Polidocanol

Pronunciation: pol-ee-DOE-ka-nole
Class: 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.

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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

Monitor

Keep 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.

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