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Does diosmin help varicose veins?

A little, for swelling and aching, but not for the veins themselves. In a Cochrane review, vein-toning pills that include diosmin probably reduced lower-leg swelling slightly (13 trials, 1,245 people) but made little or no difference to quality of life. Grade B. The trials tracked symptoms and swelling, not whether varicose veins shrank. Diosmin can raise blood levels of some medicines, and a vein specialist can close the faulty vein.

Last reviewed

How we grade evidenceEditorial policy

What the studies found

  • Grade B. Swelling eased slightly. A Cochrane review of vein-toning pills taken by mouth (diosmin and others) found they probably reduce lower-leg swelling a little (13 trials, 1,245 people) and ankle size by about 4 mm (15 trials, 2,010 people), with moderate certainty. Only 11 of the trials with usable data tested diosmin or its close relative hidrosmine, so diosmin's own effect is less certain. (Martinez-Zapata 2020)
  • Grade B. Aching and heaviness: a diosmin product helped, but daily life barely changed. A 2018 review of 7 placebo-controlled trials of micronized purified flavonoid fraction (MPFF, 90% diosmin with hesperidin) found less leg pain, heaviness, cramps and feeling of swelling. Across all vein pills, Cochrane found little or no difference in quality of life (5 trials, 1,639 people). (Kakkos 2018; Lyseng-Williamson 2003; Martinez-Zapata 2020)
  • Grade C. Leg ulcers: vein pills made little or no difference to healing (6 trials, 461 people, low certainty). (Martinez-Zapata 2020)
  • Grade B. Horse chestnut seed extract, the other common vein pill, eased leg pain in 6 of 7 placebo-controlled trials and cut leg volume slightly over the short term. (Pittler 2012)

Who should be careful

  • Vein pills probably cause slightly more side effects than placebo, mostly stomach and gut upsets, and only short-term safety is known (Martinez-Zapata 2020).
  • In small studies of healthy volunteers, 10 days of diosmin raised blood levels of carbamazepine (a seizure medicine) and fexofenadine (an allergy medicine) (Bedada 2017a; Bedada 2017b). Ask a pharmacist before adding it to any regular medicine, and don't stop or change a prescribed medicine on your own.
  • Raw horse chestnut seeds, bark, flowers and leaves are unsafe to eat; only the processed seed extract was tested (NCCIH).
  • Get care the same day for a bleeding varicose vein, or one leg that suddenly swells and hurts. See a doctor for a hard, painful vein, skin changes, or a sore below the knee that hasn't healed in 2 weeks (NICE CG168).
  • If you are pregnant, breastfeeding or under 18, ask a clinician first.

Try first

  • See a vein specialist if your veins ache, swell or itch. The UK's national guideline (NICE) advises an ultrasound scan, then endothermal ablation (heat that seals the faulty vein shut) for confirmed varicose veins with backflow, and foam injections if that isn't suitable (NICE CG168).
  • Keep moving and manage weight: NICE advises light to moderate physical activity and weight loss advice (NICE CG168).
  • Compression stockings may ease symptoms, but the 13 trials (1,021 people) were small and low to very low certainty, and itching and discomfort were common (Knight 2021). NICE does not offer them as treatment unless a procedure is unsuitable.

Sources

  1. Martinez-Zapata MJ, et al. Phlebotonics for venous insufficiency. Cochrane Database Syst Rev. 2020. PubMed 33141449 · doi:10.1002/14651858.CD003229.pub4
  2. Kakkos SK, et al. Efficacy of micronized purified flavonoid fraction (brand name omitted) on improving individual symptoms, signs and quality of life in patients with chronic venous disease: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials. Int Angiol. 2018. PubMed 29385792 · doi:10.23736/S0392-9590.18.03975-5
  3. Lyseng-Williamson KA, et al. Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs. 2003. PubMed 12487623 · doi:10.2165/00003495-200363010-00005
  4. Pittler MH, et al. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2012. PubMed 23152216 · doi:10.1002/14651858.CD003230.pub4
  5. Bedada SK, et al. Influence of diosmin on the metabolism and disposition of carbamazepine in healthy subjects. Xenobiotica. 2017. PubMed 27690733 · doi:10.1080/00498254.2016.1244368
  6. Bedada SK, et al. The effect of diosmin on the pharmacokinetics of fexofenadine in healthy human volunteers. Xenobiotica. 2017. PubMed 27151911 · doi:10.1080/00498254.2016.1180564
  7. Knight Nee Shingler SL, et al. Graduated compression stockings for the initial treatment of varicose veins in people without venous ulceration. Cochrane Database Syst Rev. 2021. PubMed 34271595 · doi:10.1002/14651858.CD008819.pub4