lauromacrogol

Action and Spectrum

Actions and Spectrum: 

Action: 

lauromacrogol is a widely used sclerosing agent in medical procedures such as treating varicose and spider veins. Its primary action lies in its ability to induce sclerosis, a controlled chemical irritation of the inner lining of blood vessels. When injected directly into a varicose or spider vein, lauromacrogol disrupts the endothelial cells lining the blood vessel walls. This disruption triggers a series of biochemical and cellular events, leading to the closure and eventual collapse of the treated vein.

lauromacrogol’s mechanism of action is primarily through its detergent properties, as it disrupts the integrity of the endothelial cells and also promotes the formation of blood clots within the treated vessel. Over time, the body naturally reabsorbs the closed vein and blood flow is rerouted through healthier vessels, improving overall vascular health and the appearance of the treated area. 

Spectrum: 

The spectrum of action for lauromacrogol is primarily limited to its application in vascular medicine. It is not a systemic medication but a localized sclerosing agent for specific medical conditions related to venous insufficiency. lauromacrogol is particularly effective in treating minor- to medium-sized varicose and spider veins, which are typically non-functional and cosmetically undesirable.

The procedure involving lauromacrogol injections is minimally invasive and may provide significant relief from the symptoms of venous insufficiency, such as pain, swelling, and discomfort. However, it is essential to note that lauromacrogol should be carefully administered by trained medical professionals, as improper injection techniques or dosage can lead to complications such as tissue necrosis or allergic reactions. 

Drug Interaction

Adverse Reaction

Black Box Warning

Black Box Warning: 

None 

Contraindication / Caution

Contraindication/Caution: 

Contraindication 

• Allergy or hypersensitivity: Patients with a known allergy or hypersensitivity to lauromacrogol or its components should not receive this treatment, as it can lead to allergic reactions ranging from mild-severe anaphylaxis reactions. 
• Acute deep vein thrombosis (DVT): lauromacrogol should not be used in patients with active deep vein thrombosis, as it can enhance the risk of clot propagation or dislodgment, potentially leading to severe complications. 
• Arterial insufficiency: Patients with compromised arterial blood flow, such as those with arterial disease or peripheral artery disease (PAD), should not undergo lauromacrogol treatment. Using the sclerosing agent in these cases can lead to tissue damage due to inadequate blood supply. 
• Pregnancy and breastfeeding: The safety of lauromacrogol during pregnancy and breastfeeding has not been thoroughly studied, and therefore, it is typically avoided in these situations to minimize potential risks to the developing fetus or infant. 
• Active infections or inflammation: lauromacrogol should not be used in areas with active infections or inflammation, as it can exacerbate these conditions or lead to complications. 
• Recent surgery or trauma: Patients who have undergone recent surgical procedures or experienced significant trauma in the treatment area should not receive lauromacrogol injections until they have fully healed, as it may interfere with the healing process. 
• Severe coagulopathies: Patients with severe blood clotting disorders or coagulopathies may not be suitable candidates for lauromacrogol treatment, as it can increase the risk of bleeding and hematoma formation. 
• Active cancer: lauromacrogol is typically avoided in areas with active cancer or tumors, as it can cause inflammation and potentially interfere with cancer treatment. 

