Diosmin/hesperidin

Micronized purified flavonoid fraction, «venoactive» agent

ATC code: C05CA53(Diosmin, combinations (with hesperidin))

Brand names: Venosmine, Diosminol

Updated 1 Jun 2026 · Methodology

Indications

Hemorrhoidal disease

Adjunct

In hemorrhoidal flares, used short-term to reduce pain, bleeding, and edema. The Alonso-Coello 2006 meta-analysis of flavonoids in hemorrhoids showed relative risk of no response of 0.42 (95% CI 0.28–0.61). Acute dose: 6 tablets per day for 4 days, then 4 tablets per day for 3 days. Foundation therapy is stool optimization (fiber, hydration), topical care, and minimally invasive procedures for severe symptoms.

Sources

ICD-10: K64 · ICD-11: DB60

Chronic venous insufficiency

Adjunct

Used symptomatically for leg heaviness, edema, and pain in chronic venous insufficiency CEAP classes C0s–C3. Evidence is modest: the 2020 Cochrane meta-analysis of flavonoids showed moderate effect on pain and edema with low certainty. No effect has been described on hard outcomes (disease progression, venous ulcer healing) apart from a small effect on venous ulcer healing alongside compression. ESVS 2022 foundation therapy is compression and lifestyle change; diosmin/hesperidin does not replace them.

Sources

ICD-10: I87.2 · ICD-11: BD74

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Micronized purified flavonoid fraction: 90% diosmin and 10% hesperidin. Claimed in vitro effects: raised venous tone via adrenergic receptors, reduced capillary permeability, antioxidant and anti-inflammatory activity. Diosmin bioavailability in humans is low (gut microbiota metabolize it to active diosmetin). Evidence for hard clinical outcomes (ulcer healing, disease progression) is limited.

Safety

Contraindications

Hypersensitivity to diosmin, hesperidin, or excipients
Pregnancy in T1 (limited data)

Serious adverse effects

Severe allergic reactions (rare)

Common adverse effects

Nausea
Epigastric pain
Diarrhea
Headache
Skin rash (rare)

Pregnancy: can you take Diosmin/hesperidin?

Avoid in T1 where possible due to limited data. Short courses in T2 and T3 are acceptable when indicated. For pregnancy venous symptoms, class 2 graduated compression stockings are first-line.

Breastfeeding: can you take Diosmin/hesperidin?

Limited data on milk excretion. Lactation use is not recommended without clear indication.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Evidence

Evidence for micronized diosmin/hesperidin and other «venotonics» (hidrosmin, troxerutin, rutosides) is limited. On clinically meaningful CVI outcomes (venous ulcer healing, thrombosis rates, disease progression), only small effects in combination with compression have been described. Use is justified as a symptomatic adjunct to compression and lifestyle change. Replacing compression with diosmin alone is not meaningful.

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Frequently asked

What is Diosmin/hesperidin used for?

Diosmin/hesperidin is evaluated for the following indications with varying evidence strength: Hemorrhoidal disease (evidence tier C), Chronic venous insufficiency (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Diosmin/hesperidin?

Common side effects of Diosmin/hesperidin (≥ 1 in 100): Nausea, Epigastric pain, Diarrhea, Headache, Skin rash (rare). See the Safety section for uncommon and serious reactions.

Is Diosmin/hesperidin safe during pregnancy?

Avoid in T1 where possible due to limited data. Short courses in T2 and T3 are acceptable when indicated. For pregnancy venous symptoms, class 2 graduated compression stockings are first-line.

Is Diosmin/hesperidin compatible with breastfeeding?

Limited data on milk excretion. Lactation use is not recommended without clear indication.

Who should not take Diosmin/hesperidin?

Diosmin/hesperidin is contraindicated in: Hypersensitivity to diosmin, hesperidin, or excipients; Pregnancy in T1 (limited data). Full list in the Safety section.

Other drugs in this group

Calcium dobesilate, Hidrosmin