Veterans Affairs



Polidocanol (Asclera® and Varithena®)

National Drug Monograph

May 2014

VA Pharmacy Benefits Management Services,

Medical Advisory Panel, and VISN Pharmacist Executives

The purpose of VA Pharmacy Benefits Management Services (PBM), Medical Advisory Panel (MAP), and VISN Pharmacist Executive (VPE) drug monographs is to provide a comprehensive drug review for making formulary decisions. These documents will be updated when new clinical data warrant additional formulary discussion. Documents will be placed in the Archive section of the PBM Web site when the information is deemed to be no longer current.

Executive Summary:

• Polidocanol is a sclerosing agent available as an injectable solution 0.5% and 1% (Asclera®) and injectable foam 1% (Varithena®).1-2

• Polidocanol injectable solution (Asclera®) is approved for the treatment of varicose veins including uncomplicated spider veins in the lower extremity (less than or equal to 1 mm in diameter) and for uncomplicated reticular veins (1-3mm in diameter).1

• Polidocanol injectable foam (VarithenaTM), is approved for the treatment of incompetent great saphenous veins, accessory saphenous veins and visible varicosities of the great saphenous vein system above and below the knee.2

• Polidocanol solution was as effective as sodium tetradecyl sulfate (STS) in patients with reticular and spider veins as measured by improvement in veins at 12 weeks, patient satisfaction, and treatment success rates, but with a better safety profile (refer to next bullet).3

• Polidocanol solution had less frequent occurrences of injection site discoloration (41.1% vs 74.3%, p ................
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