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Detralex - official* instructions for use. Auxiliary substance for polishing tablets. Directions for use and doses

Instructions:

Clinical and pharmacological group

01.074 (Venotonic drug)

Release form, composition and packaging

Orange-pink, oval, film-coated tablets; at the break - from pale yellow to yellow color, heterogeneous structure.

Excipients: gelatin, magnesium stearate, microcrystalline cellulose, sodium carboxymethyl starch, talc, purified water.

Film shell composition: macrogol 6000, sodium lauryl sulfate, orange-pink premix for film shell (glycerol, magnesium stearate, hypromellose, yellow iron oxide, red iron oxide, titanium dioxide).

15 pcs. - blisters (2) - cardboard packs. 15 pcs. - blisters (4) - cardboard packs.

pharmachologic effect

A drug used for venous circulation disorders. Detralex® has venotonic and angioprotective properties. The drug reduces the distensibility of veins and venous stasis, reduces capillary permeability and increases their resistance. results clinical trials confirm the pharmacological activity of the drug in relation to indicators of venous hemodynamics.

A statistically significant dose-dependent effect was demonstrated for the following venous plethysmographic parameters: venous capacity, venous distensibility, venous emptying time.

The optimal dose-effect ratio is observed when taking 2 tablets.

Increases venous tone: using venous occlusion plethysmography, a decrease in venous emptying time has been shown. In patients with signs of severe microcirculation disorders, there is a (statistically significant) increase in capillary resistance, assessed by angiostereometry, after treatment with Detralex, compared with placebo.

Proven therapeutic effectiveness in the treatment of functional and organic chronic venous insufficiency lower limbs, as well as in proctology in the treatment of hemorrhoids.

Pharmacokinetics

Metabolism

The drug undergoes active metabolism, which is confirmed by the presence of phenolic acids in the urine.

Removal

T1/2 of diosmin is 11 hours.

Diosmin is excreted from the body mainly in feces. 14% is excreted by the kidneys dose taken.

Dosage

Overdose

No cases of overdose of Detralex® have been reported.

Drug interactions

Drug interactions The drug Detralex® has not been described.

Use during pregnancy and lactation

To date there have been no reports of any side effects when using the drug in pregnant women.

It is unknown whether diosmin is released from breast milk in humans, therefore it is not recommended to prescribe the drug during lactation.

In experimental studies, no teratogenic effects of Detralex were observed.

Side effects

Frequency adverse reactions presented in accordance with the following gradation: very often (>1/10), often (>1/100,<1/10), умеренно (>1/1000, <1/100), редко (>1/10 000, <1/1000), очень редко (<10 000), включая отдельные сообщения.

From the digestive system: often - diarrhea, nausea, vomiting, dyspepsia.

From the side of the central nervous system: rarely - dizziness, headache, general malaise.

Dermatological reactions: rarely - rash, itching, urticaria.

Storage conditions and periods

List B. The drug should be stored out of the reach of children. Shelf life - 4 years. Do not use after the expiration date indicated on the package.

Indications

Symptomatic treatment of venous-lymphatic insufficiency:

- feeling of heaviness in the legs;

- "morning fatigue" of the legs.

Symptomatic treatment of acute hemorrhoids.

Contraindications

- hypersensitivity to the components of the drug.

special instructions

In case of exacerbation of hemorrhoids, the prescription of this drug does not replace the specific treatment of other anal disorders. The duration of treatment should not exceed the recommended periods. If symptoms do not disappear after short therapy, a proctological examination should be performed and the therapy reviewed.

In the presence of venous circulation disorders, the maximum effect of treatment is ensured by a combination with a healthy, well-balanced lifestyle, in which it is advisable to avoid long exposure to the sun, long periods of standing, and also reduce excess body weight, take walks and, in some cases, wear special stockings , improving blood circulation.

Impact on the ability to drive vehicles and operate machinery

The drug does not affect the ability to drive vehicles or perform work that requires a high speed of psychomotor reactions.

Conditions for dispensing from pharmacies

The drug is available with a doctor's prescription.

Registration numbers

. tab., cover film coating, 450 mg+50 mg: 30 or 60 pcs. P N011469/01 (2026-06-09 - 0000-00-00)

Tradename

Detralex®

Dosage form

Compound

Active substance:

Excipients:

Film shell:

Sodium lauryl sulfate 0.130 mg, premix for film shell of orange-pink color OY-S-8761, consisting of: glycerol 1.628 mg, hypromellose 27.039 mg, macrogol 6000 0.651 mg, magnesium stearate 1.628 mg, red iron oxide dye 0.211 mg, titanium dioxide 5.205 mg, iron dye yellow oxide 0.633 mg.

macrogol 6000 1,300 mg. The mass of the film-coated tablet is 1378.425 mg. 1) Taking into account the average moisture content of the purified, micronized flavonoid fraction - 4%, (or 40 mg per tablet), the amount of substance per tablet is 1040.00 mg.

Description

  • PHARMACOLOGICAL PROPERTIES

    Pharmacodynamics

    • venous capacity,
    • venous distensibility,

    Pharmacokinetics

    Pharmacotherapeutic group

    ATX code: C05CA53

  • INDICATIONS AND CONTRAINDICATIONS

    Indications

    • pain;
    • spasms of the lower extremities;
    • "tired" legs.
    • swelling of the lower extremities;
    • venous trophic ulcers.

    Contraindications

    Pregnancy:

    Lactation:

  • METHOD OF APPLICATION AND DOSES

    1 tablet per day.

  • SIDE EFFECT

    Side effects of the drug

    <1/10); нечасто (≥1/1 000, <1/100); редко (≥1/10 000, <1/1 000); крайне редко (<1/10 000), неуточненной частоты (частота не может быть подсчитана по доступным данным).

    Uncommon: colitis. Unspecified frequency: abdominal pain.

    From the skin: Rarely: rash, itching, urticaria.

    Overdose

    Not noted.

  • SPECIAL INSTRUCTIONS

  • Release form

    Storage

    Best before date

    Vacation conditions

    Available without a prescription.

    • GENERAL INFORMATION

      Tradename

      Detralex®

      Purified micronized flavonoid fraction (diosmin + flavonoids in terms of hesperidin)

      Dosage form

      Suspension for oral administration.

      Compound

      One sachet (10 ml) contains:

      Active substance:

      Purified micronized flavonoid fraction 1000 mg, containing diosmin 900.0 mg (90%) and flavonoids, calculated as hesperidin 100.0 mg (10%).

