If you have checked out the San Francisco Vein Center’s website, you may already know the full range of surgical treatments for vein disease.  You may also have learned about the non-surgical option of compression stockings or varicose vein socks, which are an extremely effective way to hold the disease at bay as well improve symptoms.

But what about alternative medical therapy? Is there a “magic pill” that will help varicose veins and venous insufficiency? In fact, there are medicines which can help alleviate venous insufficiency and the symptoms that accompany it.  They can be quite effective in some patients.


The first alternative medication for venous insufficiency is hydroxyethylrutoside. This hard-to-pronounce medicine is quite effective at reducing leg swelling and improving the symptoms of heaviness, throbbing, and pain in the legs that often accompanies vein disease. This is a French medication that has been used in Europe for over 30 years, but is not currently available in the United States. Studies state that it acts by reducing the “leakiness” of the tiny blood vessels in the leg, thereby reducing the swelling in the leg and reducing the symptoms of venous insufficiency.

So since we are not in Europe, do we in the Bay Area have any medications available to us to treat this condition?  In fact, there is one.

Horse chestnut seed extract (HSE)

Horse chestnut seed extract (HSE) is available in many stores including online stores that sell herbs and supplements. HSE requires no prescription. The medication in horse chestnut seed extract is escin. The usual dose is 300 mg of horse chestnut seed extract (corresponding to 50 mg of escin) twice daily. Horse chestnut seed works by stimulating the release of powerful compounds in our bodies called prostaglandins (F series prostaglandins, such as PGF2-alpha), which cause blood vessel constriction thereby decreasing swelling and the symptoms of venous disease. This natural medication actually works well and has been studied in several clinical trials. Furthermore, it has few side effects and most people tolerate it well.

Horse chestnut seed extract is a good option for people who would prefer to forgo surgical treatment. It is also good for patients who find they do not regularly use compression stockings or who are unable to do so because of physical limitations.  It is helpful for patients who have venous reflux in their deep venous system which cannot effectively be treated with surgical treatment.

Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency.
Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review.
Horse chestnut seed extract for chronic venous insufficiency.