Usage
Polidocanol is a sclerosing agent primarily used for the treatment of varicose veins (spider veins ≤1 mm and reticular veins 1-3 mm in diameter) and telangiectasias in the lower extremities. It is also utilized in sclerotherapy for hemorrhoids. Its pharmacological classification is as a sclerosant. The mechanism of action involves damaging the endothelium of the vein, causing it to shrink and eventually close off, allowing for the formation of new, healthy tissue.
Alternate Names
Other names include: Lauromacrogol 400, Hydroxypolyethoxydodecane. Brand names: Asclera, Varithena.
How It Works
Pharmacodynamics: Polidocanol works by causing irritation and damage to the intimal lining of the vein. This leads to endothelial damage, fibrosis, and eventual obliteration of the vein.
Pharmacokinetics:
Following intravenous injection, polidocanol is widely distributed in the body and rapidly metabolized. Little information exists on its absorption, metabolism, and elimination, although one source states that its metabolites were found in the milk of lactating rats for at least 48 hours after a single IV dose. Elimination pathways are not precisely established.
Mode of Action: At the cellular level, polidocanol disrupts the cell membranes of endothelial cells. It triggers an inflammatory reaction, which leads to the formation of a thrombus within the vein.
Receptor Binding, Enzyme Inhibition, Neurotransmitter Modulation: This information is not available.
Elimination Pathways: Detailed information is scarce. Some sources suggest metabolites are found in rat milk after 48 hours, hinting at potential hepatic metabolism and excretion.
Dosage
Standard Dosage
Adults:
- Asclera (Intravenous Injection):
- Spider Veins (≤1 mm): 0.1-0.3 mL of 0.5% solution per injection, maximum 10 mL per session.
- Reticular Veins (1-3 mm): 0.1-0.3 mL of 1% solution per injection, maximum 10 mL per session.
- Varithena (Injectable Foam): Up to 5 mL per injection, maximum 15 mL per session.
Children:
Safety and efficacy have not been established in pediatric patients for varicose vein treatment. Limited information on rectal prolapse management indicates a 3-5 mg/kg submucosal injection of Polidocanol.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically recommended but caution is advised in those with hepatic or renal impairment.
- Patients with Renal Impairment: Use with caution. Consider lower doses, especially in moderate to severe impairment.
- Patients with Hepatic Dysfunction: Use with caution. Consider lower doses, especially in moderate to severe impairment.
- Patients with Comorbid Conditions: Exercise caution in patients with cardiovascular disease, diabetes, or bleeding disorders. Consult a vascular surgeon for those with underlying arterial disease.
Clinical Use Cases
Dosage information specifically for intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is not available. Polidocanol’s use in these contexts is not established.
Dosage Adjustments:
Adjustments may be needed based on the individual patient’s response and the severity of varicose veins. For patients with renal or hepatic impairment, careful dose reduction should be considered.
Side Effects
Common Side Effects:
- Pain, swelling, bruising, itching, and discoloration at the injection site.
- Warm sensation, hyperpigmentation, or hypertrichosis in the treatment area.
- Headache, dizziness.
Rare but Serious Side Effects:
- Allergic reactions (anaphylaxis, angioedema, urticaria).
- Deep vein thrombosis (DVT), pulmonary embolism (PE).
- Arterial embolism, tissue necrosis, nerve injury.
- Vasculitis, circulatory collapse, syncope.
- Cerebrovascular accident, migraine, paresthesia.
Long-Term Effects:
Information on chronic complications from prolonged use is not available.
Adverse Drug Reactions (ADR):
Any sign of allergic reaction, including difficulty breathing, swelling of face or throat, hives, requires immediate medical attention. Signs of DVT/PE, such as leg pain, swelling, or shortness of breath, warrant prompt evaluation.
Contraindications
- Known hypersensitivity to polidocanol.
- Acute thromboembolic disease.
- Some sources mention pregnancy and thrombophilia as contraindications.