      Excipients:

      Citric acid 12.5 mg, orange flavor 15.0 mg, maltitol 1800.0 mg, sodium benzoate 15.0 mg, xanthan gum 50.0 mg, purified water q.s. up to 10 ml.

      Description

      A homogeneous suspension of light yellow color with a characteristic odor.

    • PHARMACOLOGICAL PROPERTIES

      Pharmacodynamics

      Detralex® has venotonic and angioprotective properties. The drug reduces the distensibility of veins and venous stagnation, reduces capillary permeability and increases their resistance. The results of 1 clinical studies confirm the pharmacological activity of the drug in relation to indicators of venous hemodynamics. A statistically significant dose-dependent effect of the drug Detralex® was demonstrated for the following venous plethysmographic parameters: venous capacity, venous distensibility, venous emptying time. The optimal dose-effect ratio is observed when taking 1000 mg per day. Detralex® increases venous tone: using venous occlusion plethysmography, a decrease in the time of venous emptying was shown. In patients with signs of severe microcirculation disorders after drug therapy. Detralex® is observed (statistically significant compared to placebo) increase in capillary resistance, assessed by angiostereometry. The therapeutic effectiveness of the drug Detralex® has been proven in the treatment of chronic diseases of the veins of the lower extremities, as well as in the treatment of hemorrhoids. Detralex® reduces undesirable side effects of invasive methods of treating CVD (reduces the frequency of undesirable side effects during surgical and endovascular treatment of varicose veins: significantly reduces the intensity of postoperative pain, swelling and severity of hemorrhages after endovascular and surgical treatment).

      Pharmacokinetics

      The main excretion of the drug occurs in the feces. On average, about 14% of the administered amount of the drug is excreted in the urine. The half-life is 11 hours. The drug undergoes active metabolism, which is confirmed by the presence of phenolic acids in the urine.

      Pharmacotherapeutic group

      Venotonic and venoprotective agent.

      ATX code: C05CA53

    • INDICATIONS AND CONTRAINDICATIONS

      Indications

      Detralex® is indicated for the treatment of symptoms of chronic venous diseases (elimination and relief of symptoms).

      Treatment of symptoms of venous-lymphatic insufficiency:

      • pain;
      • spasms of the lower extremities;
      • feeling of heaviness and fullness in the legs;
      • "tired" legs.

      Treatment of manifestations of venous-lymphatic insufficiency:

      • swelling of the lower extremities;
      • trophic changes in the skin and subcutaneous tissue;
      • venous trophic ulcers.

      Symptomatic treatment of acute and chronic hemorrhoids.

      Contraindications

      Hypersensitivity to the active substance or to the excipients included in the drug. Fructose intolerance. The drug is not recommended for nursing women.

      Pregnancy and lactation period

      Pregnancy:

      Experiments on animals did not reveal teratogenic effects. To date, there have been no reports of adverse effects when using the drug by pregnant women.

      Lactation:

      Due to the lack of data regarding the excretion of the drug in breast milk, taking the drug is not recommended for nursing women.

      Effect on reproductive function:

      Reproductive toxicity studies showed no effect on reproductive function in rats of either sex.

    • METHOD OF APPLICATION AND DOSES

      1000 mg (contents of 1 sachet) per day, preferably in the morning, with meals. The duration of treatment can be several months (up to 12 months). In case of recurrence of symptoms, on the recommendation of a doctor, the course of treatment can be repeated.

      3000 mg per day (1000 mg (contents of 1 sachet) in the morning, afternoon and evening) for 4 days, then 2000 mg per day (1000 mg (contents of 1 sachet) morning and evening) for the next 3 days.

      1000 mg (contents of 1 sachet) per day at any convenient time of the day with meals.

    • SIDE EFFECT

      Side effects of the drug

      Side effects of Detralex® observed during clinical trials were mild. Disorders from the gastrointestinal tract (diarrhea, dyspepsia, nausea, vomiting) were predominantly observed. While taking the drug Detralex®, the following side effects were reported, in the following gradation: very often (>1/10); often (>1/100,<1/10); нечасто (>1/1 000, <1/100); редко (>1/10 000, <1/1 000); крайне редко (<1/10 000), неуточненной частоты (частота не может быть подсчитана по 5 доступным данным).

      From the central nervous system:

      Rarely: dizziness, headache, general malaise.

      From the gastrointestinal tract:

      Common: diarrhea, dyspepsia, nausea, vomiting.

      Uncommon: colitis.

      Unspecified frequency: abdominal pain.

      From the skin:

      Rarely: rash, itching, urticaria.

      Unspecified frequency: isolated swelling of the face, lips, eyelids.

      In exceptional cases, angioedema.

      INFORM YOUR DOCTOR ABOUT ANY ADVERSE REACTIONS AND SENSATIONS YOU HAVE, INCLUDING ANY ADVERSE REACTIONS AND SENSATIONS, INCLUDING THOSE NOT MENTIONED IN THIS INSTRUCTION, AS WELL AS CHANGES IN LABORATORY VALUES DURING THE THERAPY.

      Overdose

      No cases of overdose have been described.

      In case of drug overdose, seek medical help immediately.

      Interaction with other drugs

      Not noted.

      YOU SHOULD INFORM YOUR DOCTOR ABOUT ALL MEDICINES YOU ARE TAKEN.

    • SPECIAL INSTRUCTIONS

      • Before you start taking Detralex®, it is recommended to consult your doctor.
      • In case of exacerbation of hemorrhoids, the prescription of Detralex® does not replace the specific treatment of other anal disorders. The duration of treatment should not exceed the periods specified in the "Method of administration and dosage" section. If the symptoms do not disappear after the recommended course of therapy, you should be examined by a proctologist, who will select further therapy.
      • In the presence of venous circulation disorders, the maximum effect of treatment is ensured by a combination of therapy with a healthy (balanced) lifestyle: it is advisable to avoid long exposure to the sun, long periods of standing, and it is also recommended to reduce excess body weight. Walking and, in some cases, wearing special stockings help improve blood circulation. Contact your doctor immediately if your condition worsens or does not improve during treatment.
      • Impact on the ability to drive a car and perform work that requires high speed of mental and physical reactions: No effect.
    • RELEASE FORM AND STORAGE CONDITIONS

      Release form

      Oral suspension, 1000 mg/10 ml. 10 ml of suspension for oral administration in multilayer sachets (polyester, aluminum, polyethylene). 15 or 30 sachets along with instructions for medical use in a cardboard pack.

