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Polidocanol (Local) (Monograph)

Brand name: Asclera
Drug class: Vasodilating Agents

Medically reviewed by on Apr 10, 2024. Written by ASHP.


Sclerosing agent; nonionic detergent.

Uses for Polidocanol (Local)


Treatment of uncomplicated spider veins (varicose veins ≤1 mm in diameter) in lower extremity.

Treatment of uncomplicated reticular veins (varicose veins 1–3 mm in diameter) in lower extremity.

Not studied in varicose veins >3 mm in diameter.

Polidocanol (Local) Dosage and Administration


IV Administration

Administer only by IV injection. Avoid extravasation. (See Administration Precautions under Cautions.)

Commercially available as 0.5 or 1% solution in single-use ampuls (containing a total of 10 or 20 mg, respectively, in each 2-mL ampul). Has been administered as an endovenous foam or microfoam; these preparations not commercially available in US and extemporaneous preparation of polidocanol foam not approved by FDA.

Administration Procedure

Use a syringe (glass or plastic) with a fine needle (typically, 26- or 30-gauge). Insert needle tangentially into target vein and inject solution slowly while needle is still in vein. To prevent vein rupture, only apply gentle pressure during injection.

After removing needle from target vein and covering injection site, apply compression in the form of a stocking or bandage. After treatment session, have patient walk for 15–20 minutes and observe patient to detect any anaphylactic or allergic reaction. (See Sensitivity Reactions under Cautions.)

Advise patient to maintain compression (stocking or bandage) for 2–3 days after treatment of spider veins or 5–7 days after treatment of reticular veins. For extensive varicosities, longer compression treatment with compression bandages or gradient compression stocking of a higher compression class is recommended.

If small intravaricose blood clots (thrombi) develop, they may be removed by stab incision and thrombus expression (microthrombectomy).



Uncomplicated Varicose Veins in Lower Extremity

Concentration of polidocanol solution (0.5 or 1%) and injection volume depend on type and size of varicose veins. After polidocanol treatment, compression is necessary to reduce risk of deep vein thrombosis. (See IV Administration under Dosage and Administration.)

Spider veins (varicose veins ≤1 mm in diameter): 0.1–0.3 mL (0.5–1.5 mg) of 0.5% solution for each injection. Do not exceed 10 mL (50 mg) per treatment session.

Reticular veins (varicose veins 1–3 mm in diameter): 0.1–0.3 mL (1–3 mg) of 1% solution for each injection. Do not exceed 10 mL (100 mg) per treatment session.

Repeat treatments may be necessary if extent of varicose veins requires >10 mL of solution. Separate treatment sessions by 1–2 weeks.

Prescribing Limits


Uncomplicated Varicose Veins in Lower Extremity

Maximum 0.3 mL of 0.5 or 1% solution (1.5 or 3 mg, respectively) per injection site; maximum 10 mL per treatment session.

Cautions for Polidocanol (Local)



Sensitivity Reactions

Severe allergic reactions (e.g., anaphylactic reactions), including some fatalities, reported. Severe reactions more frequent with larger volumes (>3 mL). Use minimal required dose.

Postmarketing reports of allergic dermatitis, angioedema, generalized urticaria, and asthma.

Observe patient for 15–20 minutes after polidocanol treatment session in case an anaphylactic or allergic reaction occurs. Clinicians should be prepared to provide appropriate treatment of anaphylaxis.

Administration Precautions

Extravasation may result in severe adverse local effects, including tissue necrosis. Carefully place IV needle into target vein; use smallest effective volume of solution at each injection site. Overdosage may result in higher incidence of localized reactions such as necrosis.

After polidocanol treatment session, apply compression to treatment area with a stocking or bandage and have patient walk for 15–20 minutes. (See IV Administration under Dosage and Administration.) Supervise patient during this period in case an anaphylactic or allergic reaction occurs. (See Sensitivity Reactions under Cautions.)

Accidental Intra-arterial Injection

Accidental intra-arterial injection may cause severe necrosis, ischemia, or gangrene. Immediately consult vascular surgeon if occurs.

Inadvertent Perivascular Injection

Inadvertent perivascular injection can cause pain. If pain is severe, a local anesthetic (without adrenaline) may be injected.

Specific Populations


Category C.

Do not use during pregnancy.

Labor and Delivery

Effects on labor and delivery unknown.


Not known whether distributed into human milk. Potential for serious adverse reactions in nursing infants; avoid use in nursing women.

Pediatric Use

Safety and efficacy not established in pediatric patients.

Geriatric Use

Insufficient experience in patients ≥65 years to determine whether geriatric patients respond differently than younger adults.

Common Adverse Effects

Injection site reactions including hematoma, irritation, discoloration, pain, pruritus, warmth, neovascularization, thrombosis.

Drug Interactions

No drug interaction studies.

Polidocanol (Local) Pharmacokinetics



Rapid onset and offset of local sclerosing effect.

Plasma Concentrations

Following IV injection of 4.5–18 mg in 4 adults, low systemic plasma concentrations were observed. Peak concentrations occurred 5 minutes after IV injection.



Not known.

Elimination Route

Not known.


Mean apparent terminal half-life is 1.5 hours.




Solution for IV Injection

15–30°C. Use immediately after opening ampul; does not contain a preservative.


Advice to Patients


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.



Dosage Forms


Brand Names



Injection, for IV use







AHFS DI Essentials™. © Copyright 2024, Selected Revisions April 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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