improves lymphatic drainage, and reinforces capillary resistance.
- Pharmacokinetics: MPFF is orally administered and well-absorbed. The micronization process enhances bioavailability. It is metabolized in the liver and excreted primarily through the kidneys and feces. The elimination half-life is around 11 hours.
- Mode of Action: MPFF inhibits the inflammatory cascade by reducing the release of inflammatory mediators such as leukotrienes and prostaglandins. It also decreases leukocyte adhesion to the endothelium.
- Receptor Binding/Enzyme Inhibition: It prolongs the activity of norepinephrine by inhibiting its breakdown, leading to increased venous tone.
Dosage
Standard Dosage
Adults:
- Chronic Venous Insufficiency: 1000 mg daily (either two 500 mg tablets or one 1000 mg tablet), taken with meals, typically one tablet at midday and one in the evening.
- Acute Hemorrhoidal Attack: 3000 mg daily (six 500 mg tablets or three 1000 mg tablets) for the first 4 days, then 2000 mg daily (four 500 mg tablets or two 1000 mg tablets) for the next 3 days. A maintenance dose of 1000 mg daily may be continued for up to 2 months or more based on the physician’s discretion.
Children:
- MPFF is not recommended for children under 18 due to insufficient data regarding safety and efficacy.
Special Cases:
- Elderly Patients: No specific dose adjustment is generally recommended for elderly patients. However, it should be used cautiously and patient response monitored.
- Patients with Renal Impairment: Use with caution in patients with severe renal impairment as MPFF is primarily renally excreted.
- Patients with Hepatic Dysfunction: Use with caution in patients with hepatic impairment due to liver metabolism of MPFF.
- Patients with Comorbid Conditions: Consider comorbidities like bleeding disorders, as MPFF can potentially exacerbate bleeding. Close monitoring is advisable when used concomitantly with anticoagulants or antiplatelet agents.
Clinical Use Cases
- Dosing for intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is not specifically established. The standard or acute hemorrhoidal attack dosage may be applied based on the underlying condition and clinical judgment.
Dosage Adjustments
- Dosage adjustments should be made based on individual patient response, renal/hepatic function, and other relevant factors. Therapeutic drug monitoring is not routinely performed.
Side Effects
Common Side Effects:
- Gastrointestinal discomfort (nausea, vomiting, diarrhea, abdominal pain)
- Headache
- Dizziness
Rare but Serious Side Effects:
- Allergic reactions (rash, itching, swelling, angioedema)
Long-Term Effects:
- Long-term use is generally considered safe, but regular monitoring is recommended.
Adverse Drug Reactions (ADR):
- Angioedema requires immediate medical attention.
Contraindications
- Hypersensitivity to MPFF components (diosmin, hesperidin).
Drug Interactions
- Anticoagulants (warfarin, heparin)
- Antiplatelet agents (aspirin, clopidogrel)
- Medications metabolized by CYP450 2E1 or 2C9, or by P-glycoprotein
- Antihypertensive medications
- Antihistamines
- Muscle relaxants
- Anticonvulsants
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Limited data available. Use should generally be avoided as a precautionary measure.
- Breastfeeding: It is unknown if MPFF is excreted in breast milk. Breastfeeding should be avoided during treatment.
Drug Profile Summary
- Mechanism of Action: Venotonic and vasculoprotective agent that improves venous tone and capillary resistance.
- Side Effects: Generally well-tolerated, with common side effects being gastrointestinal. Rarely, allergic reactions may occur.
- Contraindications: Hypersensitivity to MPFF.
- Drug Interactions: Anticoagulants, antiplatelet agents, drugs metabolized by CYP450 2E1, 2C9, or by P-glycoprotein.
- Pregnancy & Breastfeeding: Avoid use.
- Dosage: See detailed dosage guidelines above.
- Monitoring Parameters: Observe for efficacy (reduction in venous symptoms) and side effects.
Popular Combinations
- Often used as monotherapy. Combining with other venotonics is not common.
Precautions
- Assess for allergies to MPFF before initiation. Evaluate renal and hepatic function.
- Caution in pregnancy, breastfeeding, and in children.
- Patients operating machinery should be aware of potential dizziness.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Micronised Purified Flavonoid Fraction?
A: See detailed dosage guidelines above.
Q2: What are the common side effects?
A: Common side effects include gastrointestinal upset (nausea, vomiting, diarrhea, abdominal pain), headache, and dizziness.
Q3: Is MPFF safe during pregnancy?
A: MPFF should generally be avoided during pregnancy due to limited safety data.
Q4: Can MPFF be used with blood thinners?
A: Use with caution in patients taking anticoagulants or antiplatelet agents.
Q5: How long does it take for MPFF to work?
A: Response to MPFF varies, but improvement in venous symptoms may be observed within a few weeks.
Q6: What should I do if I miss a dose?
A: Take the missed dose as soon as remembered, unless it is close to the next scheduled dose. Do not double the dose.
Q7: Is MPFF addictive?
A: MPFF is not considered addictive.
Q8: Are there any dietary restrictions with MPFF?
A: No specific dietary restrictions are associated with MPFF. However, a healthy diet and lifestyle can complement therapy.
A: MPFF is metabolized in the liver.
Q10: Can MPFF be crushed or chewed?
A: MPFF tablets should be swallowed whole with water and not crushed or chewed.
