Polidocanol
VARITHENA
Pronunciation: pol-ee-doe-KAY-nol
“Polly dockin’ all Varicose things (Varicose Athena)”
Sclerosing agent injected into varicose veins
What it isDetergent sclerosant for leg veins: a 1% injectable foam (VARITHENA, 2013) for incompetent great saphenous and accessory saphenous veins and the visible varicosities of the GSV system above and below the knee, and a 0.5%/1% solution (ASCLERA, 2010) for uncomplicated spider veins (≤1 mm) and reticular veins (1–3 mm).
Why this oneIts hydrophobic tail attaches to the endothelial lipid membrane, the osmotic barrier fails and the endothelium is destroyed; vasospasm and a thrombogenic surface follow, the vein occludes and is replaced by fibrous tissue. Deactivated on contact with blood, so the action is confined to the injected segment.
What limits itUp to 5 mL per injection and 15 mL per session (foam); 0.1–0.3 mL per injection and 10 mL per session (solution). Risks: anaphylaxis, severe necrosis or gangrene with intra-arterial injection or extravasation, and venous thrombosis — monitor after treatment. Terminal half-life 102–153 min; no CYP interactions are described.
FDA-approved for
- varicose veins (great saphenous vein system, foam) (2013)
- spider and reticular veins of the lower extremity (solution) (2010)
Principal riskAnaphylaxis (some fatal); tissue necrosis, ischemia or gangrene with intra-arterial injection or extravasation; venous thrombosis and pulmonary embolism
Classes and tags
Clinical profile
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Sclerotherapy of spider veins (varicose veins <=1 mm diameter) | Adults | IV (0.5% solution): 0.1-0.3 mL per injection into each varicose vein | Volume per strength/extent of varicosities; repeat sessions if >10 mL needed, separated by 1-2 weeks | 10 mL per treatment session |
| Sclerotherapy of reticular veins (varicose veins 1-3 mm diameter) | Adults | IV (1% solution): 0.1-0.3 mL per injection into each varicose vein | Volume per strength/extent of varicosities; repeat sessions if >10 mL needed, separated by 1-2 weeks | 10 mL per treatment session |
Renal Undefined
Hepatic Undefined
Repeat treatment sessions separated by 1-2 weeks
Instructions
- For intravenous use only — never intra-arterially
- Use fine needle (26- or 30-gauge); insert tangentially into vein and inject slowly with needle in vein; only gentle pressure to prevent vein rupture
- After injection, cover site and apply compression (stocking/bandage): 2-3 days for spider veins, 5-7 days for reticular veins; longer/higher-class compression for extensive varicosities (reduces DVT risk)
- Have patient walk 15-20 minutes post-session and keep under observation for anaphylactic/allergic reaction
- Do not use if particulate matter, discoloration, or damaged vial
- Small intravaricose thrombi may be removed by microthrombectomy
Available strengths
- inj 180 mg/18 mL
- inj 10, 20 mg/2 mL
Contraindications
- Acute thromboembolic diseases
Cautions
- Severe allergic reactions incl. fatal anaphylaxis — more frequent with volumes >3 mL; minimize dose; be prepared to treat anaphylaxis
- Venous thrombosis and pulmonary embolism — monitor after treatment; higher risk with reduced mobility, prior DVT/PE, recent major surgery, prolonged hospitalization, or pregnancy
- Arterial embolism (stroke, TIA, MI, impaired cardiac function) reported; avoid product foamed with room air (safety/efficacy not established)
- Intra-arterial injection or extravasation can cause severe necrosis, ischemia, or gangrene — consult vascular surgeon immediately if intra-arterial injection occurs
Adverse reactions
- Injection-site: hematoma (42%), irritation (41%), discoloration (38%), pain (24%), pruritus (19%), warmth (16%), thrombosis (6%); neovascularization (8%)
- Postmarketing: anaphylactic shock, DVT, pulmonary embolism, CVA, cardiac arrest, circulatory collapse, skin hyperpigmentation, injection-site necrosis, nerve injury
Pregnancy Case reports identify no drug-associated risk, but minimal benefit to treating spider/reticular veins in pregnancy — varicosities may regress postpartum
Lactation No data; may consider interrupting breastfeeding with pump-and-discard for up to 8 h after administration
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 180 mg/18 mL | inj | per unit | not offered | |
| 10 mg/2 mL | inj | per unit | not offered | |
| 20 mg/2 mL | inj | per unit | not offered |