ascorbic-acid and Venous-Insufficiency

In Russia, physicians are virtually unaware of drugs based on needle extract. However, abroad, saponins and, in particular, a combined preparation containing needle extract, hesperidin and vitamin C is one of drugs of choice, if not the leading medication in treatment of venous oedemas and other venous symptoms.. The authors conducted a systematic review of the Russian-and English-language literature using the following search terms: saponins, hesperidin, needle, ruscus, ruscogenin (and their Russian equivalents), each of which was entered in a combination with the word 'venous' or its Russian equivalent, respectively.. Ruscogenin and neoruscogenin from the root of needle possess anti-inflammatory properties and induce venous wall contraction, thus making it possible to use needle extract in treatment of chronic venous insufficiency. It was experimentally determined that needle extract stimulates vein contractility, decreasing permeability of the venous wall, influencing extracellular matrix proteins, inhibiting leukocyte migration through regulation of both proteins and matrix ribonucleic acid. Analysed herein are the results of original studies of a combination of needle extract, flavonoid hesperidin methyl chalcone and ascorbic acid, also examining in detail the mechanism of action conditioned by synergism of pharmacological effects of these components. This is followed by discussing the place of saponins in the classification of phlebotropic drugs and comparing efficacy of needle root extract with that of other phlebotonics.. It was experimentally determined that a combination of needle extract, hesperidin and vitamin C possesses multiple additive phlebotropic effects. According to clinical trials, it leads to relief of most symptoms and a decrease in the ankle volume (high level of evidence 1A), being not inferior by clinical efficiency and duration of action to the best-known flavonoids, whereas by the venotonizing effect, decreased permeability of the vascular wall, and inhibition of leukocytic aggression even superior thereto. Further experimental and clinical studies of efficacy of this combination for various forms of chronic venous diseases and venous thromboses are warranted.. В России врачи практически незнакомы с препаратами на основе экстракта иглицы колючей. Хотя за рубежом сапонины и, в частности, комбинированный препарат экстракта иглицы, гесперидина и витамина С является одним из препаратов выбора, если не ведущим в лечении венозных отеков и других венозных симптомов. Авторы выполнили систематический обзор русскоязычной и англоязычной литературы по поисковым запросам: сапонины, гесперидин, иглица колючая, ruscus, ruscogenin, saponin, butcher’s broom, hesperidin, каждый из которых вводился в сочетании со словом 'венозный' или 'venous'. Результаты исследования. Рускогенин и неорускогенин из корня иглицы колючей обладают противовоспалительными свойствами и вызывают сокращение стенки вен. Это позволяет использовать экстракт иглицы при лечении хронической венозной недостаточности. Экспериментально установлено, что экстракт иглицы стимулирует сокращение вен, уменьшает проницаемость венозной стенки, влияет на белки экстрацеллюлярного матрикса, подавляет миграцию лейкоцитов посредством регуляции как белков, так и матричной рибонуклеиновой кислоты. Проанализированы результаты оригинальных исследований комбинации экстракта сапонина иглицы колючей, флавоноида гесперидина метилхалькона и аскорбиновой кислоты. Детально изучен механизм действия, обусловленный синергизмом фармакологических эффектов этих компонентов. Обсуждается место сапонинов в классификации флеботропных препаратов и сравнивается эффективность экстракта корня иглицы с другими флеботониками. Заключение. Экспериментально установлено, что комбинация экстракта иглицы, гесперидина и витамина C обладает множественными аддитивными флеботропными эффектами. Согласно клиническим исследованиям это вызывает уменьшение большинства симптомов, а также сокращение объема лодыжек (высокий уровень доказательности 1A), не уступая по клинической результативности и продолжительности действия наиболее известным флавоноидам, а по венотонизирующему эффекту, снижению проницаемости сосудистой стенки и подавлению лейкоцитарной агрессии превосходит последние. Необходимы дальнейшие экспериментальные и клинические исследования по изучению эффективности этой комбинации при различных формах хронических заболеваний вен и венозных тромбозах.

Topics: Ascorbic Acid; Hesperidin; Humans; Plant Extracts; Ruscus; Russia; Venous Insufficiency

With our increasing knowledge of the epidemiology, pathophysiology, investigation and clinical aspects of chronic venous disease (CVD) and new data on the various therapies available, an update of the recommendations on CVD and its management appears to be necessary. The symposium New Data on Chronic Venous Disease: A New Place for Cyclo 3® Fort, held during the annual meeting of the European Venous Forum on June 30th, 2017 in Porto, Portugal, reported the recent developments on the Ruscus, hesperidin methyl chalcone (HMC), and vitamin C combination (Cyclo 3® Fort), including the results of a series of in-vivo pharmacological experiments and a recent meta-analysis. Additionally, the symposium provided first-hand information on the process, rules, main findings, and expected contents of the prospective 2018 CVD guidelines. Analysis of the evidence showed that the effect of the Ruscus, HMC, and vitamin C combination on pain, heaviness, feeling of swelling, tingling, ankle circumference and global symptoms score reached Grade A. Therefore, the new guidelines should specify that the Ruscus, HMC, and vitamin C combination merits a Grade 1A recommendation.

