Ointments for leg swelling

There are quite a few pathologies in which ointment for leg swelling helps reduce the severity of such a symptom as fluid retention in soft tissues: extra pounds, impaired lymph drainage (lymphostasis), varicose veins or thrombophlebitis of the lower extremities.

Of course, when swelling is associated with low blood protein levels, heart, kidney or thyroid problems, systemic drugs are used, but in some cases a local decongestant is recommended, that is, a properly selected ointment for leg swelling.

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Release form

Many modern ointments are produced not on a fat basis, but on a gel basis, the hydrophilic properties of which contribute to better penetration of pharmacologically active components into the skin and increase their biological availability. Therefore, almost all the names of ointments for leg swelling included in this review are gel-like preparations, and their release form is a gel of various concentrations (in tubes).

Heparin ointment (other trade names - Hepatrombin, Hepalpan, Thrombless, Trombofob, Lyoton, Venobene, Viatromb), according to the official instructions, has the following indications for use: thrombophlebitis of the veins of the lower extremities, phlebitis and periphlebitis, external hemorrhoids, trophic ulcers of the skin and subcutaneous tissue of the shins, hematomas and edema of the extremities.

• Ointment for leg swelling due to varicose veins: Troxevasin (synonyms: Troxerutin, Venorutinol, Venoruton), Heparin ointment, Venogepanol (Venolaif), Venitan (Escin, Essaven, Venastat, Venen, Cycloven forte).
• Ointment for legs against swelling and fatigue: Girudoven (analogues, also containing leech extract - Venosol, gel-balm 911+).
• Ointments for pain and swelling of the leg: Heparin ointment, Ginkor, Dolobene, Indovazin.
• Ointment for swelling of the legs after a fracture: Heparin ointment, Dolobene, Indovazin.
• Ointment for leg swelling during pregnancy: Venitan, Venogepanol, Ginkor Gel.
• Ointments for leg swelling in the elderly: Heparin ointment, Venogepanol, Venitan, Herbion esculus.

The listed remedies can help with various injuries accompanied by pain and swelling.

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Pharmacodynamics

Heparin ointment acts by reducing blood clotting (increasing the activity of its plasma factors - AT III, KFG II and thrombin), and this drug is classified as a direct anticoagulant, which prevents the formation of fibrin from fibrinogen. Endogenous heparin is a natural sulfated glycosaminoglycan - a biopolymer that is synthesized by basophils and mast cells and enters the bloodstream at the sites of vascular and tissue damage. Sodium heparin, which is part of this ointment, also inhibits blood clotting factors. Negatively charged heparin molecules bind positively charged molecules of interstitial (intercellular) fluid, due to which Heparin ointment for leg edema of any etiology is an effective anti-exudative agent.

Benzonicotinic acid, which is part of Heparin Ointment, dilates blood vessels, facilitating the access of heparin to tissues, and the local anesthetic benzocaine (anesthesin) relieves pain.

Pharmacodynamics of Dolobene ointment is provided by sodium heparin, dimexide and dexpanthenol. How heparin works is already clear; anti-inflammatory and anti-edematous action of dimexide is associated with suppression of hydroxide radical activity at the site of inflammation and absorption of excess fluid; dexpanthenol is converted into pantothenic acid, which helps normalize metabolism in cells.

Ointment for leg swelling with varicose veins Troxevasin contains hydroxyethylrutoside (troxerutin) - flavonol, a semi-synthetic derivative of quercerin glycoside rutin (rutoside), which is part of the vitamin P group, that is, it helps strengthen the vascular walls of blood vessels, reducing the permeability of small vessels. Troxerutin is also an antioxidant, as it blocks the activity of lipoxygenase, which catalyzes the processes of peroxidation of polyunsaturated fatty acids; inhibits the synthesis of anti-inflammatory glycosaminoglycans and blocks the release of histamine from mast cells, helping to reduce inflammation.

In addition to troxerutin, the ointment for pain and swelling of the leg Indovazin contains the non-steroidal anti-inflammatory drug indomethacin, which relieves inflammation, pain and tissue swelling by suppressing platelet aggregation and improving tissue trophism - by inhibiting the action of catalysts for the synthesis of inflammatory mediators (COX-1 and COX-2).

The pharmacodynamics of the combined ointment Venogepanol is based on three components – heparin, venorutinol (analog of troxerutin) and dexpanthenol (see above).

The remedy for swelling in varicose veins and thrombophlebitis Ginkor Gel contains not only troxerutin, but also ginkgo biloba extract, which is a powerful antioxidant, inhibits the phospholipid inflammation mediator PAF, reduces vascular tone and helps strengthen blood vessels.

Another effective angioprotective drug is Venitan ointment, based on horse chestnut extract (Aesculus), which contains the saponin escin (which reduces blood viscosity, increases the elasticity and strength of blood vessels) and the glycoside esculin (which reduces the permeability of capillary walls and improves blood circulation in them).

