Indications
Traditionally used for the symptomatic treatment associated with venous insufficiency and varicose veins.
Composition
EACH 25 DROP DOSE (0.76 ml) CONTAINS:
Fresh Horse Chestnut (Aesculus hippocastanum) seed tincture...........767 mg standardized to 17.92 mg aescin.
Non-medicinal ingredients: 1ml of tincture contains 0.64 ml of alcohol (ethanol).
Dosage
DOSAGE ADULTS: Take 25 drops in a small amount of water, 3 times per day, during meals. Salivate before swallowing.
Duration of use: May be used 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 edema, inflammation, etc. Its precise cause is still unknown but
many risk factors have been identified: excess weight, 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 hemorrhoids 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) and fragile capillaries.
Actions and pharmacology
Compared
to the tablet, the tincture has the advantage of being more quickly
absorbed and of allowing a fine-tuning of the dosage according to each
patient.
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 (edema,
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 leg cramps, pruritus and swelling of
the legs.
Scientific studies
Although
most of the published research was conducted on dry extracts of Horse
Chestnut seed, these extracts are derived from the more traditional
extract, the tincture. The results of the studies below may therefore
be extrapolated to the liquid form of Venaforce®.
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 edema 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)
Precautions,contraindications and interactions
Contraindication: known allergy to Horse Chestnut.
Horse Chestnut seed is not recommended during pregnancy and nursing.
It
can theoretically interact with anticoagulant drugs: do not combine
Venaforce® with Coumadin or other blood-thinning medications. Do not
use if you have impaired heart, kidney and/or liver functions.
The only reported side effect is a mild gastric discomfort that is eliminated when Venaforce® is taken with food.
The
most important risk factors of venous insufficiency can be controlled.
It is therefore necessary to modify these factors (lose excess weight;
improve the diet by eating more fruits, vegetables and whole grains;
stop smoking; exercise; etc.) to effectively stop the disease
progression.
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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