Caution 

• Allergic reactions: Even if a patient has no known allergy to lauromacrogol, there is still a potential risk of allergic reactions. Healthcare providers should be prepared to manage allergic reactions, and patients should be monitored closely during and after the procedure for any signs of hypersensitivity. 
• Ulcerations and open wounds: lauromacrogol should not be injected directly into open wounds or ulcerations. The solution can cause significant irritation and may delay the healing process. 
• Skin pigmentation changes: After treatment with lauromacrogol, some patients may experience temporary changes in skin pigmentation in the treated area. This may include lightening or darkening of the skin. Patients should be informed about this potential side effect. 
• Nerve damage: Injection of lauromacrogol too close to sensory nerves can result in nerve damage, leading to numbness or altered sensation in the treated area. Careful injection technique and precise placement are essential to avoid nerve injury. 
• Infection risk: While lauromacrogol has antibacterial properties, there is still a risk of infection at the injection site. Proper sterile techniques should be followed during the procedure to minimize this risk. 
• Temporary discomfort: Patients should be informed that they may experience temporary discomfort, burning, or stinging sensations at the injection site during the procedure. This discomfort usually subsides relatively quickly. 
• Recurrence: lauromacrogol treatment may not eliminate all varicose or spider veins, and recurrence is possible over time. Patients should be aware of the need for potential follow-up treatments or additional interventions. 
• Post-procedure care: Proper post-procedure care, including using compression stockings and avoiding certain activities, is essential to ensure the best outcomes and minimize potential complications. 
• Pregnancy and breastfeeding: While lauromacrogol is generally avoided during pregnancy and breastfeeding if deemed necessary, the potential risks and also benefits should be carefully weighed, and the patient should be closely monitored. 
• Patient expectations: Patients should have realistic expectations about the results of lauromacrogol treatment. While it can improve the appearance and symptoms of varicose and spider veins, it may not achieve perfect, vein-free legs in all cases. 

Pregnancy / Lactation

Pregnancy consideration:  

US FDA pregnancy category: Not assigned. 

Lactation:   

Excreted into human milk: Not known. 

Pregnancy category: 

• Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    
• Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence, these categories of drugs need to be avoided by pregnant women.    
• Category N: There is no data available for the drug under this category. 

Pharmacology

Pharmacology: 

lauromacrogol is a synthetic non-ionic detergent-like compound used as a sclerosing agent in medical procedures. Its pharmacological action is primarily attributed to its ability to disrupt the endothelial cells lining the inner walls of blood vessels. When injected directly into veins, lauromacrogol causes local irritation and inflammation, leading to endothelial damage.

This disruption triggers a cascade of events, including platelet aggregation, fibrosis, and inflammation, ultimately resulting in the closure and obliteration of the treated blood vessels. The sclerosing effect reduces or eliminates blood flow through these vessels, making it a valuable treatment for varicose veins, spider veins, and specific vascular malformations. 

Pharmacodynamics: 

Mechanism of action: The mechanism of action of lauromacrogol (polidocanol) lies in its ability to induce sclerosis-controlled chemical irritation of the inner lining of blood vessels. lauromacrogol is commonly used in medical procedures to treat conditions like the varicose veins and spider veins.  

Endothelial Disruption: When lauromacrogol is injected directly into a varicose or spider vein, it comes into contact with the endothelial cells that line the inner surface of the blood vessel. These endothelial cells are crucial in maintaining the vessel’s structure and function. 

Chemical Irritation: lauromacrogol acts as a detergent-like compound. It disrupts the integrity of the endothelial cells and irritates the vessel’s inner lining.  

Inflammatory Response: The irritation caused by lauromacrogol triggers an inflammatory response within the treated blood vessel. This response involves the activation of various inflammatory mediators and recruiting immune cells to the injection site. 

Fibrosis and Closure: Over time, the inflammatory process and the irritation caused by lauromacrogol lead to the formation of fibrous tissue within the treated vessel. This fibrosis causes the blood vessels to contract, collapse, and stick together. As a result, the blood vessel is closed off and becomes non-functional. 

Natural Clearance: The body’s natural processes then clear the closed vessel. The body gradually absorbs and eliminates the treated vein, and blood flow is rerouted through healthier, nearby vessels. 

Pharmacokinetics: 

Absorption 

lauromacrogol is administered directly into blood vessels or tissues during medical procedures. As such, it does not undergo significant systemic absorption when used in this manner. The compound is designed to have localized effects on the target blood vessels, minimizing its entry into the bloodstream. 

Distribution 

lauromacrogol is expected to have limited distribution throughout the body because of its minimal systemic absorption. It primarily stays within the area where it is injected, exerting its sclerosing effects on the targeted blood vessels. 

