Polidocanol
Pronunciation: pol-ee-DOE-ka-noleClass: Sclerosing agent
Trade Names
Asclera
- Injection, solution 0.5%
- Injection, solution 1%
Pharmacology
Induces endothelial damage, resulting in platelet aggregation and attachment to the venous wall. Subsequent formation of a dense network of platelets, cellular debris, and fibrin at the site of damage occludes the blood vessel and eventually replaces the occluded vein with connective fibrous tissue.
Pharmacokinetics
Absorption
Low systemic blood levels of polidocanol were seen in some patients.
Elimination
Half-life is 1.5 h.
Indications and Usage
Treatment of uncomplicated spider veins (varicose veins 1 mm or less in diameter) and uncomplicated reticular veins (varicose veins 1 to 3 mm in diameter) in the lower extremities.
Contraindications
Known allergy (anaphylaxis) to polidocanol; acute thromboembolic diseases.
Dosage and Administration
Reticular Veins (1 to 3 mm in diameter)Adults
IV 0.1 to 0.3 mL of 1% solution per injection (max, 10 mL per session).
Spider Veins (1 mm or less in diameter)Adults
IV 0.1 to 0.3 mL of 0.5% solution per injection (max, 10 mL per session).
General Advice
- For IV injection only.
- Use a syringe (glass or plastic) with a fine needle (26- or 30-gauge). Inject the solution slowly while the needle is still in the vein. Apply only gentle pressure during injection to prevent vein rupture.
- After injection, cover the injection site and apply compression in the form of stockings or bandage. Encourage the patient to walk for 15 to 20 minutes after the treatment session.
- Repeat treatments may be necessary if the extent of the varicose veins requires more than 10 mL. Separate treatments by 1 to 2 weeks.
- Small intravaricose blood clots (thrombi) that develop may be removed by stab incision and thrombus expression (microthrombectomy).
Storage/Stability
Store between 59° and 68°F. Each ampule is intended for immediate use. Unopened ampules are stable for up to 3 years.
Drug Interactions
None well documented.
Adverse Reactions
Cardiovascular
Cardiac arrest, cerebrovascular accident, circulatory collapse, deep vein thrombosis, hot flush, palpitations, pulmonary embolism, syncope vasovagal, vasculitis (postmarketing).
CNS
Confusional state, dizziness, loss of consciousness, migraine, paresthesia (local) (postmarketing).
Dermatologic
Dermatitis allergic, hypertrichosis (in the area of sclerotherapy), skin hyperpigmentation (postmarketing).
Hypersensitivity
Anaphylactic shock, angioedema, asthma, urticaria generalized (postmarketing).
Local
Hematoma (42%); irritation (41%); discoloration (38%); pain (24%); pruritus (19%); warmth (16%); neovascularization (8%); thrombosis (6%); necrosis, nerve injury (postmarketing).
Miscellaneous
Dyspnea, pyrexia (postmarketing).
Precautions
MonitorKeep the patient under observation to detect any anaphylactic or allergic reaction. |
Pregnancy
Category C .
Lactation
Undetermined.
Children
Safety and effectiveness have not been established.
Hypersensitivity
Severe allergic reactions, including anaphylactic reactions, some fatal, have been reported more frequently with the use of volumes more than 3 mL.
Accidental intra-arterial injection
Can cause severe necrosis, ischemia, or gangrene.
Extravasation
Severe adverse local effects, including tissue necrosis, may occur following extravasation.
Inadvertent perivascular injection
Can cause pain. Severe pain may be treated with a local injectable anesthetic (without adrenaline).
Overdosage
Symptoms
Overdose may result in a higher incidence of localized reactions, such as necrosis.
Patient Information
- Advise patient to wear compression stockings or support hose on the treated legs continuously for 2 to 3 days and for 2 to 3 weeks during the daytime.
- Advise patient to walk for 15 to 20 minutes immediately after the procedure and daily for the next few days.
- Advise patient to avoid heavy exercise, sunbathing, long plane flights, hot baths, or saunas for 2 to 3 days following treatment.
Copyright © 2009 Wolters Kluwer Health.
