polidocanol


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polidocanol

(po-li-doe-ka-nole) ,

Ascelera

(trade name)

Classification

Therapeutic: sclerosing agents
Pregnancy Category: C

Indications

Treatment of uncomplicated spider veins (varicose veins ≤1 mm in diameter) and uncomplicated reticular veins (varicose veins 1 to 3 mm in diameter) in legs.

Action

Causes local endothelial damage following intravenous administration, followed by platelet aggregation and attachment to the venous wall, resulting in a dense network of platelets, cellular debris, and fibrin, which occludes the vein. This is followed by replacement with connective fibrous tissue.

Therapeutic effects

Improved appearance of spider/reticular veins.

Pharmacokinetics

Absorption: Local IV administration results in low systemic blood levels.
Distribution: Action is primarily local.
Metabolism and Excretion: Unkown.
Half-life: 1.5 hr.

Time/action profile (vessel occlusion)

ROUTEONSETPEAKDURATION
IVrapid3–6 wkunknown

Contraindications/Precautions

Contraindicated in: Known allergy; Known thromboembolic disease; Obstetric / Should not be used during pregnancy; Lactation: Avoid breastfeeding.
Use Cautiously in: Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Local

  • mild injection site reactions

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Local: Intravenous (Adults) Spider veins—0.1–0.3 mL of 0.5% solution for each injection into each varicose vein; Reticular veins—0.1–0.3 mL of 1% solution for each injection into each varicose vein. Not to exceed 10 mL/treatment session.

Availability

Solution for local intravenous injection (contains ethanol): 5 mg/mL in 2 mL ampules (0.5%), 10 mg/mL in 2 mL ampules (1.0%)

Nursing implications

Nursing assessment

  • Assess extent of spider and/or reticular veins in lower extremities.
  • Monitor for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing) for at least 15–20 min following administration.

Potential Nursing Diagnoses

Activity intolerance (Indications)
Disturbed body image (Indications)

Implementation

  • Intravenous Administration
  • Administer undiluted. Using a fine-gauge (26 or 30 gauge) needle, insert needle tangentially into affected vein and inject solution slowly while needle is still in vein. Apply only gently pressure during injection to prevent vein rupture. If repeated treatments are needed, separate by 1–2 wks.
    • Inadvertent perivascular injection may cause pain. If severe, inject local anesthetic.
    • Intra-arterial injection can cause severe necrosis, ischemia, or gangrene; consult a vascular surgeon immediately if this occurs.
    • Following injection, apply compression via stocking or bandage to reduce risk of deep vein thrombisis. After treatment session, encourage patient to walk for 15–20 minutes.

Patient/Family Teaching

  • Instruct patient to wear compression stockings or support hose on treated legs continuously for 2–3 days and for 2–3 wks during daytime. Compression stockings or support hose should be thigh high or knee high depending on area treated.
  • Advise patient to walk for 15–20 min immediately after procedure and daily for next few days.
  • Advise patient to avoid heavy exercise, sunbathing, long plane flights, and hot baths or sauna for 2–3 days following treatment.
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • ↓ in size and visibility of spider and/or uncomplicated reticular veins in lower extremities.
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References in periodicals archive ?
Just after the aspiration in Gharbi type 1 and 2, without aspiration Gharbi type 3, for each centimeter of the long diameter of the cysts, 2 cc of pure alcohol (96 %) and 1 cc of polidocanol 1% (ethoxysclerol 1%, Kreussler Pharma, Wiesbaden, Germany) were injected into the cysts.
Surgical procedures (marsupialization, evacuation of the cyst elements, and filling the cyst with saline), percutaneous drainage, and administration of a sclerosing agent such as 96% alcohol and 1% polidocanol under ultrasound guidance are the general treatment modalities for HC in the liver (4, 6).
Sclerotherapy, using tetracycline or polidocanol injected into the vaginal cavity or plication or removal of redundant portions of the vaginal tunic, has been used to treat men affected with hydrocele, but these treatments have not been evaluated in affected stallions.
(55) Another sclerosing agent Polidocanol also has been injected successfully.
Although hypertonic glucose is primarily used as the irritant, polidocanol, manganese, zinc, human growth hormone, and autologous cellular solutions such as platelet-rich plasma are also used.
[6] have reported favourable results with 3% polidocanol (hydroxypolyethoxydodecan) for sclerotherapy in ABC.
(28) The mucocele was aspirated while polidocanol 1% was injected into the gland.
A number of sclerosing agents are available, including a hypertonic solution of sodium chloride (23.4%); detergents such as sodium tetradecyl sulphate, polidocanol, and sodium morrhuate; and other agents such as sodium iodide and chromaled glycerin.
evaluated the results of five prospective case series and four controlled trials (three prolotherapy, two polidocanol, three autologous whole blood, and one platelet-rich plasma) for the treatment of refractory tennis elbow [19].
In group I the surgical procedure consisted in crossectomy of the affected saphenous vein and the distal saphenous vein was canalized with a 6 F silicon Nelaton urethral tube until the knee level and slowly filled with foam; meanwhile the tube was withdrawn; the foam was built with 6cc of polidocanol 1% (Polydosclerol, Sigvaris, Sig Med, 16 Parkway North Deerfield, IL, USA) foamed with 18 cc of air (3: 1) using Tessari's technique [5] (Figures 1(a) and 1(b)) with a three-way stopcock (Elcam Medical A.C.A.L., Bar-Am 13860 Israel) and two plastic syringes, BD Plastipak, Becton Dickinson, Mexico.
The sclerosant agents used are 5% sodium morrhuate, quinine urethrone, 5% ethanolamine oleate, 1% polidocanol and hypertonic saline.6