Topics: Animals; Ascorbic Acid; Chalcones; Chronic Disease; Congresses as Topic; Drug Therapy, Combination; Hesperidin; Humans; Phytotherapy; Plant Extracts; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Ruscus; Venous Insufficiency

Treatment of venous and lymphatic insufficiency of the lower limbs is based on 3 components: elastic support, venotonic drugs and radical treatments (surgery or sclerotherapy) of insufficient veins. Venotonic drugs have specific indications limited to functional impairment: heavy feeling in the legs, pain and impatience in the evening. There are different categories of venolymphatic drugs. Flavonoids have various pharmacological actions, most notably an increase in venous tone, reduction of capillary permeability and increase of capillary resistance. Choice of a venotonic drug is funded on knowledge of pharmacodynamics and pharmacokinetics of the molecule, critical evaluation of clinical studies, physician's personal experience and drug cost. Venotonic drugs are useful when venous insufficiency leads to functional manifestations. They are especially the treatment of heavy leg syndromes during warm seasons when elastic support is uncomfortable.

Topics: Adenosine Diphosphate; Ascorbic Acid; Capillary Permeability; Capillary Resistance; Drug Costs; Flavonoids; Ginkgo biloba; Humans; Patient Selection; Phytotherapy; Plants, Medicinal; Vasodilator Agents; Venous Insufficiency

The aim of this study was to compare the change in functional signs of venous insufficiency and venous refilling time measured by mercury strain-gauge plethysmography under the effects of the combination of Ruscus aculeatus, hesperidin methylchalcone and ascorbic acid (Cyclo 3 Fort).. An open-label clinical trial conducted in 65 women presenting with CEAP class C2s and C3s assessment criteria. At D0 and D28, functional signs were measured on a visual analog scale (VAS), venous refilling time by mercury strain-gauge plethysmography and venous reflux by echo-Doppler method.. Under treatment, venous refilling time increased from 11.7±4 s to 13.8±4.4 s with Δ of 26% (P<0.0001) and the percentage of patients showing improvement of functional symptoms ≥30% was significantly correlated (P=0.04) with the percentage of patients presenting an improvement in venous refilling time ≥10%.. Improvement in subjective functional signs under treatment with Cyclo 3 Fort was correlated with objective plethysmographic parameter improvement. There-fore, this study contributes to objectively document the benefit of prescribing this venoactive drug to active women with CEAP class C2s to C3s.

Topics: Activities of Daily Living; Analysis of Variance; Ascorbic Acid; Cardiovascular Agents; Chalcones; Chi-Square Distribution; Drug Therapy, Combination; Female; France; Hesperidin; Humans; Plant Extracts; Plethysmography; Predictive Value of Tests; Recovery of Function; Ruscus; Treatment Outcome; Ultrasonography, Doppler; Venous Insufficiency

The present study assessed the effect of Ruscus aculeatus, hesperidin methyl-chalcone and ascorbic acid (HMC-AA), in the treatment of chronic venous disorders (CVD) in Latin American patients.. This study is an observational, single arm, multicentric and prospective trial. Patients suffering from CVD and belonging to C0s-C3 Clinical Etiological Anatomical and Physiopathological (CEAP) classes were included. Patient profiles, risk factors, clinical symptomatology and quality of life (QoL) assessed by SF-12 and CIVIQ questionnaires were evaluated at inclusion and after 12-week treatment.. The main factors influencing the previous management of patients were age, gender, body mass index (BMI), familial history, physical activity, exposure to heat, heavy loads lifting, profession and clinical characteristics. All clinical symptoms significantly improved with treatment and, as BMI and CEAP classes increased. Ankle circumferences decreased over time, correlating with BMI and CEAP classes. The physical and psychological dimensions of the SF-12 score significantly increased over time and improved within each CEAP class. The CIVIQ score significantly improved over time, correlating with age and CEAP classes.. A 12-week treatment with Ruscus aculeatus HMC-AA showed a significant decrease in the clinical symptoms and a significant improvement in the QoL of patients with CVD.