The ointment Gerbion Aesculus also contains substances of plant origin: liquid extracts of horse chestnut fruits and sweet clover (Melilotus officinalis) herb, which increase the tone of venous vessels and reduce the activity of blood clotting (including due to the anticoagulant properties of dicoumarol found in sweet clover).

The mechanism of action of the ointment for legs against swelling and fatigue, as well as against heaviness and pain in the legs - Girudoven - is due to the improvement of microcirculation in the vessels of the lower extremities, which is facilitated by horse chestnut extract (see earlier), medicinal leech extract (Hirudo medicinalis), camphor and menthol. Leech extract contains an anticoagulant peptide of its salivary glands - hirudin, which suppresses the activity of blood clotting factors. Menthol and camphor activate local blood circulation - due to irritation of skin receptors and a reflex response of the vessels of the skin and subcutaneous tissue.

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Pharmacokinetics

The pharmacokinetics of the above-mentioned ointments for leg swelling are not presented in the official instructions for the drugs.

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Dosing and administration

Any ointment for swelling is used locally and applied in a thin layer:

• Heparin ointment, Venogepanol - no more than three times a day, after application the drug is rubbed into the skin;
• Troxevasin, Venitan - gently rub into the skin twice a day (morning and evening) (until the ointment is completely absorbed); it is possible to apply a bandage or apply under an elastic bandage;
• Dolobene and Indovazin – twice a day (no longer than a week).
• Ginkor Gel – two or three times a day (do not expose skin areas treated with the ointment to sunlight);
• Herbion Aesculus ointment - apply up to four times a day (do not rub in);
• Girudoven ointment for legs against swelling and fatigue can be applied three to five times during the day.

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Use ointments for swollen feet during pregnancy

The attending physician should prescribe Venogepanol or Heparin ointment for leg swelling during pregnancy - after a blood test for platelet levels.

Troxevasin is contraindicated for use in the first trimester of pregnancy; in the second and third trimesters, the drug may be prescribed if the expected benefit to the mother is higher than the risk to the normal development of the fetus.

Venitan and Ginkor Gel ointments are approved for use during pregnancy and breastfeeding.

According to the instructions, Herbion Aesculus can be used during pregnancy and lactation (due to the absence of a systemic effect on the body). However, it should be noted that sweet clover is contraindicated during pregnancy due to the presence of coumarin and dicoumarol.

Pregnant women are prohibited from using Dolobene, Indovazin and Girudoven ointments.

Contraindications

General contraindications for use for all products included in the review: the presence of damage or any pathological changes in the skin at the site of application of the ointments, as well as individual hypersensitivity to a specific drug or any of its components.

Heparin ointment for edema and Hirudoven are not used in cases of poor blood clotting.

Dolobene ointment is not used in cases of bronchial asthma and renal failure, as well as in children under five years of age. Venogepanol is prohibited for use in children under 12 years of age, and Ginkor Gel is not used for children at all.

Troxevasin is contraindicated in case of exacerbation of chronic gastritis, gastric ulcer and duodenal ulcer; Indovazin – in case of tendency to bleeding; Venitan – in case of increased level of platelets in the blood.

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Side effects ointments for swollen feet

The instructions note the following side effects of ointments for leg swelling:

Heparin ointment, Troxevasin, Indovazin, Venogepanol, Venitan, Ginkor, Girudoven - skin hyperemia, rashes, itching;

Dolobene - redness of the skin, burning or itching, the smell of garlic from the mouth (which can be caused by dimexide);

Herbion Aesculus – skin irritation and increased dryness.

Overdose

Overdose of these external agents is not described in the instructions due to the lack of data on exceeding doses.

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Interactions with other drugs

General recommendation regarding these preparations: to avoid external interaction with other preparations, never apply different ointments at the same time.

Heparin ointment should not be used during treatment with antibiotics, NSAIDs or antihistamines; Dolobene ointment is incompatible with oral administration of drugs containing acetylsalicylic acid.

Storage conditions

Ointments for leg swelling Indovazin and Venogepanol, Heparin ointment are stored at a temperature not exceeding +18°C (in addition, Heparin ointment and all ointments with heparin should be kept in a dark place); ointments Troxevasin, Dolobene, Venitan and Gerbion esculus - at a temperature not exceeding +25°C; Ginkor Gel and Girudoven - at a temperature of +10-20°C.

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Shelf life

The shelf life of Dolobene, Troxevasin, Heparin Ointment and Ginkor Gel ointments is three years; Indovazin, Venogepanol, Venitan, Gerbion Aesculus and Girudoven are suitable for use for two years from the date of manufacture (indicated on the packaging).

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In conclusion, it should be remembered that no matter how effective and easy to use a particular ointment for leg swelling is, the causes of swelling are different, so it is necessary to undergo a medical examination to identify the etiology of fluid stagnation in the lower extremities and direct treatment not to the symptom, but to the disease itself.