Drug Interactions
While some sources report no known drug interactions, others mention potential interactions with blood thinners/antiplatelet drugs (e.g., clopidogrel, warfarin, dabigatran) and hormonal medications like birth control pills.
Pregnancy and Breastfeeding
Pregnancy Category C. Polidocanol is generally not recommended during pregnancy due to potential fetal risks observed in animal studies. While limited human data haven’t shown clear risks, the benefits of treatment during pregnancy must be weighed against potential harms. Varicosities arising during pregnancy may resolve spontaneously postpartum.
It’s unknown whether polidocanol is excreted in human milk. However, it is present in rat milk. Lactating women should consider interrupting breastfeeding and pumping and discarding breast milk up to 8 hours after administration to minimize infant exposure.
Drug Profile Summary
- Mechanism of Action: Damages the endothelium of veins, causing them to collapse and be replaced by fibrous tissue.
- Side Effects: Common: Injection site reactions (pain, bruising, discoloration). Serious: Allergic reactions, DVT/PE.
- Contraindications: Hypersensitivity, acute thromboembolic disease.
- Drug Interactions: Potential interactions with blood thinners and hormonal medications.
- Pregnancy & Breastfeeding: Not recommended unless benefits clearly outweigh risks.
- Dosage: Varies based on vein size and solution concentration. See detailed dosage guidelines.
- Monitoring Parameters: Observe for allergic reactions post-injection. Monitor for signs of DVT/PE.
Popular Combinations
Information on commonly used drug combinations with polidocanol is not available.
Precautions
- Screen for allergies and assess for thromboembolic risk factors.
- Pregnant Women: Avoid unless absolutely necessary.
- Breastfeeding Mothers: Interrupt breastfeeding for at least 8 hours post-administration.
- Children & Elderly: Use with caution, particularly in patients with hepatic or renal impairment.
- Lifestyle Considerations: No specific lifestyle restrictions are mentioned in the provided information.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Polidocanol?
A: The dosage depends on the type and size of the varicose veins being treated and the formulation used (liquid or foam). See detailed dosage guidelines above.
Q2: What are the most common side effects of Polidocanol?
A: The most common side effects are localized reactions at the injection site, including pain, bruising, discoloration, swelling, itching, and warmth.
Q3: What are the serious side effects of Polidocanol that require urgent attention?
A: Allergic reactions (anaphylaxis, angioedema), deep vein thrombosis (DVT), pulmonary embolism (PE), arterial embolism, and tissue necrosis are serious side effects that warrant immediate medical intervention.
Q4: Can Polidocanol be used during pregnancy?
A: Polidocanol is generally not recommended during pregnancy. The benefits of treatment should be carefully weighed against potential fetal risks, especially during the first trimester.
Q5: Is it safe to breastfeed while taking Polidocanol?
A: The safety of breastfeeding while using polidocanol is uncertain. It is advisable to interrupt breastfeeding for at least 8 hours after administration and discard pumped milk during that period.
Q6: What are the contraindications for using Polidocanol?
A: Polidocanol is contraindicated in individuals with known hypersensitivity to the drug and those with acute thromboembolic disease.
Q7: Are there any drug interactions I should be aware of with Polidocanol?
A: Potential interactions with blood thinners and hormonal medications exist. Consult with a pharmacist or drug interaction database for the most up-to-date information.
Q8: How does Polidocanol work to treat varicose veins?
A: It works by damaging the inner lining of the vein, leading to its closure and eventual replacement by fibrous tissue.
Q9: How long does it take to see results after Polidocanol treatment?
A: It may take several weeks or even months for the treated veins to disappear completely. Multiple treatment sessions might be required.
Q10: What precautions should I take before administering Polidocanol?
A: Before administering, screen patients for any history of allergies to the drug and assess for risk factors for thromboembolic events. Exercise caution in patients with renal or hepatic impairment, cardiovascular diseases, or bleeding disorders. Always inform patients about potential side effects and obtain their informed consent.