      Storage

      At a temperature not higher than 30°C. Keep out of the reach of children.

      Best before date

      3 years. Do not use after the expiration date stated on the package.

      Vacation conditions

      Available without a prescription.

    • ADDITIONAL INFORMATION

      Detralex®: effect

      The action of Detralex® and its venotonic properties are due to the special composition of the drug and special production technology, micronization. It contains five natural plant components - flavonoids: diosmin, hesperidin, linarin, isorhoifolin, diosmetin. Active substances in a complex, enhancing the effect of each other, reduce the main symptoms of chronic venous diseases: - heaviness and pain in the legs, - leg fatigue, - swelling.

      What does the drug treat and what does the drug help with?

      The use of Detralex® is indicated in the treatment of chronic diseases of the veins of the lower extremities and hemorrhoids. The drug increases venous tone, reduces capillary permeability, and as a result, reduces venous stagnation, the main cause of disturbing symptoms. At the same time, Detralex® works quickly - venous tone increases within the first hour after taking two tablets of the drug. The drug also has a venoprotective effect. Such outstanding properties of Detralex® are explained by the use of a special technology, micronization, when the particles of active substances are reduced by 20 times. As a result, the drug is absorbed in the gastrointestinal tract twice as well (compared to the non-micronized form of diosmin), which helps to quickly eliminate the unpleasant symptoms of vein diseases.

      How does it work and what does the drug do?

      The benefits of the drug have been proven at the level of the venous and microcirculatory (capillary) systems. A healthy lifestyle is a necessary condition for effective treatment of venous insufficiency. Along with taking Detralex®, you need to make adjustments to your daily habits: avoid prolonged stress on your legs, move more, reduce exposure to the sun, try to reduce excess body weight.

      Pharmacotherapeutic group of the drug

      Venotonic and venoprotective agent. Detralex® is an oval film-coated tablet of orange-pink color. The drug belongs to the group of over-the-counter drugs.

      Russian clinical guidelines for the diagnosis and treatment of chronic venous disease. Phlebology, special. issue May 2013

      "IM ES Health", 3 sq. 2016, phlebotropic drugs, sales in euros, on an annual basis

      GFC. Surgical monitor. December 2013

      *Instructions on the medical use of the drug Detralex® suspension. Reg. beat No. LP-004247

      • GENERAL INFORMATION

        Tradename

        Detralex®

        Dosage form

        Film-coated tablets.

        Compound

        One film-coated tablet contains:

        Active substance:

        Purified, micronized flavonoid fraction, in terms of dry matter, 1000.00 mg, consisting of: diosmin 900 mg (90%), flavonoids in terms of hesperidin 100 mg (10%).

        Excipients:

        Purified water 40.00 mg, gelatin 62.00 mg, magnesium stearate 8.00 mg, microcrystalline cellulose 124.00 mg, sodium carboxymethyl starch type A 54.00 mg, talc 12.00 mg. Tablet core weight: 1340 mg1).

        Film shell: sodium lauryl sulfate 0.130 mg, premix for film shell of orange-pink color OY-S-8761, consisting of: glycerol 1.628 mg, hypromellose 27.039 mg, macrogol 6000 0.651 mg, magnesium stearate 1.628 mg, red iron oxide dye 0.211 mg, titanium dioxide 5.205 mg, iron dye yellow oxide 0.633 mg.

        Auxiliary substance for polishing tablets:

        Macrogol 6000 1,300 mg. The mass of the film-coated tablet is 1378.425 mg. 1) Taking into account the average moisture content of the purified, micronized flavonoid fraction - 4%, (or 40 mg per tablet), the amount of substance per tablet is 1040.00 mg.

        Description

        Oval tablets, film-coated, orange-pink in color, scored on both sides. The appearance of the tablet on the break: from pale yellow to yellow, with a heterogeneous structure.

      • PHARMACOLOGICAL PROPERTIES

        Pharmacodynamics

        Detralex® has venotonic and angioprotective properties. The drug reduces the distensibility of veins and venous stagnation, reduces capillary permeability and increases their resistance. The results of clinical studies confirm the pharmacological activity of the drug in relation to indicators of venous hemodynamics. A statistically significant dose-dependent effect of the drug Detralex® was demonstrated for the following venous plethysmographic parameters:

        • venous capacity,
        • venous distensibility,
        • time of venous emptying.

        The optimal dose-effect ratio is observed when taking 1000 mg per day. Detralex® increases venous tone: using venous occlusion plethysmography, a decrease in the time of venous emptying was shown. In patients with signs of severe microcirculation disorders, after treatment with Detralex® there is a (statistically significant compared to placebo) increase in capillary resistance, assessed by angiostereometry. The therapeutic effectiveness of the drug Detralex® has been proven in the treatment of chronic diseases of the veins of the lower extremities, as well as in the treatment of hemorrhoids.

        Pharmacokinetics

        The main excretion of the drug occurs in the feces. On average, about 14% of the administered amount of the drug is excreted in the urine. The half-life is 11 hours. The drug undergoes active metabolism, which is confirmed by the presence of phenolic acids in the urine.

        Pharmacotherapeutic group

        Venotonic and venoprotective agent.

        ATX code: C05CA53

      • INDICATIONS AND CONTRAINDICATIONS

        Indications

        Detralex® is indicated for the treatment of symptoms of chronic venous diseases (elimination and relief of symptoms).

        Treatment of symptoms of venous-lymphatic insufficiency:

        • pain;
        • spasms of the lower extremities;
        • feeling of heaviness and fullness in the legs;
        • "tired" legs.

        Treatment of manifestations of venous-lymphatic insufficiency:

        • swelling of the lower extremities;
        • trophic changes in the skin and subcutaneous tissue;
        • venous trophic ulcers.

        Symptomatic treatment of acute and chronic hemorrhoids.

        Contraindications

        Hypersensitivity to the active components or excipients included in the drug. The drug is not recommended for nursing women.

        Pregnancy and lactation period

        Pregnancy:

        Experiments on animals did not reveal teratogenic effects. To date, there have been no reports of adverse effects when using the drug by pregnant women.

        Lactation:

        Due to the lack of data regarding the excretion of the drug in breast milk, taking the drug is not recommended for nursing women.

