polidocanol

REMS

Asclera

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

Varithena

Incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system above and below the knee

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 and incompetent veins and visible varicosities.

Pharmacokinetics ⬆ ⬇

Absorption: Local IV administration results in low systemic blood levels.

Distribution: Action is primarily local.

Metabolism/Excretion: Unknown.

Half-Life: 1.5 hr.

Time/Action Profile ⬆ ⬇

(vessel occlusion)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	3–6 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Known allergy;
History of venous thromboembolism, reduced mobility, major surgery in previous 3 mo, or recent prolonged hospitalization (↑ risk of venous thromboembolism);
OB: Pregnancy (may cause fetal harm).

Use Cautiously in:

Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Safety and effectiveness not established.

Adv. Reactions/Side Effects ⬆ ⬇

CV: DEEP VEIN THROMBOSIS, MI, STROKE, TRANSIENT ISCHEMIC ATTACK

Local: mild injection site reactions, tissue ischemia/necrosis/gangrene

Resp: PULMONARY EMBOLISM

Misc: ANAPHYLAXISALLERGIC REACTIONS INCLUDING

Interactions ⬆ ⬇

Drug-drug:

None noted.

Route/Dosage ⬆ ⬇

Asclera

LocalIV (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.

Varithena

LocalIV (Adults ): Up to 5 mL per injection. Not to exceed 15 mL/treatment session.

Availability ⬆ ⬇

Solution for injection (contains ethanol) (Asclera): 0.5%; 1%
Foam for injection (Varithena): 10 mg/mL

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.
Monitor for signs and symptoms of DVT or PE in patients with history of venous thromboembolism, reduced mobility, major surgery in previous 3 mo, or recent prolonged hospitalization.

Implementation ⬆ ⬇

IV Administration:

IV Push: Administer Asclera undiluted. Varithena must be activated prior to use (see Manufacturer's instructions). 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 gentle pressure during injection to prevent vein rupture. If repeated treatments are needed, separate by 1–2 wks for Ascelera and 5 days for Varithena.
- 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 thrombosis. After treatment session, encourage patient to walk for 15–20 minutes.

Patient/Family Teaching ⬆ ⬇

Instruct patient to keep bandages dry and in place for 48 hrs and to wear compression stockings or support hose on treated legs continuously for 2 wks after Varithena and for 2–3 days and for 2–3 wks during daytime after Asclera. 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 notify health care professional if signs or symptoms of DVT or PE develop.
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.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