Home' Australian Pharmacist : March 2011 Contents Vol.30–March#03
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
1. Which of the following might
be appropriate advice for a
patient experiencing mild
to moderate chronic venous
insufficiency (CVI) and who is
currently using compression
stockings to manage
a) Discontinue use of compression
stockings as they have been
associated with the formation of
b) Discontinue use of compression
stockings and replace with horse
chestnut seed extract (HCSE) once
c) Continue use of compression
stockings and add horse chestnut
seed extract (HCSE) twice daily.
d) Discontinue all therapies as there
is no evidence of benefit for
compression stockings or herbal
2. Which of the following would
be the most appropriate
dosage regime for a person
wishing to try horse chestnut
seed extract (HCSE)?
a) 50 mg HSCE once daily with food
for 8 weeks then 50 mg HCSE
twice daily with food.
b) 50 mg HSCE twice daily with food
for 8 weeks then 50 mg HCSE
once daily with food.
c) 100 mg HSCE once daily between
meals for 8 weeks.
d) 100 mg HSCE twice daily with
food for 8 weeks then 50 mg
HCSE twice daily with food.
3. Which medications might
horse chestnut seed extract
(HCSE) interact with and
what advice should be given
to patients taking these
a) HCSE may interact with
hypoglycaemic drugs and
anticoagulants. Patients should
have their blood glucose and INR
monitored regularly and observe
for signs of bruising or bleeding.
b) HCSE may interact with
anticoagulants. Patients should
have their blood pressure and INR
A score of 3 out of 4 attracts 0.75 CPD credits.
c) HCSE may interact with
antihypertensives and lipid
lowering medications. Patients
should have their blood pressure
and blood lipids monitored
d) There are no known interactions.
Patients should be monitored for
adverse reactions but these are
4. Pycnogenol is the name
a) a group of flavonoids known as
proanthocyanidins found in French
maritime pine bark.
b) a toxic glycoside found in horse
chestnut that may increase
c) the component of butcher’s broom
which exhibits significant anti-
d) the total triterpenic fraction of gotu
13. Dickson S, Gallagher J, McIntyre L, et al. An open
study to assess the safety and efficacy of Aesculus
hippocastanum tablets (Aesculaforce 50mg) in the
treatment of chronic venous insufficiency. J Herb
Pharmacother. 2004; 4(2):19–32.
14. Diaz-Perales A, Collada C, Blanco C, et al. Cross-
reactions in the latex-fruit syndrome: A relevant role
of chitinases but not of complex asparagine-linked
glycans. J Allergy Clin Immunol. 1999; 104(3 Pt
15. Tiffany N, Boon H, Ulbricht C, et al. Horse chestnut:a
multidisciplinary clinical review. J Herb Pharmacother.
16. Cesarone MR, Belcaro G, Rohdewald P, et al.
Improvement of signs and symptoms of chronic venous
insufficiency and microangiopathy with Pycnogenol:
a prospective, controlled study. Phytomedicine. 2010;
17. Cesarone MR, Belcaro G, Rohdewald P, et al.
Rapid relief of signs/symptoms in chronic venous
microangiopathy with pycnogenol: a prospective,
controlled study. Angiology. 2006; 57(5):569–76.
18. Belcaro G, Cesarone MR, Errichi B, et al. Pycnogenol
treatment of acute hemorrhoidal episodes. Phytother
Res. 2010; 24(3):438–44.
19. 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;
20. Bamigboye AA, Smyth R. Interventions for varicose
veins and leg oedema in pregnancy. Cochrane Database
of Systematic Reviews 2007, Issue 1. Art. No.:
21. Guex JJ, Avril L, Enrici E, et al. Quality of life
improvement in Latin American patients suffering from
chronic venous disorder using a combination of Ruscus
aculeatus and hesperidin methyl-chalcone and ascorbic
acid (quality study). Int Angiol. 2010; 29(6):525–32.
22. Incandela L, Cesarone MR, Cacchio M, et al.
Total triterpenic fraction of Centella asiatica in
chronic venous insufficiency and in high-perfusion
microangiopathy. Angiology. 2001; 52 Suppl 2:S9–13.
23. De Sanctis MT, Belcaro G, Incandela L, et al. Treatment
of edema and increased capillary filtration in venous
hypertension with total triterpenic fraction of Centella
asiatica: a clinical, prospective, placebo-controlled,
randomized, dose-ranging trial. Angiology. 2001; 52
24. Zhou W, Chai H, Lin PH, et al. Clinical use and molecular
mechanisms of action of extract of Ginkgo biloba
leaves in cardiovascular diseases. Cardiovasc Drug Rev.
25. Cohen-Boulakia F, Valensi PE, Boulahdour H, et al.
In vivo sequential study of skeletal muscle capillary
permeability in diabetic rats: effect of anthocyanosides.
Metabolism. 2000; 49(7):880–5.
26. Janssens D, Michiels C, Guillaume G, et al. Increase in
circulating endothelial cells in patients with primary
chronic venous insufficiency: protective effect of Ginkor
Fort in a randomized double-blind, placebo-controlled
clinical trial. J Cardiovasc Pharmacol. 1999; 33(1):7–11.
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patients with multiple risk factors for coronary heart disease
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non-fatal stroke. Contraindications: Hypersensitivity to
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dysfunction; perform periodic LFTs; high alcohol intake;
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References: 1. Sever P et al. Eur Heart J 2006; 27:2982–2988.
2. Sever P et al. Lancet 2003; 361:1149–1158. 3. Dahlof B
et al. Lancet 2005; 366:895–906. 4. LaRosa JC et al.
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