        Effect on reproductive function:

        Reproductive toxicity studies showed no effect on reproductive function in rats of either sex.

      • METHOD OF APPLICATION AND DOSES

        1 tablet per day, preferably in the morning, with meals. The score on the tablet is intended solely for scoring purposes to make it easier to swallow. The duration of treatment can be several months (up to 12 months). In case of recurrence of symptoms, on the recommendation of a doctor, the course of treatment can be repeated.

        3 tablets per day (1 tablet in the morning, afternoon and evening) for 4 days, then 2 tablets per day (1 tablet in the morning and evening) for the next 3 days.

        1 tablet per day.

      • SIDE EFFECT

        Side effects of the drug

        Side effects of Detralex® observed during clinical trials were mild. Disorders from the gastrointestinal tract (diarrhea, dyspepsia, nausea, vomiting) were predominantly observed. While taking the drug Detralex®, the following side effects were reported, in the following gradation: very often (≥1/10); often (≥1/100,<1/10); нечасто (≥1/1 000, <1/100); редко (≥1/10 000, <1/1 000); крайне редко (<1/10 000), неуточненной частоты (частота не может быть подсчитана по доступным данным).

        From the central nervous system:

        Rarely: dizziness, headache, general malaise.

        From the gastrointestinal tract:

        Common: diarrhea, dyspepsia, nausea, vomiting.

        Uncommon: colitis. Unspecified frequency: abdominal pain.

        From the skin:

        Rarely: rash, itching, urticaria.

        Unspecified frequency: isolated swelling of the face, lips, eyelids.

        In exceptional cases, angioedema.

        INFORM YOUR DOCTOR ABOUT ANY ADVERSE REACTIONS AND SENSATIONS YOU HAVE, INCLUDING ANY ADVERSE REACTIONS AND SENSATIONS, INCLUDING THOSE NOT MENTIONED IN THIS INSTRUCTION, AS WELL AS CHANGES IN LABORATORY VALUES DURING THE THERAPY.

        Overdose

        No cases of overdose have been described. In case of drug overdose, seek medical help immediately.

        Interaction with other drugs

        Not noted.

        YOU SHOULD INFORM YOUR DOCTOR ABOUT ALL MEDICINES YOU ARE TAKEN.

      • SPECIAL INSTRUCTIONS

        • Before you start taking Detralex®, it is recommended to consult your doctor.
        • In case of exacerbation of hemorrhoids, the prescription of Detralex® does not replace the specific treatment of other anal disorders. The duration of treatment should not exceed the periods specified in the "Method of administration and dosage" section. If the symptoms do not disappear after the recommended course of therapy, you should be examined by a proctologist, who will select further therapy.
        • In the presence of venous circulation disorders, the maximum effect of treatment is ensured by a combination of therapy with a healthy (balanced) lifestyle: it is advisable to avoid long exposure to the sun, long periods of standing, and it is also recommended to reduce excess body weight. Walking and, in some cases, wearing special stockings help improve blood circulation. Contact your doctor immediately if your condition worsens or does not improve during treatment.
        • Impact on the ability to drive a car and perform work that requires high speed of mental and physical reactions: No effect.
      • RELEASE FORM AND STORAGE CONDITIONS

        Release form

        Produced by Servier Industry Laboratory, France

        Film-coated tablets, 1000 mg. 10 tablets in a blister (PVC/Al). 3 or 6 blisters with instructions for medical use in a cardboard pack. 9 tablets in a blister (PVC/Al). 3 blisters with instructions for medical use per cardboard pack.

        Produced by Serdix LLC, Russia

        10 tablets in a blister (PVC/Al). 3 or 6 blisters with instructions for medical use in a cardboard pack. 9 tablets in a blister (PVC/Al). 3 blisters with instructions for medical use per cardboard pack.

        Storage

        At a temperature not higher than 30°C. Keep out of the reach of children.

        Best before date

        3 years. Do not use after the expiration date stated on the package.

        Vacation conditions

        Available without a prescription.

        • GENERAL INFORMATION

          Tradename

          Detragel®

          International nonproprietary or generic name

          Heparin sodium + Phospholipids + Escin

          Dosage form

          Gel for external use.

          Compound

          1 g of gel contains:

          Active substance:

          Heparin sodium 100.0 IU, Essential phospholipids 10.0 mg, Escin 10.0 mg

          Excipients:

          Isopropanol 300.00 mg, glycerol 85% 20.00 mg, trolamine 10.80 mg, methyl parahydroxybenzoate 0.75 mg, 2 ethyl parahydroxybenzoate 0.75 mg, propyl parahydroxybenzoate 0.25 mg, carbomer-980 8.00 mg, cologne 0.70 mg, rosemary oil 0.40 mg, lavender oil 0.40 mg, water up to 1.00 g.

          Tablet polishing aid: Macrogol 6000 1,300 mg. The mass of the film-coated tablet is 1378.425 mg. ) Taking into account the average moisture content of the purified, micronized flavonoid fraction - 4%, (or 40 mg per tablet), the amount of substance per tablet is 1040.00 mg.

          Description

          Transparent, light yellow gel with a characteristic odor.

        • PHARMACOLOGICAL PROPERTIES

          Pharmacodynamics

          The combined drug has local anticoagulant, anti-inflammatory, venotonic and antiplatelet effects, reduces venous permeability, and improves microcirculation. Detragel® contains 3 active ingredients: sodium heparin, essential phospholipids and escin, which have pharmacodynamic and pharmacokinetic synergism. Heparin sodium is a direct anticoagulant; due to the inactivation of biogenic amines and blocking of lysosomal enzymes in the tissue, it exhibits an anti-inflammatory effect, accelerates the dissolution of microthrombi in the area of ​​subcutaneous capillaries, prevents thrombus formation, and activates the fibrinolytic system; improves microcirculation, promotes the regeneration of connective tissue by inhibiting the activity of hyaluronidase. Essential phospholipids reduce blood viscosity due to their effect on fat metabolism and reduce platelet aggregation processes. Escin is a venotonic herbal agent. Prevents the activation of lysosomal enzymes that break down proteoglycan, increases the tone of the venous wall, eliminates venous stagnation; reduces permeability and fragility of capillaries. Reduces exudation, reduces the effusion of fluid into the tissue and accelerates the resorption of existing edema. Inhibits inflammation processes, improves microcirculation, promotes tissue repair.

