Herbs & Supplements:
Oxerutins

Supplement Forms / Alternate Names
  • Hydroxyethylrutosides (HERs), Troxerutin
Principal Proposed Uses
  • Varicose Veins, Venous Insufficiency, Hemorrhoids
Other Proposed Uses
  • Lymphedema, Postsurgical Edema, Vertigo, Lower-Leg Edema in People with Diabetes

Oxerutins have been widely used in Europe since the mid-1960s, primarily as a treatment for varicose veins, but this supplement remains hard to find in North America. Oxerutins are not a single substance, but a group of chemicals derived from a naturally occurring bioflavonoid called rutin. It is not clear whether this particular derivative of rutin is more effective than the many other bioflavonoid-based therapies believed to be effective for these conditions, but oxerutins are by far the best studied. Numerous experiments have found them to improve symptoms of varicose veins such as aching, swelling, and fatigue.

Oxerutins appear to strengthen the capillaries, tiny blood vessels that deliver oxygen and energy to every cell of the body. In people with varicose veins, capillaries are under increased pressure, causing them to leak fluid and molecules of protein. The result is swelling (edema), pain, and fatigue in the lower legs. Oxerutins have been found to reduce these symptoms, probably by making the capillaries less permeable.

Requirements/Sources

Although they are closely related to a natural flavonoid, oxerutins are not found in food. The only way to take them is in a supplement.

Therapeutic Dosages

For varicose veins, oxerutins are usually taken in dosages ranging from 900 mg to 1,200 mg daily. A typical dosage is 1,000 mg daily, taken in two separate doses of 500 mg.

For treating lymphedema and postsurgical edema, a typical dosage is a good deal higher: 3,000 mg daily.

One particular oxerutin called troxerutin may be taken alone as a treatment for varicose veins, in similar dosages. There is no evidence as yet that rutin itself is effective.

Therapeutic Uses

"Varicose" means "enlarged" or "distended." A varicose vein is abnormally enlarged, allowing blood to pool and stagnate instead of moving it efficiently toward the heart. Surface veins of the leg are those most vulnerable to becoming varicose. Venous insufficiency is a closely related condition affecting larger veins deep within the leg. In either case, blood pools within the vein and exerts pressure against the vein walls and capillaries, resulting in pain, aching, swelling, and feelings of heaviness and fatigue. In addition, varicose veins present a cosmetic problem: bulging, often ropy, blue or purple lines visible on the skin of the lower legs.

Strong evidence shows that oxerutins can be helpful for these conditions, improving aching, swelling, and fatigue in the legs.^1–15

Mixed evidence suggests that oxerutins might also be helpful for the leg ulcers that can develop in venous insufficiency.^16,17,18 There is no evidence as yet that oxerutins can improve the cosmetic appearance of varicose veins.

Oxerutins have also been found safe and effective for treating varicose veins when they occur during pregnancy.^19,20

Hemorrhoids are a special type of varicose vein, and oxerutins may be helpful for treating them as well, although there have been some negative studies.^21,22

Some evidence suggests that oxerutins may be helpful for lymphedema (chronic arm swelling caused by damage to the lymph drainage system) following surgery for breast cancer, ^23,24,25 as well as for edema in the immediate postsurgical period.²⁶

One small double-blind study suggests oxerutins may be helpful for reducing vertigo and other symptoms of Meniere's disease.²⁷

Preliminary evidence suggests that oxerutins might also be helpful for reducing foot and ankle swelling in people with diabetes.²⁸ In these trials, oxerutin therapy did not affect blood sugar control.

What Is the Scientific Evidence for Oxerutins?

Varicose Veins/Venous Insufficiency

At least 17 double-blind placebo-controlled studies, enrolling a total of more than 2,000 participants, have examined oxerutins' effectiveness for treating varicose veins and venous insufficiency. All but one found oxerutins significantly more effective than placebo, giving substantial relief from swelling, aching, leg pains, and other uncomfortable symptoms, while causing no significant side effects. Together, this research makes a strong case for the use of oxerutins in these conditions.

For example, one large placebo-controlled double-blind study published in 1983 enrolled 660 people with symptoms of venous insufficiency.²⁹ Three out of four participants were randomly assigned to receive oxerutins (1,000 mg daily) while one out of four was given placebo. After 4 weeks of treatment, those who took oxerutins reported less heaviness, aching, cramps, and "restless leg" or "pins and needles" symptoms than those who took placebo. According to the researchers' calculations, oxerutins had produced significantly better results than placebo. This report has been criticized, however, for omitting key information (such as whether or not any participants also wore support stockings) and for failing to present data in a usable form.

