Usual Adult Dose for Varicose Vein

INJECTION SOLUTION:

• The strength of the solution and the volume injected depend on the size and extent of the varicose veins. Extensive varicosities may require multiple treatment sessions.
• Spider veins (varicose veins 1 mm or less in diameter): Use 0.5% solution

Reticular veins (varicose veins 1 to 3 mm in diameter): Use 1% solution

• Use 0.1 to 0.3 mL for each injection into each varicose vein. The maximum recommended volume per treatment session is 10 mL.

Comments:

• For IV use only.
• Be prepared to treat anaphylaxis.
• Do not inject intra-arterially.
• Do not inject intra-perivascularly.
• Use a syringe (glass or plastic) with a fine needle (typically, 26- or 30-gauge). Insert the needle tangentially into the vein and inject the solution slowly while the needle is still in the vein.
• Apply gentle pressure during injection to prevent vein rupture.
• After the needle has been removed and the injection site has been covered, apply compression in the form of a stocking or bandage.
• After the treatment session, encourage the patient to walk for 15 to 20 minutes.
• Keep the patient under observation to detect any anaphylactic or allergic reaction.
• Maintain compression for 2 to 3 days after treatment of spider veins and for 5 to 7 days for reticular veins.
• For extensive varicosities, longer compression treatment with compression bandages or a gradient compression stocking of a higher compression class is recommended. Posttreatment compression is necessary to reduce the risk of deep vein thrombosis.
• Repeat treatments may be necessary if the extent of the varicose veins requires more than 10 mL. These treatments should be separated by 1 to 2 weeks.
• Small intravaricose blood clots (thrombi) that develop may be removed by stab incision and thrombus expression (microthrombectomy).

Use: The solution is used to sclerose uncomplicated spider veins (varicose veins 1 mm in diameter or less) and uncomplicated reticular veins (varicose veins 1 to 3 mm in diameter) in the lower extremity

INJECTABLE FOAM:
Use up to 5 mL per injection and no more than 15 mL per session. Inject freshly generated injectable foam slowly (approximately 1 mL/second in the great saphenous vein (GSV) and 0.5 mL/second in accessory veins or varicosities) while monitoring using ultrasound. Confirm venospasm of the treated vein using ultrasound. When treating the proximal GSV, stop the injection when this drug is 3 to 5 cm distal to the saphenofemoral junction (SFJ).

Comments:

• The injectable foam should be administered within 75 seconds of extraction from the canister to maintain injectable foam properties.
• This drug is intended for IV injection using ultrasound guidance, administered via a single cannula into the lumen of the target incompetent trunk veins or by direct injection into varicosities.
• Be prepared to treat anaphylaxis.
• Do not inject intra-arterially.
• Do not inject intra-perivascularly.
• Physicians administering this drug must be experienced with venous procedures, possess a detailed working knowledge of the use of the duplex ultrasound in venous disease, and be trained in the administration of this drug.
• A local anesthetic may be administered prior to cannula insertion but neither tumescent anesthesia nor patient sedation is required.
• Apply compression bandaging and stockings and have the patient walk for at least 10 minutes, while being monitored.
• Maintain compression for 2 weeks after treatment.
• Repeat treatment may be necessary if the size and extent of the veins to be treated require the use of more than 15 mL.
• Separate treatment sessions by a minimum of 5 days.
• Retained coagulum may be removed by aspiration (microthrombectomy) to improve comfort and reduce skin staining.

Use: The injectable foam is a sclerosing agent used for the treatment of incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein (GSV) system above and below the knee. This drug improves the symptoms of superficial venous incompetence and the appearance of visible varicosities.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Storage requirements:

• Consult the manufacturer product information.

Reconstitution/preparation techniques:

• Consult the manufacturer product information.