Metabolism 

lauromacrogol is not known to undergo extensive metabolism in the body, as its intended use is for local effects rather than systemic circulation. Its chemical structure is stable and not designed to be metabolized by enzymes in the body. 

Elimination and Excretion 

Since lauromacrogol is minimally absorbed systemically, there is generally no significant excretion of the compound through the kidneys or other routes of elimination. Any residual amount entering the bloodstream will likely be rapidly diluted and cleared. 

Adminstartion

Administration: 

The administration of lauromacrogol, also known as polidocanol, is typically performed by healthcare professionals trained in vascular medicine or interventional radiology. It is used for the treatment of varicose veins and spider veins.  

Patient Evaluation: 

Before administering lauromacrogol, the healthcare provider thoroughly evaluates the individuals medical history and performs a physical examination to typically assess the extent and severity of the venous insufficiency. The healthcare provider may also use diagnostic tools like ultrasound to visualize the veins and assess their condition. 

Informed Consent: 

The healthcare provider discusses the procedure, its potential benefits, risks, and alternatives with the patient. 

Informed consent is generally obtained from the patient, ensuring they understand the procedure and any potential side effects. 

Preparation: 

The patient is typically positioned comfortably on an examination table. 

The treatment area is cleaned and sterilized to minimize the risk of infection. 

Local Anesthesia (Optional): 

Depending on the patient and the size of the veins being treated, a local anesthetic may be administered to numb the area. Some procedures are performed without anesthesia, while others use topical numbing cream or local injection. 

lauromacrogol Injection: 

The healthcare provider injects the lauromacrogol solution directly into the affected veins by using a fine needle. 

The solution generally irritates the inner lining of the veins, causing them to collapse and stick together. This process is known as sclerosis. 

The provider carefully administers the solution while monitoring the procedure with ultrasound guidance to ensure accurate placement and coverage of the affected veins. 

The number of injections and the volume of lauromacrogol depend on the size and extent of the treated veins. 

Post-Treatment Care: 

After the injections, the healthcare provider may apply compression bandages or stockings to the treated area. These help compress the treated veins and promote their closure. 

Patients are typically advised to wear the compression stockings for a specified duration and to avoid certain activities for a period after the procedure. Patients may experience temporary discomfort, bruising, or swelling at the injection sites, yet these side effects usually subside over time. 

Follow-Up: 

Patients may be scheduled for follow-up appointments to monitor their progress and assess the need for additional treatments or touch-ups. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: lauromacrogol 

Why do we use lauromacrogol? 

lauromacrogol has several medical and cosmetic uses, primarily related to its ability to induce sclerosis (the closure or hardening) of blood vessels.  

Treatment of Varicose Veins and Spider Veins: lauromacrogol is commonly used to treat varicose and spider veins, dilated and often unsightly veins that occur most frequently in the legs. When injected directly into these veins, lauromacrogol irritates the vessels’ inner lining, causing them to collapse and stick together. Over time, the treated veins are absorbed by the body, improving the appearance and symptoms of varicose and spider veins. 

Hemorrhoid Treatment: lauromacrogol can be used as a sclerosing agent to treat internal hemorrhoids. Similar to its action on veins in the legs, it helps shrink and harden the swollen blood vessels in the rectal area, reducing discomfort and bleeding associated with hemorrhoids. 

Vascular Malformations: In some cases, lauromacrogol may treat specific vascular malformations, such as venous and lymphatic malformations. These conditions involve abnormal growth or dilation of blood vessels or lymphatic vessels, and lauromacrogol can help reduce their size and symptoms. 

Cosmetic Procedures: lauromacrogol is sometimes used in cosmetic medicine for non-surgical treatments. For instance, it can be injected into small unwanted blood vessels on the face (such as telangiectasias or broken capillaries) to improve facial appearance. 

Sclerotherapy for Leg Ulcers: In some cases, lauromacrogol may treat leg ulcers related to chronic venous insufficiency. Sclerotherapy with lauromacrogol can help close off malfunctioning veins contributing to ulcer formation.