A more recent, better-designed study supported these positive findings.³⁰ This 12-week double-blind placebo-controlled study enrolled 133 women with moderate chronic venous insufficiency. Half received 1,000 mg oxerutins daily, and the rest took a matching placebo. All participants were also fitted with standard compression stockings, and wore them for the duration of the study. The researchers measured subjective symptoms such as aches and pains, as well as objective measures of edema in the leg.

Those who took oxerutins had significantly less lower-leg edema than the placebo group. Furthermore, these results lasted through a 6-week follow-up period, even though participants were no longer taking oxerutins. Compression stockings, on the other hand, produced no lasting benefit after participants stopped wearing them. They gave symptomatic relief while they were worn, but they didn't improve capillary circulation in a lasting way, as oxerutins apparently did.

Regarding aching, sensations of heaviness, and other uncomfortable symptoms, however, there was little difference between the two groups. The authors theorized that the compression stockings gave both groups so much symptomatic relief that it was difficult to demonstrate a separate subjective benefit of oxerutin therapy.

Several other double-blind placebo-controlled studies have also found benefits with oxerutins for varicose veins and venous insufficiency.^31–40

As mentioned above, there is some evidence that troxerutin—one of the compounds in the standardized mixture sold as oxerutins—may be effective when taken alone. One study found it more effective than placebo,⁴¹ but another (very small) study found it less effective than the standard oxerutin mixture.⁴²

Pregnant women are at especially high risk for varicose veins and venous insufficiency. A 1975 study examined 69 pregnant women with varicose leg veins, and found that oxerutins (900 mg daily) were significantly more effective than placebo against pain as well as swelling.⁴³ A more recent study also found positive results,⁴⁴ but because it was neither placebo-controlled nor double-blind its results mean little.

Skin ulcers sometimes form on the legs of people with varicose veins or venous insufficiency, when capillary circulation has become too impaired to keep the skin healthy. A French study published in 1987 found that oxerutins combined with compression stockings were significantly more helpful for leg ulcers than the stockings alone.⁴⁵ Other positive results have been reported as well.⁴⁶

However, some experiments found oxerutins to have no benefit in treating or preventing leg ulcers.^47,48 Until more research is done, the most we can say is that oxerutins might be helpful for leg ulcers—especially if combined with compression stockings.

Hemorrhoids

Some evidence suggests that oxerutins might be helpful for hemorrhoids as well. A double-blind study enrolling 97 pregnant women found oxerutins (1,000 mg daily) significantly better than placebo in reducing the pain, bleeding, and inflammation of hemorrhoids.⁴⁹

Lymphedema

Women who have undergone surgery for breast cancer may experience a lasting and troublesome side effect: swelling in the arm caused by damage to the lymph system. Along with the veins, the lymph system is responsible for returning fluid to the heart, but when the system is damaged, fluid can accumulate. Three double-blind placebo-controlled studies enrolling more than 100 people total have examined the effectiveness of oxerutins in this condition.^50,51,52

In one trial, oxerutins worked significantly better than placebo at reducing swelling, discomfort, immobility, and other measures of lymphedema over a 6-month treatment period, with better results appearing each month⁵³—suggesting that, for women with this condition, the full effect of oxerutins might take months to realize.

Two smaller studies also found oxerutins to be more effective than placebo, but the researchers were not sure that the improvement was large enough to make a real difference.^54,55

In all of these studies, the dosage used was 3 g daily—about 3 times the typical dosage for venous insufficiency.

Post Surgical Edema

Swelling often occurs in the recovery period following surgery. In one double-blind trial, researchers gave oxerutins or placebo for 5 days to 40 people recovering from minor surgery or other minor injuries, and found oxerutins significantly helpful in reducing swelling and discomfort.⁵⁶

Safety Issues

Oxerutins appear to be safe and well tolerated. In most studies, oxerutins have produced no more side effects than placebo. For example, in a study of 104 elderly people with venous insufficiency, 26 participants taking oxerutins reported adverse events, compared with 25 in the placebo group.⁵⁷ The most commonly observed side effects were gastrointestinal symptoms, headaches, and dizziness.⁵⁸

Oxerutins have been given to pregnant women in some studies, with no apparent harmful effects. However, their safety for pregnant or nursing women cannot be regarded as absolutely proven. In addition, the safety of oxerutins has not been established for people with severe liver or kidney disease.

Last reviewed March 2002 by Medical Review Board

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