E-mail: itlambev@mail.bg Medical University of Sofia, Faculty of Medicine Department of Pharmacology and Toxicology Angio (vaso)- protectors (Summary) Assoc. Prof. Iv. Lambev E-mail: itlambev@mail.bg

I. Drugs improving capillary function (capillarotonic drugs) They reduce capillary fragility and permeability and prevent basal edothelium membrane damage. They act like antioxidants and prevent vitamin C and adrenaline oxidation. These drugs also inhibit lipid oxidation and synthesis of active oxygen species.

Drugs improving capillary function  Bioflavonoids: Diosmin Hesperidin, Hyperoside, Naringin, Quercetin, Rutin Rutascorbin® (rutin/ascorbic acid)  Semisynthetic flavonoids: Troxerutin® Saponins: Escin (derived from Aesculus hippocastanum – Horse-chestnut) Combinations: Peflavit C®  Synthetic preparations: Calcium dobesilate (Doxium® – in retinopathy)

Aesculus hippocastanum (Horse-chestnut)

Bioflavonoids Fr. Cynosbati (Dog rose) Hb. Hyperici (St. John’s wort) Fr. Crataegi (Hawthorn) Fruits of citrus

Hb. Hyperici (St. John’s wort)

Fr. Crataegi (Hawthorn)

Drugs improving capillary function are indicated in haemorrhagic diathesis, skin and retinal haemorrhages, different forms of capillary dysfunctions, radiation disease, infections and allergic diseases, varicose veins, atherosclerosis, hypertension, rheumatism, hepatitis, glomerulonephritis, meno- and methrorrhagias, paradontosis, drug capillary dysfunctions (caused by NSAIDs, glucocorticoids, reserpine, anticoagulants, arsenic compounds, gold salts).

Atherosclerotic gangrene of foot

Warfarin necrosis of breast skin 5 days after intaking of warfarin

Detralex® (diosmin/hesperidine) II. VENOTONIC DRUGS Detralex®, Endotelon®, Phelobodia® Troxerutin (Troxevasin®) Detralex® (diosmin/hesperidine) improves capillary functions, has venotonic and antiexudative action too, due to inhibition of PGs release. It inhibits leukocyte adhesion and migration. Detralex enhances lymphatic flow and drainage.

Detralex®. Its venotonic effects is due to the prolonged NA action. Detralex improves skin perfusion and rheological properties of the blood. It is effective in chronic venous insufficiency, venous ulcer, hemorrhoids. Dosage: 2 x 1 tablet daily.

Endotelon® is a purified and standardized extract of of grape seeds, contains procyanidolic oligomeres. It has endothelium protective and venotonic effects. Endotelon is prescribed p.o. in chronic venous and lymphatic insufficiency.

Varicose veins Varicose ulcer

Troxerutin (trihydroxyethylrutin) has venotonic, antiexudative and haemostatic activity. It improves capillary function and inhibits thrombocyte aggregation too. Troxerutin is used in varicose ulcers, chronic venous insufficiency, superficial thrombophlebitis, haemorrhoids, phlebo- sclerosis, muscle cramps, pain of traumatic origin (sprain, luxation). It is administered orally or locally, applied on the damaged area (2% gel).

III. Heparin-containing… ointments (used in superficial thrombophlebitis and varicose veins): Heparoid®, Lioton® 1000 gel IV. Antihaemorrhoidal drugs Detralex® (orally) Doloproct® (fluocortolone/lidocaine): supp. and ointment Procto-Glyvenol® (tribenoside/lidocaie): supp. Ultraproct® (fluocortolone/cinchocaine): supp.