          Pharmacokinetics

          There is no information on the pharmacokinetics of escin and phospholipids when used externally. When applied topically, heparin sodium quickly penetrates the epidermis and accumulates in the upper layers of the skin. A small amount of sodium heparin is absorbed from the skin surface into the systemic circulation (less than 0.2% of the total applied amount). The maximum concentration (Cmax) in the blood is observed 8 hours after application. After absorption, it is biotransformed in the liver and in the reticuloendothelial system. Heparin sodium is excreted mainly in the urine. The half-life (T1/2) is 12 hours. Heparin does not penetrate the placental barrier and is not excreted in breast milk. Thanks to their own hydrophilic and lipophilic properties, essential phospholipids promote rapid penetration of active ingredients through the sebaceous and sweat glands, which has been confirmed by tests with radioisotopes.

          • Hypersensitivity to the components of the drug, hemorrhagic diathesis (including thrombocytopenic purpura), hemophilia, violation of the integrity of the skin at the site of application of the drug (open wounds, ulcerative necrotic lesions), burns, eczema, skin infections
          • Contraindicated for use on mucous membranes
          • Age up to 18 years

          Pregnancy and lactation period

          To date, there have been no reports of adverse effects on mother and fetus when using the drug in pregnant women. Use during pregnancy and breastfeeding is possible only in cases where the expected benefit of therapy for the mother outweighs the potential risk to the fetus, so you should consult your doctor before using the drug.

        • METHOD OF APPLICATION AND DOSES

          For external use. The gel is applied in a thin layer to the problem area of ​​the skin and evenly distributed with light massaging movements: 2-3 times a day every day until the symptoms disappear. If necessary, the gel can be applied under elastic stockings or bandages. If you have thrombophlebitis, you should avoid rubbing the gel. Application of the gel to mucous membranes is contraindicated.

          The duration of treatment is no more than 15 days. If your condition worsens or does not improve after 15 days, you should consult a doctor. The possibility of a longer course of treatment is determined by the doctor. Do not exceed the recommended dose and duration of use of the drug.

        • SIDE EFFECT

          Side effects of the drug

          Side effects are given in the following gradation: very often (>1/10); often (>1/100,<1/10); нечасто (>1/1 000<1/100); редко (>1/10 000, <1/1 000); очень редко (<1/10 000), неуточненной частоты (частота не может быть подсчитана по доступным данным).

          From the skin:

          Very rare: delayed allergic reactions (contact dermatitis)

          Very rare: immediate allergic reactions (skin rash, itching, urticaria)

          From the respiratory system, chest and mediastinal organs:

          Very rare: bronchospasm. With local use of escin, isolated cases of acute anaphylactic reactions have been reported (see section "Special Instructions").

          INFORM YOUR DOCTOR ABOUT ANY ADVERSE REACTIONS AND SENSATIONS YOU HAVE, INCLUDING ANY ADVERSE REACTIONS AND SENSATIONS, INCLUDING THOSE NOT MENTIONED IN THIS INSTRUCTION, AS WELL AS CHANGES IN LABORATORY VALUES DURING THE THERAPY.

          Overdose

          There is no data on drug overdose. In case of overdose, you should immediately consult a doctor. Treatment: in case of overdose, the effect of heparin can be neutralized with a solution of protamine sulfate.

          Interaction with other drugs

          There is currently no data on interactions with other drugs. The drug should not be applied to the same area of ​​skin simultaneously with other medications for external use.

          YOU SHOULD INFORM YOUR DOCTOR ABOUT ALL MEDICINES YOU ARE TAKEN.

        • SPECIAL INSTRUCTIONS

          • Application of the gel to mucous membranes is contraindicated.
          • If allergic reactions develop, use of the drug should be stopped immediately and consult a doctor.
          • Medicines for topical use, especially after prolonged use, have a sensitizing effect. If this occurs, treatment with the drug should be discontinued and, if necessary, appropriate treatment should be prescribed.
          • With prolonged use of the drug on large areas of the skin and simultaneous use of indirect anticoagulants (warfarin, acenocoumarol, etc.), prothrombin time and blood clotting time should be monitored.
          • It is not recommended to use Detragel® for deep vein thrombosis.
          • There is no experience with the use of the drug in children under 18 years of age.
          • If your condition worsens or does not improve after 15 days, you should consult a doctor.
          • Impact on the ability to drive vehicles and machinery: No studies have been conducted to study the effect of the drug on the ability to drive a car or operate machinery.
  • Detralex(Detralex).

    Pharmacological group

    Angioprotector, venotonic agent.

    Release form and composition

    Detralex is produced in the form of coated tablets.

    1 tablet contains 500 mg of micronized flavonoid fraction, which includes diosmin - 450 mg, and hesperedin - 50 mg.

    Excipients: microcrystalline cellulose, sodium carboxymethyl starch, gelatin, magnesium stearate, purified water, talc.

    The film shell consists of macrogol 6000, sodium lauryl sulfate, an orange-pink premix for the film shell (magnesium stearate, glycerol, hypromellose, yellow iron oxide (E172), titanium dioxide (E171), red iron oxide.

    The tablets are packaged in blisters of 15 pieces, 2 or 4 blisters in a cardboard box. Instructions included.

    Description of the drug Detralex

    The tablets are oval in shape and pink-orange in color; on the fracture, the contents are heterogeneous, pale yellow in color (coloring to yellow is allowed).

    pharmachologic effect

    Pharmacodynamics
    Detralex has angioprotective and venotonic properties. It maintains the tone (tension) of the vascular wall, preventing it from stretching, which reduces the release of plasma and proteins from the bloodstream into the surrounding tissues and reduces the fragility of capillaries. This leads to a reduction in congestion. This drug has a dose-dependent effect: the optimal therapeutic effect is observed when taking 2 tablets.

    Pharmacokinetics
    The half-life of Detralex from the body is 11 hours.

    The drug is excreted mainly through the intestines. Only 14% of the administered dose of Detralex is excreted in the urine.

    Indications for use of the drug Detralex

    1. Symptomatic treatment and prevention of chronic venous insufficiency
    Venous insufficiency includes such manifestations as a feeling of fatigue and heaviness in the legs, swelling of the lower extremities, pain in the legs, impaired sensitivity in the form of paresthesia, convulsions, and trophic disorders.

