Vol 19, No 1-2 (2017)
Review articles
Published online: 2018-07-02
Ruscus aculeatus extract in the therapy of chronic venous disorders
Chirurgia Polska 2017;19(1-2):13-17.
Abstract
Treatment of chronic venous disorders combines conservative treatment, which includes compression therapy and use of pharmacotherapy, and surgical procedures. Venoactive drugs are recommended for all stages of chronic venous disorders.
One of the most commonly used venoactive drugs are extracts from butcher's broom (Ruscus aculeatus). They contain saponins sterols: ruscogenin and neoruscogenin that reduce vascular permeability, exhibit anti-inflammatory, vasoconstrictor, and anticoagulants actions, and inhibit the activity of elastase damaging the elastin fibers. Preparations containing Ruscus aculeatus extract used to reduce the severity of chronic pain, cramps, heaviness of the legs and paresthesias, as well as reduce the residual venous volume of the lower extremities (0.7 ml/100 ml), leading to a decrease in calf (by 7.3 mm) and ankle circumferences (by 11.7 mm) and the reduction of the lower limb edema in patients with chronic venous disorders. A comparable effect of preparations containing diosmin and butcher's broom extract, on the healing process of venous ulcers was recently showed in an observational study.
The efficacy of formulations containing extracts of Ruscus aculeatus in alleviating symptoms of chronic venous disorders has been confirmed in a randomized trial with the placebo
Keywords: Ruscus aculeatus extractruscogeninneoruscogeninchronic venous insufficiencychronic venous disorders
References
- Ziaja D, Kocełak P, Chudek J, et al. Compliance with compression stockings in patients with chronic venous disorders. Phlebology. 2011; 26(8): 353–360.
- Chudek J. Skuteczność i tolerancja diosminy w leczeniu chorych z przewlekłą niewydolnością żylną w codziennej praktyce klinicznej. Probl Med Rodz. 2008; 10: 45–51.
- Chudek J, Kocełak P, Ziaja D, et al. Compliance in pharmacotherapy in patients with chronic venous disorders. Int Angiol. 2012; 31(4): 393–401.
- Yu BY, Xu GJ. Studies on resource utilization of Chinese drug Radix Ophiopogon japonicus. J Chin Herbs. 1995; 26: 205–210.
- Svensjö E, Bouskela E, Cyrino FZ, et al. Antipermeability effects of Cyclo 3 Fort in hamsters with moderate diabetes. Clin Hemorheol Microcirc. 1997; 17(5): 385–388.
- Huang YL, Kou JP, Ma Li, et al. Possible mechanism of the anti-inflammatory activity of ruscogenin: role of intercellular adhesion molecule-1 and nuclear factor-kappaB. J Pharmacol Sci. 2008; 108(2): 198–205.
- Facino RM, Carini M, Stefani R, et al. Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedera helix, Aesculus hippocastanum, and Ruscus aculeatus: factors contributing to their efficacy in the treatment of venous insufficiency. Arch Pharm (Weinheim). 1995; 328(10): 720–724.
- Bouskela E, Cyrino FZ, Marcelon G. Effects of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation. J Cardiovasc Pharmacol. 1993; 22(2): 221–224.
- Bouskela E, Cyrino FZ, Marcelon G. Inhibitory effect of the Ruscus extract and of the flavonoid hesperidine methylchalcone on increased microvascular permeability induced by various agents in the hamster cheek pouch. J Cardiovasc Pharmacol. 1993; 22(2): 225–230.
- Kou J, Yu B, Xu Q. Inhibitory effects of ethanol extract from Radix Ophiopogon japonicus on venous thrombosis linked with its endothelium-protective and anti-adhesive activities. Vascul Pharmacol. 2005; 43(3): 157–163.
- Hönig I, Felix W. Effect on the permeability of the isolated eat vein of the pig; a comparison between flavonoids and saponins. In: Davy A, Stemmer R. ed. Phlébologie. John Libbet Eurotext Ltd 1989: 680–682.
- Felix W, Schmidt Y, Nieberle J. Protective effect of Ruscus extract against injury of vascular endothelium and vascular smooth muscle caused by ethracrynic acid. Int Angiol. 1984; 3: 77–79.
- Bouaziz N, Michiels C, Janssens D, et al. Effect of Ruscus extract and hesperidin methylchalcone on hypoxia-induced activation of endothelial cells. Int Angiol. 1999; 18(4): 306–312.
- Marcelon G, Verbeuren TJ, Lauressergues H, et al. Effect of Ruscus aculeatus on isolated canine cutaneous veins. Gen Pharmacol. 1983; 14(1): 103–106.
