# Symptomatic Varicose Veins & Chronic Venous Insufficiency - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Cochrane Review CD003229 Phlebotonics for venous insufficiency (Martinez-Zapata 2020) · NICE Guideline CG168 Varicose Veins in Legs 2013 · No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020) - Verified date: 2026-08 ## Verified against - No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020) ## Treatment metadata - Diosmin + Hesperidin — 500 mg — oral.solid - Diosmin — 500 mg — oral.solid ## Complete treatment card ```text SYMPTOMATIC VARICOSE VEINS & CHRONIC VENOUS INSUFFICIENCY Sources: Cochrane Review CD003229 Phlebotonics for venous insufficiency (Martinez-Zapata 2020) · NICE Guideline CG168 Varicose Veins in Legs 2013 · No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020) Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Heaviness in the affected leg - Itching over the veins [itching] - Cramping in the leg [muscle cramps] - Mild tenderness along the vein - Discoloration of the overlying skin - Reduced tolerance for exercise - Fatigue in the leg [fatigue] SIGNS - what you find (3) - Visibly distended veins running from the thigh to the ankle - Discoloration is usually most marked around the ankle and calf - The Trendelenburg maneuver, releasing groin compression after leg elevation, tests deep valve competence TESTS (4) - Color duplex venous ultrasound assesses vein anatomy and valve function - Duplex ultrasound also checks for a deep vein thrombosis at the same time - A peak reflux velocity above about 27.4 cm/sec on ultrasound distinguishes diseased from normal limbs - Contrast venography is now rarely used IF NOT THIS - what else fits (4) - Lymphedema is on the differential for a swollen, symptomatic leg - Deep vein thrombosis must be excluded - Cellulitis is also considered - Stasis dermatitis is on the differential list Source StatPearls "Varicose Veins" - disease-level clinical article Status traced to the source above 1. DIOSMIN + HESPERIDIN [1st line] Adult 500 mg (450 mg diosmin + 50 mg hesperidin) twice daily, or 1000 mg once daily, with meals x 2-3 months Peds Not applicable to children Source No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020) Why The micronised flavonoid fraction, and the one most studied. Cochrane 2020 (CD003229), moderate-certainty evidence: phlebotonics probably reduce swelling slightly, probably make little or no difference to quality of life, and probably cause slightly more side effects than placebo - mostly gastrointestinal. They do not heal ulcers. NICE does not recommend them at all; this is Egyptian practice, and the patient should know the benefit is modest. Caution Micronized flavonoid fraction reduces venous distensibility and microvascular permeability. The non-pharmacological mainstay is graduated compression stockings (Class 1 or 2) and leg elevation. Refer to vascular surgery for duplex ultrasound evaluation, endothermal ablation, or sclerotherapy. The treatment that fixes varicose veins is a referral - duplex ultrasound, then endothermal ablation or sclerotherapy. A tablet does not close an incompetent vein. Egypt DIOSMIN PLUS 500 MG 30 F.C.TABS. MARCYRL PHARM... 111.00 EGP (3.70/unit) VASCUREST 500MG 30 F.C.TABS. D B K PHARMA ... 147.00 EGP (4.90/unit) DAFLON 500 MG 30 F.C. TABS. SERVIER 236.00 EGP (7.87/unit) 2. DIOSMIN [2nd line] Adult 500 mg twice daily, or 1000 mg once daily, with meals x 2-3 months Peds Not applicable to children Source No openable label for the dose - diosmin is absent from the Egyptian formulary chapters held here, and 500 mg twice daily is the manufacturer regimen. Evidence from Cochrane Review CD003229, Phlebotonics for venous insufficiency (Martinez-Zapata 2020) Why Single-ingredient alternative where the combination is unavailable or unaffordable. The same modest evidence applies. Caution Helps alleviate heaviness, leg pain, and nocturnal cramps. Inspect legs for venous eczema, lipodermatosclerosis, or active stasis ulceration. The treatment that fixes varicose veins is a referral - duplex ultrasound, then endothermal ablation or sclerotherapy. A tablet does not close an incompetent vein. Diosmin is a single-ingredient phlebotonic alternative. Egypt DIFLORUTACINE 500 MG 30 F.C.TABS. ARAB DRUG COMPANY (ADCO) 46.50 EGP (1.55/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)