    Chronic venous insufficiency is a group of symptoms resulting from impaired blood flow through the veins of the lower extremities and changes in the permeability of the vascular wall. It develops more often in women. The disease occurs when the valves that close the lumen of the veins cannot prevent the reverse flow of blood due to increased pressure on them for various reasons. As a result, blood pressure on the wall of the venous vessels increases, which leads to its stretching. In this case, the permeability of the vascular wall for blood and plasma proteins increases, swelling and compaction of adjacent tissues appear. Foci of ischemia (insufficient blood supply with oxygen) occur in places where small vessels are compressed, which contributes to the formation of trophic ulcers.

    The main risk factors for the development of chronic venous insufficiency include:

    • weakness of the muscular wall of the veins (hereditary);
    • overweight and obesity;
    • pregnancy and childbirth;
    • long-term constant work in a standing or sitting position, with limited movement (cooks, office workers, surgeons, etc.);
    • chronic constipation;
    • fluctuations in hormonal levels in women (contraception with hormonal drugs, hormonal treatment during menopause, etc.);
    • wearing tight underwear and clothing, corsets.
    The following stages of development of varicose veins are distinguished:
    • Stage 0 – no major symptoms upon examination.

    • Stage I- “morning fatigue” of the legs, complaints of intermittent swelling in the evenings (disappear in the morning).

    • Stage II– persistent swelling, skin pigmentation disorders; some areas of the skin become thicker, the skin above them cannot be folded (lipodermatosclerosis), redness appears on the skin, accompanied by itching and weeping (eczema).

    • Stage III– the formation of trophic ulcers (active or healed), difficult to treat with medication.
    All stages of the disease are accompanied by pain of varying intensity and the presence of evening cramps. Patients note a feeling of tingling, crawling, and slight numbness.

    In the treatment of the disease in the early stages, compression with elastic bandages and compression hosiery is used, and the prescription of medications that increase venous tone (for example, Detralex), physiotherapeutic treatment and rehabilitation in sanatoriums.

    2. Preoperative preparation and postoperative treatment of chronic venous insufficiency

    3. Symptomatic treatment of hemorrhoids
    Hemorrhoids are dilation of the veins of the anus and lower rectum. Dilated veins filled with blood become visible as separate nodes. Based on the location of the nodes, external and internal hemorrhoids are distinguished. It can be acute (accompanied by the development of complications) and chronic, occurring without complications.
    Hemorrhoids are caused by:

    • sedentary lifestyle, work in a sitting and standing position (programmers, miners, teachers);
    • prolonged constipation;
    • pregnancy, childbirth, uterine bends;
    • abuse of alcohol, spicy, salty, smoked foods;
    • inflammatory diseases of the pelvic organs.
    One of the first symptoms is a feeling of itching in the anus. The development of the disease is accompanied by the appearance of pain, bleeding from the rectum during bowel movements, streaks of blood in the stool, the appearance and further loss of nodes (they can become pinched during bowel movements and become inflamed).

    If symptoms occur, you should consult a doctor. In the absence of complications, treatment is carried out using conservative methods. Positive results are achieved with complex treatment: adequate regimen (physical activity), dietary nutrition rich in fiber, drug therapy. To reduce the intensity of itching and pain, rectal suppositories are used - topically into the rectum. To reduce the stretching of the venous wall, various venotonics are used - orally through the mouth, including the drug Detralex.

    Contraindications to the use of Detralex

    Increased individual sensitivity to the constituent components of the drug in the form of allergic reactions.

    Detralex dosage regimen

    For treatment venous circulation insufficiency Detralex tablets must be taken orally, 2 pieces each. 2 times a day, during meals. After 7 days of taking the drug, it is necessary to reduce the dose to 2 tablets per day (1 tablet in the afternoon and in the evening). The duration of treatment is determined by the attending physician.

    Acute attack of hemorrhoids: for 4 days you need to take 3 tablets in the morning and evening with meals (6 tablets in total per day), then over the next 3 days the dose is reduced to 2 tablets in the morning and evening (4 tablets in total per day).

    Chronic course of hemorrhoids: for 1 week, Detralex is taken 2 tablets 2 times a day with meals, then the dose is reduced to 2 tablets per day, in one dose with meals.

    The average course of treatment is 2-3 months, depending on the severity of the disease and determined by the attending physician.

    Side effects of the drug Detralex

    • From the gastrointestinal tract, nausea and stomach discomfort, vomiting and diarrhea may be observed.
    • From the central nervous system, headache and dizziness may occur.
    • Very rarely, allergic manifestations such as rash, itching, and urticaria may occur on the skin.
    Urticaria is an acute allergic reaction characterized by the rapid appearance of blisters. Accompanied by itching.

    If any side effects occur, you should consult your doctor about the need to adjust treatment.

    Symptoms of an overdose of Detralex

    During clinical trials of the drug Detralex, cases of its toxic effects on the body and overdose were not registered.

    Interaction of the drug Detralex with other drugs
    means

    The effect of Detralex on the medicinal effect of other pharmaceuticals was not detected.

    Special instructions for the use of the drug Detralex

    If, after a short course of treatment for acute hemorrhoids, symptoms of the disease persist, you should consult a doctor for additional examination and change of medication.

    Pregnancy and breastfeeding
    In animal experiments, no negative effects on the embryo were observed when taking the drug Detralex. There were no data on the occurrence of side effects in pregnant women, as well as in children during breastfeeding. However, taking the drug during pregnancy and breastfeeding is not recommended due to insufficient research and data.

    Children
    Detralex has not been used in the treatment of children. There are no data on its effects, possible side effects and overdose.

    Driving vehicles and operating machinery
    The drug Detralex does not affect the speed of mental and physical reactions.

    Analogues of the drug Detralex

    Full analogues (generics):
    • Venarus(Venarus) is a generic drug with the same active ingredients (diosmin and hesperidin). The principle of action is the same as that of Detralex. Release form: coated tablets. Use during lactation is contraindicated. Shelf life - 2 years. Manufacturer: FP Obolenskoye CJSC.
    • Venozol(Venozolum) - a drug with the main active ingredients - diosmin and hesperedin. pharmachologic effect similar to Detralex. Release form: tablets, gel and cream. Manufacturer: VIS LLC.

