Diosmin is a natural flavonoid predominantly found in citrus fruits, known for its remarkable antioxidant properties. These plant compounds play a crucial role in defending the body against inflammation and protecting it from unstable molecules known as free radicals. Isolated for the first time from the figwort plant (Scrophularia nodosa L.) in 1925, diosmin has been utilized since 1969 as a natural remedy for various ailments, including hemorrhoids, varicose veins, venous insufficiency, leg ulcers, and other circulatory conditions. This compound is thought to diminish inflammation and improve blood circulation in individuals suffering from venous insufficiency, a medical condition characterized by impaired blood flow.

In contemporary practices, diosmin is often sourced from another flavonoid called hesperidin, which is also present in citrus fruits, particularly in the peels of oranges. Diosmin is frequently combined with micronized purified flavonoid fraction (MPFF), a blend of flavonoids that includes disomentin, hesperidin, linarin, and isorhoifolin. Typically, diosmin supplements contain approximately 90% diosmin and 10% hesperidin, and they are commonly referred to as MPFF. It is important to note that the terms “diosmin” and “MPFF” are often used interchangeably.

This supplement is readily available over the counter across various regions, including the United States, Canada, and several European countries. Depending on the location, it may be marketed under names such as Diovenor, Daflon, Barosmin, citrus flavonoids, Flebosten, Litosmil, or Venosmine.

Benefits and Uses

Diosmin is predominantly utilized for managing blood vessel disorders, particularly conditions such as hemorrhoids and chronic venous insufficiency (CVI). Hemorrhoids are characterized by swollen veins near the anus, while CVI involves swollen and blocked veins in the legs.

This compound may also be beneficial for other vascular issues, including varicose veins, blood clots, retinal hemorrhage (known as netra raktapaat in Hindi), venous leg ulcers, and venous stasis (a condition marked by slow blood flow in the legs).

Hemorrhoids

Multiple studies have indicated that diosmin is effective in treating both internal and external hemorrhoids. A review encompassing 24 studies with over 2,300 participants found that plant flavonoids like diosmin significantly decreased symptoms associated with hemorrhoids, such as itchiness, bleeding, discharge, and other related discomforts. Additional research corroborates these findings, revealing that diosmin can also shorten recovery time after hemorrhoidectomy, which is the surgical removal of hemorrhoids. While these outcomes are encouraging, it is important to note that most benefits are observed in individuals experiencing early stages of hemorrhoid disease. Overall, diosmin may not be as effective as alternative hemorrhoid treatments.

Chronic Venous Disease

Chronic venous disease (CVD) is a general term encompassing various conditions associated with weakened or diseased veins, including CVI, varicose veins, spider veins, leg ulcers, and phlebitis, where leg veins become inflamed.

A 2012 review of ten studies found moderate evidence supporting the efficacy of MPFF (diosmin) in alleviating CVD symptoms, which include leg ulcers, edema, varicose veins, sensations of tingling, overall quality of life, and subjective pain levels. Moreover, a 2016 review and a 2018 meta-analysis reinforced these conclusions, demonstrating that diosmin effectively reduced symptoms such as leg heaviness, swelling, cramps, and restless leg syndrome.

The mechanisms through which diosmin aids CVD involve decreasing inflammation, enhancing vein health, and boosting both blood and lymphatic circulation. However, a 2017 study involving 1,051 participants indicated that diosmin might not be as effective as other medications, such as Venoruton (produced by Novartis) and Pycnogenol (derived from pine bark extract). Similar findings have been reported in other studies. While diosmin can help alleviate CVD symptoms, consulting a healthcare professional before starting any supplementation is advisable.

Back Pain

In one investigation, 300 participants reported minor relief from back pain after taking 900 mg of diosmin three times daily for two weeks, followed by the same dosage twice daily for two additional weeks, concluding with a maintenance dose of 450 mg twice daily for one month. Nonetheless, when compared to a control group receiving mannitol and dexamethasone, diosmin did not demonstrate superior effectiveness in reducing back pain sensations.

Further research is essential to determine whether diosmin can effectively assist in managing back pain compared to more established treatment options.

Other Conditions

Some individuals use diosmin for various conditions such as lymphedema (swelling due to lymphatic system issues), varicocele (enlargement and pain in veins of the scrotum), minor bleeding episodes, pelvic pain, and rosacea. Diosmin is recognized as an anti-inflammatory compound and may contribute to the treatment of several inflammatory and circulatory disorders. Though small-scale studies have shown promising results in alleviating symptoms of lymphedema, varicocele, minor nasal bleeding, and pelvic pain, more extensive research is necessary before making widespread clinical recommendations.

Potential Side Effects and Safety Precautions

Diosmin is widely regarded as a safe supplement available over-the-counter. This natural compound, typically derived from citrus fruits, is often used to support vascular health and improve circulation. While side effects are infrequent, some individuals may experience discomfort such as abdominal pain, diarrhea, headaches, dizziness, skin rashes, hives, muscle aches, and, in rare instances, an irregular heartbeat. It's essential to monitor your body's reactions when introducing a new supplement.

