Is There a Difference in the Clinical Efficacy of Diosmin and Micronized Purified Flavonoid Fraction for the Treatment of Chronic Venous Disorders? Review of Available Evidence

Abstract

Flavonoids are oral venoactive drugs frequently prescribed to relieve the symptoms of chronic venous disorders (CVD). Among venoactive drugs, diosmin is a naturally occurring flavonoid glycoside that can be isolated from various plant sources; it can also be obtained after conversion of hesperidin extracted from citrus rinds. Micronized purified flavonoid fraction (MPFF) is a preparation that contains mainly diosmin and a small fraction of hesperidin. We performed a state-of-the-art literature review to collect and analyze well-conducted randomized clinical studies comparing diosmin – also called non-micronized or hemisynthetic diosmin – 600 mg a day and MPFF, 1000 mg a day. Three clinical studies met the criteria and were included for this literature review. These clinical studies showed a significant decrease of CVD symptom intensity (up to approximately 50%) and global patient satisfaction after one-to-six-month treatment with diosmin or MPFF, without statistical differences between these two forms of diosmin. Both treatments were well tolerated with few mild adverse drug reactions reported. Overall, based on this literature review, there is no clinical benefit to increase the dose of diosmin beyond 600 mg per day, to use the micronized form, or to add hesperidin, since clinical efficacy on venous symptomatology is achieved with 600 mg per day of pure non-micronized diosmin. This challenges the status of diosmin – 600 mg a day – in guidelines for the management of CVD, which is currently categorized 2C (weak recommendations for use and poor quality of evidence), while the most widely used and assessed preparation MPFF is rated 1B (strong recommendation for use and moderate quality of evidence).

Identification of Diosmin and Flavin Adenine Dinucleotide as Repurposing Treatments for Monkeypox Virus: A Computational Study

“…Diosmin (diosmetin-7-O-rutinoside) is a naturally occurring flavone glycoside that can be isolated from a variety of plant sources or semi-synthesized from hesperidin, another natural flavanone glycoside [ 22 ]. Diosmin has previously been shown to have antioxidant, anti-inflammatory, anti-cancer, anti-diabetic, and anti-bacterial properties in various types of disease models [ 23 ].…”

Peran dan Efektivitas Micronized Purified Flavonoid Fraction dalam Terapi Pengobatan Hemoroid Kelas I dan II

“…Diosmin (diosmetin 7-O-rutinoside) adalah flavonoid alami yang dapat terisolasi dari beberapa tanaman atau disintesis dari flavonoid lain yang bernama hesperidin. 30,31 Pada dasarnya, diosmin memiliki manfaat yang sama dengan MPFF namun diosmin memiliki ukuran molekul yang masih terlalu besar sehingga hal tersebut memberikan pengaruh terhadap daya absorpsi usus. Untuk menjadi lebih efektif secara klinis, diperlukan micronization atau pengecilan diameter partikel.…”

“…Untuk menjadi lebih efektif secara klinis, diperlukan micronization atau pengecilan diameter partikel. 19,31 Peran Micronized Purified Flavonoid Fraction (MPFF) Micronized Purified Flavonoid Fraction atau MPFF adalah salah satu obat phlebotonik oral yang sebagian besar mengandung micronized diosmin (90%) dan campuran beberapa flavonoid lain yaitu diosmetin, hesperidin, linarin, dan isorhoifolin (10%). 29,31,32 MPFF juga merupakan agen flavonoid phlebotonik yang telah dimikronisasi hingga partikelnya memiliki ukuran yang lebih kecil dari 2 μm.…”

“…19,31 Peran Micronized Purified Flavonoid Fraction (MPFF) Micronized Purified Flavonoid Fraction atau MPFF adalah salah satu obat phlebotonik oral yang sebagian besar mengandung micronized diosmin (90%) dan campuran beberapa flavonoid lain yaitu diosmetin, hesperidin, linarin, dan isorhoifolin (10%). 29,31,32 MPFF juga merupakan agen flavonoid phlebotonik yang telah dimikronisasi hingga partikelnya memiliki ukuran yang lebih kecil dari 2 μm. Mikronisasi pada MPFF ini tidak hanya meningkatkan daya absorpsi usus dan solubilitas namun juga mengurangi durasi untuk beraksi pada tubuh.…”

A nationwide study of compliance of venoactive drugs in chronic venous disease patients

“…Compared with placebo, VADs may have beneficial effects on objective measures of leg edema and on some signs and symptoms related to CVD, such as pain, cramps, restless legs, sensation of swelling, paresthesia, and trophic disorders [ 3 ]. VADs are associated with adverse effects, and the selection of VAD is usually based on drug-related adverse events or efficacy [ 4 ].…”