    Partial analogues:
    • Phlebodia 600 (Phlebodia 600) - available in tablet form. The active ingredient, diosmin, has a medicinal effect similar to Detralex (increases the tone of the venous wall, improves blood flow, normalizes the permeability of vascular walls). Manufacturer: Innotera Shuzi FRA.
    • Vasocket(Vasocet) comes in the form of oblong yellow tablets. The active substance (diosmin) reduces the distensibility and increases the tone of the veins, thereby preventing the appearance of edema. Manufacturer: Stragen/Weimer Pharma, Germany.
    Other venotonics:
    • Antistax is a bioflavonoid (active ingredients are biologically active substances) drug that belongs to the group of venotonic drugs. Available in tablet form. Manufacturer: Boehringer Ingelheim, Germany.

    • Troxevasin is produced under the trade names Venoruton, Troxerutin. It is a semi-synthetic derivative of rutin. Improves the condition of the walls of blood vessels and has an anti-edematous effect. Main forms of release: capsules, gel for topical use, solution for injection in ampoules. Manufacturer: Farmakhim BOL.

    • Anavenol is a combined venoprotective drug. Available in the form of film-coated tablets. Some antibiotics can enhance the therapeutic effect of anavenol (dopamine, etc.). The side effects of anavenol manifest themselves in the form of bleeding, dizziness, and nausea. The use of anavenol is contraindicated in children under 15 years of age. Manufacturer: Zentiva CZECH.

    • Venoruton(Venoruton) is an angioprotective drug, the active ingredient is hydroxyethylrutoside. Release form: tablets and gel for external use. Prescription in the second and third trimester of pregnancy is possible. Manufacturer: Novartis, Switzerland.

    • Ginkor fort(Ginkor Fort) has a venotonic and venoprotective effect. It contains standardized extract of ginkgo biloba, heptaminol hydrochloride and troxerutin. Available in the form of capsules and gel for external use. In case of overdose, blood pressure may increase. According to indications, the drug can be prescribed in the second and third trimesters of pregnancy. Contraindicated in hyperthyroidism and concomitant use of MAO inhibitors. Manufacturer: Bofur Ipsen, France.

    Reviews about the drug Detralex

    There are different reviews about the drug Detralex. For some it helps 100%, for others it turns out to be useless. But still, the majority of patients who took Detralex respond positively to this drug. Patients note that within a short period from the start of treatment, symptoms of venous insufficiency, such as pain, swelling, heaviness in the legs, become less pronounced or practically disappear. When treating hemorrhoids, discomfort is also relieved. This significantly improves the level of emotional and physical comfort of patients. Side effects from the drug Deralex occurred only in a small number of patients.

    Doctors note that this effect from the use of the drug Detralex is achieved thanks to its unique medicinal formula and production technology. Very small particles of active ingredients are easily absorbed by the body. But the best result, according to doctors, is achieved as a result of treatment with several repeated courses as part of complex therapy for venous insufficiency of the lower extremities and hemorrhoids. Do not forget about the regime, adequate physical activity, diet and other medications that help in the fight against the disease.

    Storage conditions and periods

    The drug Detralex belongs to list B of pharmacological drugs (potent drugs, the use and storage of which is carried out with caution). Detralex must be stored out of the reach of children!

    Storage of the drug Detralex is carried out in a dry place, at a temperature not exceeding 30 o C.
    The shelf life is 4 years (subject to storage conditions).
    It is not recommended to use a drug that has expired.

    Conditions for dispensing the drug Detralex in pharmacies

    The drug is sold in pharmacies with a doctor's prescription.

    Price for the drug Detralex

    The drug Detralex film-coated tablets, 500 mg, can be bought in pharmacies (Moscow) at an average price of 270 rubles for a package of 30 pieces, 1270 rubles for a package of 60 pieces.

    Manufacturer

    "Servier Industry Laboratories", France. Before use, you should consult a specialist.

    Detralex contains 500 mg of micronized flavonoid fraction (Purified micronized flavonoid fraction), in which diosmin is 90% (450 mg), - 10% (50 mg).

    Auxiliary components: gelatin, magnesium stearate, MCC, sodium carboxymethyl starch, talc, purified water. Composition of pos.: macrogol 6000, sodium lauryl sulfate, orange-pink premix for pos. (magnesium stearate, , hypromellose, iron dyes - yellow and red oxides, titanium dioxide).

    Release form

    Tablets p/pl. shell. In blisters of 15 pcs., package No. 30; No. 60.

    In other countries, the manufacturing company may use the trade names Variton, Daflon 500, Venitol, Capiven, Ardium, Arvenum 500 for its product.

    pharmachologic effect

    Venoprotective and venous stabilizing. Pharmacological group: microcirculation correctors and angioprotectors in combinations .

    Pharmacodynamics and pharmacokinetics

    Possesses angioprotective And venotonic action, reduces venostasis , stretchability of veins and capillary permeability, increases the tone of the venous walls, improves microcirculation and lymphatic drainage. Increases the ability of capillaries to maintain the integrity of the walls under mechanical stress.

    The use of the drug Detralex helps reduce interaction And endothelium , as well as adhesion leukocytes in postcapillary venules, which reduces the severity of the damaging effects of inflammatory mediators on the valves vein valves and venous walls .

    T½ - 11 o'clock. Excretion of active components is carried out mainly through the intestines. About 14% of the dose taken is excreted by the kidneys.

    Indications for use of Detralex

    When are vein pills prescribed?

    Indications for use of Detralex are organic and functional venolymphatic insufficiency of the lower extremities , which is manifested by swelling and pain, a feeling of heaviness in the legs, trophic disorders, and cramps.

    When is the drug used as a pill for hemorrhoids?

    The use of the drug Detralex is indicated for the symptomatic treatment of acute hemorrhoidal attack.

    Additionally

    Detralex tablets: instructions for use

    Instructions for use of Detralex for varicose veins

    At venolymphatic insufficiency recommended dose - 2 tablets. 500 g per day. The tablets are taken with meals, one in the daytime, the second in the evening.

    The medicine is prescribed only to adult patients. To enhance the effect, the doctor may also recommend using external therapy - ointment or gel.

    Duration of treatment with Detralex for varicose veins , as well as the need for repeated courses, is determined by the doctor.

    Detralex for hemorrhoids. How long to take pills for hemorrhoids?

    In the description included with the drug on how to take it when hemorrhoids Detralex, it is indicated that in the acute stage of the disease (with ) must be taken 6 tablets/day. during the first 4 days of treatment and 4 tablets/day. in the next 3 days. Take the medicine with meals, dividing the daily dose into 2-3 doses.