- Marcelon G, Vanhoutte PM. Veinotonic effect of Ruscus under variable temperature conditions in vitro. Phlebology. 1988; 3(Suppl 1): 51–54.
- Miller VM, Rud K, Gloviczki P. Interactions of Ruscus-extract with endothelin-receptors in human varicose veins. Clin Hemorheol. 1994; 14: S37–S45.
- Marcelon G, Pouget G, Tisné-Versailles J. Effect of Ruscus on the adrenoceptors of the canine lymphatic thoracic duct. Phlebology. 1988; 3(Suppl 1): 109–112.
- McHale NG. Mechanism of noradrenaline action in lymphatic vessels. In: Vanhoutte P. ed. Return circulation and norepinephrine: an update. John Libbey Eurotext, Paris 1991: 73–88.
- Lascasas-Porto CL, Milhomens AL, Virgini-Magalhães CE, et al. Use of microcirculatory parameters to evaluate clinical treatments of chronic venous disorder (CVD). Microvasc Res. 2008; 76(1): 66–72.
- Branco D, Osswald W. The influence of Ruscus extract on the uptake and metabolism of noradrenaline in the normal and varicose human saphenous vein. Phlebology. 1988; 3(Suppl 1): 33–39.
- Rubanyi G, Marcelon G, Vanhoutte PM. Effect of temperature on the responsiveness of cutaneous veins to the extract of Ruscus aculeatus. Gen Pharmacol. 1984; 15(5): 431–434.
- Bouskela E, Cyrino FZ. Possible mechanisms for the effects of Ruscus extract on microvascular permeability and diameter. Clin Hemorheol. 1994; 14: S23–S36.
- Bouskela E, Cyrino FZ, Marcelon G. Possible mechanisms for the venular constriction elicited by Ruscus extract on hamster cheek pouch. J Cardiovasc Pharmacol. 1994; 24(1): 165–170.
- Chanal JL, Mbatchi B, Sicart MT, et al. Comparison of the bioavailability of tritium-labeled Ruscus extract in the rat, according to the route of administration. Trav Soc Pharm Montp. 1981; 41: 263–272.
- Bernard P, Cousse H, Rico AG, et al. whole-body autoradiography study of the distribution of tritium in cynomolgus monkeys dosed with a tritiated extract of Ruscus. Ann Pharms Fr. 1985; 43: 573–584.
- ESCOP Monographs: The Scientific Foundation for Herbal Medicinal Products. Stuttgart, Niemcy, 2003.
- Vanscheidt W, Jost V, Wolna P, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung. 2002; 52(4): 243–250.
- Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol. 2003; 22(3): 250–262.
- Porto CL, Milhomens ALM, Pires CE, et al. Changes on venous diameter and leg perimeter with different clinical treatments for moderate chronic venous disease: evaluation using Duplex scanning and perimeter measurements. Int Angiol. 2009; 28(3): 222–231.
- Allaert FA, Hugue C, Cazaubon M, et al. Correlation between improvement in functional signs and plethysmographic parameters during venoactive treatment (Cyclo 3 Fort). Int Angiol. 2011; 30(3): 272–277.
- Guex JJ, Avril L, Enrici E, et al. Quality of life improvement in Latin American patients suffering from chronic venous disorder using a combination of Ruscus aculeatus and hesperidin methyl-chalcone and ascorbic acid (quality study). Int Angiol. 2010; 29(6): 525–532.
- Guex JJ, Enriquez Vega DME, Avril L, et al. Assessment of quality of life in Mexican patients suffering from chronic venous disorder - impact of oral Ruscus aculeatus-hesperidin-methyl-chalcone-ascorbic acid treatment - 'QUALITY Study'. Phlebology. 2009; 24(4): 157–165.
- Perrin M, Ramelet AA. Pharmacological treatment of primary chronic venous disease: rationale, results and unanswered questions. Eur J Vasc Endovasc Surg. 2011; 41(1): 117–125.
- Chudek J, Mikosiński J, Kobielski A, et al. Patients' satisfaction with therapy methods of advanced chronic venous disease. Int Angiol. 2016; 35(1): 98–107.
- Aguilar Peralta GR, Arévalo Gardoqui J, Llamas Macías FJ, et al. Clinical and capillaroscopic evaluation in the treatment of chronic venous insufficiency with Ruscus aculeatus, hesperidin methylchalcone and ascorbic acid in venous insufficiency treatment of ambulatory patients. Int Angiol. 2007; 26(4): 378–384.
- European Medicines Agency. Assessment report on ruscus aculeatus l., rhizome. 2008. Ref. EMEA/HMPC/261939/2007. 2008.
