Indications
Traditionally used for the symptomatic treatment associated with venous insufficiency and varicose veins.
Composition
EACH TABLET CONTAINS:Dry extract from fresh Horse Chestnut (Aesculus hippocastanum) seeds...............76.5 mg standardized to 20 mg aescin.
Non-medicinal
ingredients: Microcrystalline cellulose, corn starch, methacrylic acid
copolymer, colloidal silicon dioxide, soy polysaccharides, talc,
triethyl citrate.
Dosage
Adults: Take 2 tablets with water, 3 times a day during meals. Duration of use: May be used to up to 6 weeks.
Historical overview
Venous
insufficiency is a complex state involving an increase in capillary and
vein pressure, an increase in capillary permeability, a blood stasis,
an oedema, inflammation, etc. Its precise cause is still unknown but
many risk factors have been identified: overweight, hypertension,
tobacco, alcohol, lack of physical activity, bad diet, pregnancy,
standing or sitting stationary work (nurse, pharmacist, clerk),
constipation, etc. The symptoms of venous insufficiency may be
benign, like heavy and tired legs, but may also be much more serious,
like varicose veins, painful haemorrhoids and even phlebitis. Aside
from surgery (that eliminates the diseased veins but does not stop the
progression of varicose veins), there are few treatments for venous
insufficiency. Support stockings are effective but so uncomfortable
that very few people wear them.
Horse Chestnut seed extract is
used for venous insufficiency problems (including phlebitis), fragile
capillaries, liver congestion, diarrhea and fever.
Actions and pharmacology
The
active ingredients of Horse Chestnut seeds are triterpene saponines
(about thirty) collectively known as aescine or escine. Aescine
increases vein wall resistance and reduces permeability (seepage),
objectively reducing venous insufficiency symptoms (oedema, swelling,
etc.). Horse Chestnut seed extract is known for its phlebotonic,
antioxidant, anti-inflammatory and vein wall protector effects.(1) It
inhibits elastase and hyaluronidase activity. These two enzymes degrade
the vein wall and the surrounding tissues (like collagen) therefore
increasing venous insufficiency symptoms and progression (like spider
veins, varicose veins and hemorrhoids).(2)
In vitro, aescine has demonstrated an anti-inflammatory effect.(3)
Horse
Chestnut seed cannot reverse varicose veins.(4) Its effect is limited
to symptom control and a slowing down of the disease progression,
translating in an increased quality of life.
The German
Commission E acknowledges its benefits in cases of: treatment of
complaints found in pathological conditions of the veins of the legs
(chronic venous insufficiency), for example, pains and a sensation of
heaviness in the legs, nocturnal systremma (cramps in the calves),
pruritis and swelling of the legs.
Scientific studies
A
meta-analysis has collected all controlled studies conducted on Horse
Chestnut seed extract up to 1996. Horse Chestnut seed extracts have
been found effective against venous insufficiency symptoms like
swelling of the legs, itching, pain, fatigue and heavy legs. Five
studies demonstrated that Horse Chestnut seed extract was more
effective than a placebo and as effective as the other available
medications. One study demonstrated that Horse Chestnut seed extract
was as effective as support stockings. Moreover, all researchers
concluded that side effects were minor and few.(5)
A 12 weeks
placebo-controlled clinical study conducted on 240 patients
demonstrated that Horse Chestnut seed extract (50 mg aescine, twice
daily) reduces by 25% the volume of oedema in the legs (same
effectiveness as support stockings). The authors mention that the full
effect of Horse Chestnut cannot be obtained in 12 weeks and that a
longer period of use would yield better results.(6)
A
double-blind placebo-controlled multicentric study was conducted with
Venaforce® on 52 patients showing signs of chronic venous
insufficiency. In the treated group (2 tablets, 3 times daily), the
ankle diameter was reduced by 0.5 cm while, in the control group, no
changes were observed. The side effects reported were similar to those
of the placebo. Venaforce® is very well tolerated and is effective to
relieve chronic venous insufficiency symptoms.(7)
The protective
film coating the Venaforce® tablets is resistant to stomach acidic
juices. Hence, the active substance is released in the small intestine
and causes no strains to the stomach.
Precautions, contraindications and interactions
Do
not use if you have impaired heart, kidney and/or liver functions. Do
not use if you are pregnant or breastfeeding. Avoid taking in case of
known allergy to any of the ingredients of the product.
CAUTION:
Consult a health care practitioner prior to use if you are taking blood
thinners or if you have bleeding disorders. Consult a health care
practitioner if symptoms persist.
References
1-Guillaume
M, Padioleau F. Veinotonic effect, vascular protection,
anti-inflammatory and free radical scavenging properties of Horse
Chestnut extract. Arzneimittelforschung 1994;44:25-35.
2-Facino
RM, Carini M, Stefani R, et al. Anti-elastase and anti-hyaluronidase
activities of saponins and sapogenins from Hedera helix, Aesculus
hippocastanum, and Ruscus aculeatus: factors contributing to their
efficacy in the treatment of venous insufficiency. Arch Pharm
(Weinheim) 1995;328:720-724.
3-Matsuda H, Li Y, Murakami T, et
al. Effects of escins Ia, Ib, IIa, and IIb from Horse Chestnut, the
seeds of Aesculus hippocastanum L., on acute inflammation in animals.
Biol Pharm Bull 1997;20:1092-1095.
4-Brunner F, Hoffmann C,
Schuller-Petrovic S. Responsiveness of human varicose saphenous veins
to vasoactive agents. Br J Clin Pharmacol 2001 Mar;51(3):219-24.
5-Pittler
MH, Ernst E. Horse-chestnut seed extract for chronic venous
insufficiency. A criteria-based systematic review. Arch Dermatol 1998
Nov;134(11):1356-60
6-Diehm C, Trampisch HJ, Lange S, Schmidt
C. Comparison of leg compression stocking and oral horse-chestnut seed
extract therapy in patients with chronic venous insufficiency. Lancet
1996;347:292-294
7-Shah D, Bommer S, Degenring FH.
Aesculaforce (Venaforce® au Canada) dans l'insuffisance veineuse
chronique. Schweiz Zschr GanzheitMedizin 1997;9(2):86-91.
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