    Treatment chronic hemorrhoids involves taking 4 tablets daily. They are taken with meals, 2 at each dose. After 7 days, you can reduce the dose by half and reduce the frequency of applications to 1 r./day.

    How long to take the medicine depends on the degree of advanced disease and the effectiveness of therapy. On average, doctors chronic hemorrhoids It is recommended to take the tablets in courses lasting 2-3 months. In case of an acute attack, treatment is carried out in short courses lasting 7 days.

    If symptoms persist longer than this time, the patient should be examined by a proctologist.

    Reviews of Detralex with hemorrhoids mostly good. The main disadvantage of the drug, according to consumers, is its high price. However, given that Detralex is a drug with proven effectiveness (patients often notice an improvement in the situation after 2-3 days of taking the tablets), many people still prefer it over cheaper analogues.

    Overdose

    There are no reports of cases of overdose.

    Interaction

    Special studies regarding drug and other forms of drug interaction have not been conducted. However, given the extensive experience of post-registration use of Detralex, to date there are no statements about its adverse interaction with other drugs.

    Terms of sale

    Over the counter.

    Storage conditions

    The drug does not require special storage conditions. The tablets belong to the category of potent drugs (list B), so they should be kept out of the reach of children.

    Best before date

    special instructions

    The use of tablets for acute hemorrhoidal attack cannot replace specific therapy and creates barriers to treatment for others proctological diseases .

    If after a short time there is no rapid decrease in the severity of symptoms, the patient should be examined by a proctologist, and the doctor should reconsider the therapy.

    For people with impaired venous circulation, to increase the effectiveness of the drug, it is recommended:

    • avoid standing for long periods of time and prolonged exposure to the sun;
    • adjust body weight and diet;
    • wear compression stockings to improve blood circulation;
    • hike.

    Detralex analogues: what can replace the drug?

    Level 4 ATX code matches:

    Drugs similar to Detralex with a similar mechanism of action, but a different composition: , , , Venolek , , Rutin , , , Yuglanex , Phlebofa .

    Substitutes based on Hesperidine + Diosmin: Venozol , .

    The medicine and its analogues are used to treat functional and organic venous insufficiency , and also when hemorrhoids (both acute and chronic).

    The price of Detralex analogues is from 60 rubles. The cheapest analogues of Detralex are the drugs Rutin and Ascorutin.

    In Ukraine, if Detralex is not available in the pharmacy, they may offer to replace it with drugs Venorin , Venosmin , Juantal , Dioflan , , Nostalex .

    What is better - Detralex or Phlebodia 600?

    On forums, the drug is often compared with its analogues. And most often with the drug Phlebodia 600 . The basis of both products is diosmin. Its concentration in Phlebodia 600 - 600 mg/tab., in Detralex - 450 mg/tab., however, in the latter its effect is enhanced due to the presence of hesperidin (50 mg/tab.).

    At varicose veins Phlebodia 600 drink 1 tablet/day, Detralex - 2 tablets/day, that is, the daily dose of diosmin in the first case is 600 mg, in the second - 900 mg.

    If we compare the pharmaceutical effect of the drugs and the specifics of their use, there are practically no differences.

    However, thanks to the use of a unique technology for processing the active substance in its production, Detralex is absorbed into the body faster and more completely than its analogue, while its concentration in the blood plasma reaches a maximum after three to four hours.

    Which is better - Detralex or Antistax?

    Antistax is a herbal medicine that is used for venous circulation disorders. The capsules are based on dried extract of red grape leaves with a high content isoquercetin And quercetin glucuronide — flavonoids, which help stabilize cell membranes, normalize vascular permeability, and reduce edema.

    However, if the effectiveness of Detralex has been confirmed during clinical experiments, scientific confirmation of the effectiveness Antistaxa as of today no.

    Another difference between the drugs is that Detralex is allowed to be used during pregnancy, but information regarding safety and effectiveness Antistaxa no for pregnant women.

    According to experts, Antistax for vascular diseases it may be recommended more as a preventive measure and as an addition to the main treatment.

    Thrombovazim or Detralex - which is better?

    is an enzyme preparation with thrombolytic , cardioprotective And anti-inflammatory activity . Its active ingredient is a complex of proteinases produced by Bacillus subtilis.

    The medicine is prescribed as part of complex therapy for chronic venous insufficiency . It is strictly contraindicated in , pregnancy and breastfeeding.

    Considering that the drugs Detralex and Thrombovazim have different pharmacological effects, it is not correct to compare them. Especially if you take into account that doctors often recommend taking them in combination.

    Which is better - Detralex or Venarus?

    Venarus is a Russian analogue of the drug. If we compare which is better - Detralex or Venarus , then we can come to the conclusion that there is no fundamental difference between them.

    The basis of both drugs are substances And hesperidin , the products differ only slightly in the composition of the auxiliary components. Operating principle Venarus the same as its analogue, and the drug is prescribed for the same thing that Detralex tablets are used for.

    Annotations for drugs are distinguished by the fact that an additional contraindication for use Venarus the lactation period is indicated. In addition, the cheaper analogue of Detralex is characterized by lower bioavailability and is somewhat more likely to cause side effects than the drug produced by Les Laboratoires Servier.

    For children

    There are no data regarding the use of the drug in pediatric practice.

    Alcohol compatibility

    There is no categorical ban on drinking alcohol during treatment with Detralex. The active ingredients of the drug are flavonoids hesperidin And diosmin , which, according to Wikipedia, are plant pigments and powerful natural antioxidants, do not interact with other substances and have no significant side effects.

    However, it should be taken into account that, by affecting the cardiovascular system, alcoholic drinks provoke an increase in blood pressure and dilation of blood vessels, and a sharp influx of blood causes an increase in its stagnation in places of accumulation.

    Thus, alcohol reduces the effectiveness of therapy and contributes to the progression of the disease.

    Detralex during pregnancy

    Despite the fact that studies have not revealed the teratogenic properties of Detralex, it is used with caution during pregnancy.

    Due to lack of information about the ability diosmina And hesperidin penetrate into breast milk during breastfeeding, the use of the product should be avoided.

    Studies on rats have shown that the drug does not have reproductive toxicity.

    Reviews of Detralex during pregnancy allow us to conclude that the drug really helps with problems with veins and hemorrhoids . With the use of tablets, pain in the legs disappears, the legs become less tired and do not swell (and if they swell, then not so much), development is inhibited varicose veins , disappear (or significantly reduce) hemorrhoids .