Topics: Adult; Aged; Argentina; Ascorbic Acid; Cardiovascular Agents; Chalcones; Chronic Disease; Drug Combinations; Female; Hesperidin; Humans; Logistic Models; Male; Mexico; Middle Aged; Odds Ratio; Plant Preparations; Prospective Studies; Quality of Life; Risk Assessment; Risk Factors; Ruscus; Surveys and Questionnaires; Time Factors; Treatment Outcome; Venous Insufficiency

To evaluate changes on cutaneous microangiopathy in chronic venous disorder (CVD) after use of Cirkan [venotonic drug containing Ruscus aculeatus (plant extract), hesperidine methylchalcone (flavonoid) and vitamin C], elastic compression stockings (ECS) or no treatment for four weeks.. Fifty-five female patients (85 legs), 25 to 57 years, with at least one limb classified as C2,s or C2,3,s (CEAP classification), were allocated consecutively, according to entrance order, in these three groups. Ten healthy women age-matched were also investigated. Using orthogonal polarization spectral technique (noninvasive method), measurements of functional capillary density (FCD, number of capillaries with flowing red blood cells/mm(2)), capillary morphology (CM, % of abnormal capillaries/mm(2)) and diameters (mum) of dermal papilla (DDP), capillary bulk (DCB) and capillary limb (CD) were obtained on the medial perimalleolar region and later analyzed using CapImage software.. CVD patients showed significant changes on CD and CM compared to healthy subjects in agreement with our previous findings (J Vasc Surg 43:1037-1044, 2006). On Cirkan-treated patients, after 4 weeks, CD decreased on both limbs and CM improved on the left one, suggesting an amelioration of the chronic venous hypertension. No significant changes could be detected on other patient groups. These results confirm the existence of microcirculatory dysfunction in early stages of CVD, probably due to post-capillary hypertension, and further support the venotonic action of Cirkan.

Topics: Adult; Ascorbic Acid; Capillaries; Chymotrypsin; Combined Modality Therapy; Drug Combinations; Edema; Female; Hesperidin; Humans; Leg; Microcirculation; Middle Aged; Phytosterols; Plant Extracts; Stockings, Compression; Treatment Outcome; Trypsin; Venous Insufficiency; Venous Thrombosis

Clinical and capillaroscopic evaluation of an association of Ruscus aculeatus, hesperidin methylchalcone (HMC) and ascorbic acid in chronic venous insufficiency. A prospective, multicenter and open clinical study. Chronic venous insufficiency patients were studied using clinical, etiological, anatomical, physiological classification (CEAP) symptom scale. Symptomatology, CEAP scale, and baseline, 2-, 4-, 6- and 8-week skin capillaroscopy were assessed. Treatment consisted of two capsules per day of Ruscus aculeatus 150 mg/HMC 150 mg/ascorbic acid 100 mg during 8 weeks.. A total of 124 patients were studied, 109 female (89.28%), with a mean age of 52.5 (33-80+9.8). Initial intense reports were 79% pain, 85% heaviness, 74% cramps, 82% edema, decreasing to 20%, 12%, 8% and 14%, respectively, within two weeks, and symptomatology being absent at the end of treatment. Capillaroscopy changes at treatment completion were: 98% to 20% inter-capillary fluid decrease; 80% to 20% efferent loop thickening; 5% to 2% peri-capillary bed, and 5% to 4% mega-capillaries.. Severe symptom decrease started from the second week until there were no symptoms at the end of treatment. It is the first time morphologic changes were observed in chronic venous insufficiency through capillaroscopy following a pharmacological intervention. Capillary-level effect was proportional to symptom decrease. Improvement was seen from the second week of treatment.

Topics: Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; Chalcones; Chronic Disease; Female; Hesperidin; Humans; Leg; Male; Microscopic Angioscopy; Middle Aged; Phytotherapy; Plant Extracts; Ruscus; Venous Insufficiency

The authors tryed by a statistical study to evaluate the efficacy of aphlebotinic therapy in venous diseases induced or aggravated by estroprogestative contraception. During this study, it emerged that the induced functional venous problems were quite virtually corrected by this treatment.

Topics: Adult; Anthocyanins; Ascorbic Acid; Cardiovascular Agents; Contraceptives, Oral, Hormonal; Drug Combinations; Female; Humans; Leg; Lithium; Saponins; Thrombophlebitis; Time Factors; Varicose Veins; Venous Insufficiency

Topics: Adenosine; Alkanesulfonates; Ascorbic Acid; Cardiovascular Agents; Chronic Disease; Drug Combinations; Hemorrhoids; Humans; Rutin; Venous Insufficiency

Topics: Ascorbic Acid; Aspirin; Atrophy; Auscultation; Cellulitis; Drug Combinations; Edema; Humans; Leg Ulcer; Lymphatic System; Macrophages; Necrosis; Occlusive Dressings; Pigmentation Disorders; Posture; Respiration; Rest; Thrombophlebitis; Time Factors; Valsalva Maneuver; Varicose Veins; Venous Insufficiency; Venous Pressure