Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.
Aethoxysklerol (Smith & Nephew)
2 mL ampoules containing 0.5%, 1% and 3%
Approved indication: varicose veins
Australian Medicines Handbook Section 6.7.1
Laureth-9, also known as polidocanol, is an emulsifying agent. When it is injected into a vessel it damages the endothelium resulting in a thrombosis. In combination with compression bandaging, laureth-9 can be used to treat varicose veins in the legs. As laureth-9 has some anaesthetic effects this scelerotherapy is relatively painless.
In an Australian study laureth-9 was used to treat varicose veins, telangiectasia and venule ectasia. After treating 16 804 limbs, the investigators' subjective impressions were that the results were superior to sclerotherapy with hypertonic saline or sodium tetradecyl sulfate. Adverse reactions were also considered to be less severe.1
The adverse effects of laureth-9 include phlebitis, tissue necrosis at the injection site and pigmentation in the sclerosed area. Some patients will develop allergic reactions so the practitioner should be equipped to treat anaphylaxis. If the injection has been into paravenous tissue, an injection of 1% procaine hydrochloride or normal saline, and if possible hyaluronidase, is recommended.
Larger veins require a higher concentration of laureth-9. Usually only 0.1-0.3 mL needs to be injected into smaller veins. Very fine needles should be used. After the injection a compression bandage is applied and the patient should walk around for 30 minutes. For medium sized veins the bandage is worn for 4-6 weeks. Repeated treatment may be required, but the veins may still not disappear completely in all patients.
- Conrad P, Malouf GM, Stacey MC. The Australian polidocanol (aethoxysklerol) study. Results at 2 years. Dermatol Surg 1995;21:334-6.