A.Vogel Venaforce® liquid Hemorrhoids relief For the symptomatic treatment associated with venous insufficiency Varicose veins Fresh Horse Chestnut (Aesculus hippocastanum) seed tincture Sugar-, gluten- and lactose-free The symptoms of venous insufficiency may be benign, like heavy and tired legs, but may also be much more serious, like varicose veins, painful hemorrhoids and even phlebitis. Aside from surgery (that eliminates the diseased veins but does not stop the progression of varicose veins), there are few treatments for venous insufficiency. Support stockings are effective but so uncomfortable that very few people wear them. Horse Chestnut seed extract is used for venous insufficiency problems (including phlebitis) and fragile capillaries. Composition Each 25 drop dose (0.76 mL) contains: Medicinal ingredient: Fresh Horse Chestnut (Aesculus hippocastanum) seed tincture …767 mg standardized to 17.92 mg aescin. Non-medicinal ingredient: 1 mL of tincture contains 0.64 mL of alcohol (ethanol). 1 mL = 33 drops. Dropper included. Dosage Adults: Take 25 drops with water, 3 times daily, during meals. Insalivate before swallowing. Duration of use: May be used for up to 6 weeks. Historical Overview Venous insufficiency is a complex state involving an increase in capillary and vein pressure, an increase in capillary permeability, a blood stasis, an edema, inflammation, etc. Its precise cause is still unknown but many risk factors have been identified: excess weight, hypertension, tobacco, alcohol, lack of physical activity, bad diet, pregnancy, standing or sitting stationary work (nurse, pharmacist, clerk), constipation, etc. The symptoms of venous insufficiency may be benign, like heavy and tired legs, but may also be much more serious, like varicose veins, painful hemorrhoids and even phlebitis. Aside from surgery (that eliminates the diseased veins but does not stop the progression of varicose veins), there are few treatments for venous insufficiency. Support stockings are effective but so uncomfortable that very few people wear them. Horse Chestnut seed extract is used for venous insufficiency problems (including phlebitis) and fragile capillaries. Actions and pharmacology Compared to the tablet, the tincture has the advantage of being more quickly absorbed and of allowing a fine-tuning of the dosage according to each patient. The active ingredients of Horse Chestnut seeds are triterpene saponines (about thirty) collectively known as aescine or escine. Aescine increases vein wall resistance and reduces permeability (seepage), objectively reducing venous insufficiency symptoms (edema, swelling, etc.). Horse Chestnut seed extract is known for its phlebotonic, antioxidant, anti-inflammatory and vein wall protector effects.(1) It inhibits elastase and hyaluronidase activity. These two enzymes degrade the vein wall and the surrounding tissues (like collagen) therefore increasing venous insufficiency symptoms and progression (like spider veins, varicose veins and hemorrhoids).(2) In vitro, aescine has demonstrated an anti-inflammatory effect.(3) Horse Chestnut seed cannot reverse varicose veins.(4) Its effect is limited to symptom control and a slowing down of the disease progression, translating in an increased quality of life. The German Commission E acknowledges its benefits in cases of: treatment of complaints found in pathological conditions of the veins of the legs (chronic venous insufficiency), for example, pains and a sensation of heaviness in the legs, nocturnal leg cramps, pruritus and swelling of the legs. Scientific studies Although most of the published research was conducted on dry extracts of Horse Chestnut seed, these extracts are derived from the more traditional extract, the tincture. The results of the studies below may therefore be extrapolated to the liquid form of Venaforce®. A meta-analysis has collected all controlled studies conducted on Horse Chestnut seed extract up to 1996. Horse Chestnut seed extracts have been found effective against venous insufficiency symptoms like swelling of the legs, itching, pain, fatigue and heavy legs. Five studies demonstrated that Horse Chestnut seed extract was more effective than a placebo and as effective as the other available medications. One study demonstrated that Horse Chestnut seed extract was as effective as support stockings. Moreover, all researchers concluded that side effects were minor and few.(5) A 12 weeks placebo-controlled clinical study conducted on 240 patients demonstrated that Horse Chestnut seed extract (50 mg aescine, twice daily) reduces by 25% the volume of edema in the legs (same effectiveness as support stockings). The authors mention that the full effect of Horse Chestnut cannot be obtained in 12 weeks and that a longer period of use would yield better results.(6) A double-blind placebo-controlled multicentric study was conducted with Venaforce® on 52 patients showing signs of chronic venous insufficiency. In the treated group (2 tablets, 3 times daily), the ankle diameter was reduced by 0.5 cm while, in the control group, no changes were observed. The side effects reported were similar to those of the placebo. Venaforce® is very well tolerated and is effective to relieve chronic venous insufficiency symptoms.(7) Precautions,contraindications and interactions Consult a healthcare practitioner prior to use if you are taking blood thinners or have bleeding disorder. Do not use if you have impaired heart, kidney and/or liver function. Do not use if you are pregnant or breastfeeding. Avoid taking in case of allergy to any of the ingredients in the product. Consult a healthcare practitioner if symptoms persist. Do not use if security cap is broken. Keep out of the reach of children. The only reported side effect is a mild gastric discomfort that is eliminated when Venaforce® is taken with food. The most important risk factors of venous insufficiency can be controlled. It is therefore necessary to modify these factors (lose excess weight; improve the diet by eating more fruits, vegetables and whole grains; stop smoking; exercise; etc.) to effectively stop the disease progression. References 1-Guillaume M, Padioleau F. Veinotonic effect, vascular protection, anti-inflammatory and free radical scavenging properties of Horse Chestnut extract. Arzneimittelforschung 1994;44:25-35. 2-Facino RM, Carini M, Stefani R, et al. Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedera helix, Aesculus hippocastanum, and Ruscus aculeatus: factors contributing to their efficacy in the treatment of venous insufficiency. Arch Pharm (Weinheim) 1995;328:720-724. 3-Matsuda H, Li Y, Murakami T, et al. Effects of escins Ia, Ib, IIa, and IIb from Horse Chestnut, the seeds of Aesculus hippocastanum L., on acute inflammation in animals. Biol Pharm Bull 1997;20:1092-1095. 4-Brunner F, Hoffmann C, Schuller-Petrovic S. Responsiveness of human varicose saphenous veins to vasoactive agents. Br J Clin Pharmacol 2001 Mar;51(3):219-24. 5-Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review. Arch Dermatol 1998 Nov;134(11):1356-60 6-Diehm C, Trampisch HJ, Lange S, Schmidt C. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996;347:292-294 7-Shah D, Bommer S, Degenring FH. Aesculaforce (Venaforce® au Canada) dans l'insuffisance veineuse chronique. Schweiz Zschr GanzheitMedizin 1997;9(2):86-91.