Will you initiate Daflon with this list of medications or not?
Medical History:
Atrial Fibrillation (Managed with 2.5 mg bisoprolol once daily)
Allergic Rhinitis (Managed with 10 mg cetirizine once daily)
Vaginal Hysterectomy (Post-operation medications to prevent surgical site infection include : Clindamycin 300 mg 3 times per day, Cefixime 400 mg once daily along with topical treatment Clindamycin vaginal cream along with Betadine® (Povidone-iodine))
The operation (Vaginal Hysterectomy) was done on 14/3/2019 and she was precribed Enoxaprin 40 (once daily) two days consequently prior to the operation and she did take Enoxaprin on the day after the surgery also.
My Q is: Can she take Daflon one tablet daily for managing chronic venous insufficiency as she used to prior to the operation or taking Daflon can increase the risk of bleeding? Should she wait till she finish the post-op medications?
Medications administered during her stay in Hospital:
meropenem, Levofloxacin 500 mg , Acetaminophen.
450 mg Disomin and 50 mg hesperidin ( micronized purified flavonoids) Donna Lisi
There isn’t much in the literature on this drug. I did find info from RxList, which has a list of potential drug interactions https://www.rxlist.com/hesperidin/supplements.htm#
This site also warns that :Surgery: Hesperidin might prolong bleeding. There is concern that hesperidin might increase the risk of bleeding during and after surgical procedures. Stop taking hesperidin at least 2 weeks before a scheduled surgery.
It contains a list of drug interactions involving antihypertensives (Hesperidin might decrease blood pressure. Taking hesperidin along with medications used to lower high blood pressure might cause your blood pressure to go too low.) but no drug interactions with antibiotics are listed.
Other resources like Drugs.com classifies Daflon as a multivitamin and it lists only Daflon (multivitamin) Drug Interactions
- Side Effects
- Interactions
More
- Drug Interactions (11)
A total of 11 drugs are known to interact with Daflon (multivitamin).
- 2 major drug interactions
- 8 moderate drug interactions
- 1 minor drug interaction. The two major drug interactions are with capecitabine and fluorouracil. Neither reference source that I found lists a potential drug interaction between Daflon and antibiotics. Drugs.com did not find any drug interactions between bisoprolol (although one may argue that the RxList site did), cetriziine (Hesperidin might cause sleepiness and drowsiness), clindamycin and cefixime. Other meds listed no longer appear to be active in her medication list. However, it may just be that since the drug is that unavailable in the states that there is not much info on its use. Is this drug prescription or over-the-counter? If prescription, what does the prescribing info say about drug interactions? I hope that this helps.
It's probably better to wait until her post-op prescribed medications are due. Although there are no interactions or clear contraindications to its use in her case, her venous insufficiency is not an emergency at the moment. She can resume with daflon when fully recovered from the surgery.
Wish her a healthy life.
Hi Dr. Mostafa Elsersy ,
Hesperidin has moderate drug interactions with:
- Bisoprolol: leading to increased blood pressure lowering effect and this interaction may lead to hypotension.
- Enoxaparin: hesperidin in combination with diosmin may increase fibrinogen levels and clotting time and increased risk of bleeding.
Diosmine has moderate drug interactions with:
- Clindamycin: diosmine inhibits the metabolism of clindamycin and might increase the risk of infection with C. diff.
- Enoxaparin: taking diosmin with other anticoagulant/antiplatelet drugs might increase the risk of bleeding
Thanks
Daflon contains flavonoids that are known to improve capillary fragility and reduce inflammation. More research is done on Daflon use in hemorrhoids than in other conditions. That research shows that that while there may be a tendency to bleeding after hemorrhoidal surgery, Daflon use reduces the amount of bleeding and improves the outcome for clients on Daflon compared to clients not prescribed Daflon. See article from: Clinical use of Diosmin (Daflon 500mg) for, treatment of symptoms after Haemorrhoidectomy. Mohammad Farooq. et al
http://www.pjs.com.pk/journal_pdfs/apr_jun12/141.pdf#page=1
There is no clear contra indication for use of Daflon in this client however since she was on Enoxaprin it might be safe to wait until she has completed her medicines used post operatively and then restart Daflon I believe she will benefit from its use at that time and will not need to worry about possible drug-drug interactions.
to answer this question two other question are needed to be answered first
1- how effective the use of daflon on the treatment of venous insufficiency? well there are some evidence to support that but is a dose of 1000 mg a day, not 500 mg. so it is unlikely that your patient is benefiting from the one tablet a day.
2- how bad is her venous insufficiency condition? if it is severe and the patient states that daflon makes her condition better, you can resume it and monitor for the signs of bleeding (although very remote)
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