Herbal medicinal products in clinical guidelines: Horse chestnut seed extract as “well established use” medicinal product in chronic venous diseases
Conservative therapy of chronic venous insufficiency (CVI) consists largely of compression treatment. However, this often causes discomfort and has been associated with poor compliance. Therefore, oral pharmacotherapy (for example oral treatment with extracts from Aesculus hippocastanus L., fructus (horse chestnut seed extract, HCSE) is an attractive option. In this overview the clinical and pharmacological evidence (studies, Cochrane review, monographs, guidelines in this indication) concerning mechanisms of action, efficacy and safety were reviewed. The action of HCSE addresses the enhanced permeability of the venous endothelium, especially the capillaries, decreasing transfer of water from the blood to the adjacent tissue . Overall, there is an improvement in CVI related signs and symptoms with HCSE compared with placebo. This is reflected in all reviews and monographs [e.g. 2, 3] as well as in clinical guidelines [e.g. 4]. Adverse events were usually mild and infrequent. Due to pathophysiological and methodological reasons a study duration of 12 weeks seems appropriate and sufficient to demonstrate clinical efficacy in comparison to compression treatment, as long term compliance is key factor in CVI treatment and is higher for pharmacotherapy than for compression therapy. The evidence presented suggests that HCSE is an efficacious and safe treatment for CVI, as has been documented in studies of up to 12 weeks duration and allows, in conjunction with the good tolerability documented by pharmacovigilance data, the conclusion that the therapeutic usefulness of HCSE is well established also in long term treatment.
Keywords: Aesculus hippocastanus, horse chestnut, HSCE, CVI, chronic venous insufficiency, clinical guideline, monograph
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