If you encounter any adverse effects after consuming diosmin, it's advisable to stop using the product immediately and consult with your healthcare professional. In cases of severe abdominal pain, persistent diarrhea (characterized by 10 or more loose stools within a 24-hour period), or signs of an irregular heartbeat, seek emergency medical care without delay.

Dosage and Administration

Diosmin is readily available without a prescription in several countries, including the United States, Canada, and various European nations. It is primarily marketed as a micronized purified flavonoid fraction (MPFF), which typically comprises 90% diosmin and 10% hesperidin.

The most well-known and extensively studied supplement is Daflon 500, which contains 450 mg of diosmin and 50 mg of hesperidin. In some areas, this product is also referred to as Detralex. However, numerous other diosmin formulations may be found at local pharmacies and online retailers.

Most diosmin supplements suggest consuming one 500 mg tablet with a meal once in the morning and once in the evening, leading to a daily total of 1,000 mg. These dosage recommendations, when followed under the supervision of a healthcare professional, have been demonstrated to be both safe and effective for a variety of conditions:

  • Chronic venous disease: 1,000 mg daily for a duration of 3 to 6 months
  • Hemorrhoids: 1,000 to 2,000 mg daily for 4 days, followed by 1,000 mg daily for the next 3 days
  • Varicose veins: 1,000 to 2,000 mg daily for a maximum of 6 months

It is essential to avoid using diosmin for longer than 3 months or exceeding the recommended dosage indicated on the packaging, unless otherwise directed by your healthcare provider.

Overdose

As of now, there have been no documented instances of diosmin overdose or any reports indicating toxicity associated with its use. However, it is vital to adhere to the guidelines outlined on the product label and consult with a healthcare professional to ensure that it is suitable for your individual health needs.

Interactions

Diosmin has the potential to interact with several medications, which is crucial to consider for those who rely on these treatments:

  • anticoagulants (like Warfarin)
  • anticonvulsants (including Carbamazepine and Phenytoin/Dilantin)
  • antihistamines (for instance, Allegra)
  • muscle relaxants (such as Chlorzoxazone)
  • non-steroidal anti-inflammatory drugs (like Voltaren, Motrin, Advil, and Aleve)
  • acetaminophen (commonly known as Tylenol)

It is important to note that diosmin may inhibit various liver enzymes that are responsible for metabolizing these medications. Consequently, this could lead to diminished effectiveness of the medications and potentially pose risks, particularly for individuals with bleeding disorders, as it may interfere with proper blood clotting. Moreover, diosmin may also interact with certain herbal supplements, including fenugreek (methi), feverfew, garlic (lahsun), ginger (adrak), ginkgo, ginseng, and turmeric (haldi), owing to their blood-thinning properties.

If you are currently taking any of these medications or herbal supplements, it is essential to consult your healthcare provider before incorporating diosmin into your regimen.

Storage and Handling

It is essential to keep diosmin in a cool and dry place, like a medicine cabinet, to maintain its efficacy. Always check the label for any specific instructions and ensure that you do not consume any supplements after their expiration date to ensure safety and effectiveness.

Pregnancy and Breastfeeding

Given the insufficient safety research regarding diosmin, it is advisable for women who are pregnant or nursing to refrain from using this supplement. It is crucial to prioritize the health of both mother and child during this sensitive period.

Before introducing any supplements or medications into your routine, it is always wise to consult with your healthcare provider to ensure safety and appropriateness.

Considerations for Specific Populations

Individuals with bleeding disorders should exercise caution when considering diosmin, as it may exacerbate bleeding. It is advisable to refrain from using this supplement unless explicitly directed by a healthcare professional. Moreover, children and teenagers are recommended to avoid diosmin due to the lack of available safety studies in these age groups. For those with pre-existing conditions such as diabetes, cardiovascular disease, or inflammatory bowel disease (IBD), consulting a healthcare provider before starting diosmin is essential to ensure safety and appropriateness.

Alternatives

Depending on your specific health condition, there are numerous other products or treatments that may serve as effective alternatives to diosmin:

  • Hemorrhoids: A diet rich in fiber, application of topical creams and suppositories, as well as over-the-counter analgesics like Advil, Motrin, or Tylenol, can be beneficial. Additionally, prescription medications, injections, and surgical options such as hemorrhoid removal or stapling are available.
  • Cardiovascular Diseases (CVD), including varicose veins: Non-prescription pain relief options (like Advil, Motrin, or Tylenol), wearing compression socks, engaging in regular exercise, and considering supplements such as Antistax (red vine leaf extract) may help. Moreover, prescription medications, sclerotherapy, laser treatments, or radiofrequency ablation, alongside surgical options like vein ligation, are also effective.

While diosmin has demonstrated benefits for these conditions, your healthcare professional might suggest a tailored combination of therapies. For optimal outcomes, it is essential to adhere to your healthcare provider's advice.