Abstract

Extract from seeds and bark of the horse chestnut tree Aesculushippocastanum L. (Hippocastanaceae) is today used as herbal medicine in Europe against chronic venous insufficiency (CVI; i.e. varicose veins accompanied with pain, oedema, pruritus and a sense of heaviness). Administration is oral (e.g. Venastat®, Venokan®) or topical (Reparil). Recommended oral dose is 50 mg aescin twice a day. The standardized extract mostly used is D.H.E. (Bernett, Milan, Italy; standardized for 16-22% triterpene saponins). Prior to treatment, other diseases (e.g. venous thrombosis) should be excluded. Oral administration with horse chestnut capsules has in clinical studies been shown to be more effective than placebo and as effective as compression stockings in CVI. The main constituents of horse chestnut are triterpene saponins (i.e. aescin), flavonoids (e.g. quercetin, kaempherol, epicatechin, proanthocyanidin A anthocyanins) and coumarins (e.g. esculin, esculetin). Aescin (also called escin) is actually a mixture of more than 30 different triterpene saponin glycosides of which the main component is suggested to be the active component and is the major content of pharmaceutical products. Mainly three effects of horse chestnut extract on CVI can be identified: anti-oedomatous, anti-inflammatory and venotonic. The anti-inflammatory effect includes free oxygen radical scavenging and decreased vascular permeability. Also, inhibition of elastase, collagenase 2,b-aescin (C55H86O24). b-aescin is and hyaluronidase in the vascular wall has been observed. Adverse effects are few and include gastrointestinal symptoms, nausea, headache, dizziness and allergy. Possible contraindications and drug interactions have not been studied.