ASK DIS: Daflon In Pregnancy

Availability:
Diosmin 450mg/ Hesperidin 50mg
Indication

Treatment of symptoms related to venolymphatic insufficiency (heavy legs, pain, early morning restless legs),
Treatment of functional symptoms related to acute hemorrhoidal attack and chronic hemorrhoids

Contraindication

Precaution/Warning

Pregnancy

Experimental studies in animals have not demonstrated any teratogenic effect in animals.
Furthermore, no adverse effects have been reported to date in humans.

Studies & Evidences

3 pregnant females who presented with congestive haemorrhoidal disease and responded favourably to Daflon in a study in Saudi Arabia
In another study for a median of 8 weeks before delivery and 4 weeks after delivery, in 50 women with acute hemorrhoids, Treatment was well accepted, and did not affect pregnancy, fetal development, birth weight, infant growth and feeding

Alternatives

help relieve the itch or discomfort of haemorrhoids, but do not treat the underlying varicose veins.
Suppository and ointment formulations are both safe to use in pregnancy
A haemorrhoid preparation will contain some of the following medications.

Hydrocortisone and prednisolone (corticosteroids) - reduce inflammation and itching.
Lignocaine and cinchocaine (local anaesthetics) - reduce pain and irritation.
Witch hazel (hamamelis), aluminium acetate and allantoin - reduce inflammation.
Zinc oxide – protective.
Peru balsam and benzyl benzoate – mild antiseptic and anti-itching action

Other non-Pharmacological Advice

Take high fibre diet and drink lots of water
Warm (but not hot) sitz baths are a traditional therapy for piles: sit in about 8 cm of warm water for 15 minutes, several times a day, especially after a bowel movement
Try not to sit for hours at a time. If you have to, take breaks: once every hour, get up and move around for at least five minutes. A doughnut-shaped cushion can make sitting more comfortable and ease haemorrhoid pressure and pain.
Insert petroleum jelly just inside the anus to make bowel movements less painful.
Consider dabbing witch hazel (a soothing anti-inflammatory agent) on irritated haemorrhoids to reduce pain and itching.
Resist the temptation to scratch haemorrhoids
If you need a pain reliever, consider using paracetamol.
Bathe regularly to keep the anal area clean, but be gentle: excessive scrubbing, especially with soap, can intensify burning and irritation.
Don't sit on the toilet for more than five minutes at a time, and when wiping, be gentle. If toilet paper is irritating, try dampening it first, or use cotton balls or alcohol-free baby wipes
When performing any task that requires exertion, be sure to breathe evenly. It's common to hold your breath during exertion, and if you do, you're straining and contributing to haemorrhoid swelling.

Recommendation

As the use in pregnancy is still in ‘Precaution/Warning’ category, it is advisable not to initiate patient on the therapy
Other symptomatical approach such as listed above would be preferred as first line
Consider management and advice for constipation and exertion
Discuss with respective specialist on usage of agent if needed and no improvement with other managemnet

References

http://www.rcsed.ac.uk/RCSEDBackIssues/journal/svol2_6/206005.html
http://www.servier.com.ve/sites/default/files/spc-pil/spc-daflon500.pdf
http://www.ncbi.nlm.nih.gov/pubmed/9184951
http://www.just.edu.jo/DIC/AZLibrary/Diosmin%20and%20Hespiridin.pdf
http://www.webmd.boots.com/digestive-disorders/piles-haemorrhoids?page=2
http://www.seslhd.health.nsw.gov.au/mothersafe/documents/HaemorrhoidsinPregnancyandBreastfeeding2013_new.pdf

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