Sodium tetradecyl sulfate
Regulatory sources consulted
Approved indications
- Treatment of small uncomplicated varicose veins of the lower extremities showing simple dilation with competent valves, after assessing the benefit-risk balance.
Contraindications
Absolute
- Previous hypersensitivity to sodium tetradecyl sulfate or an allergic condition.
- Acute superficial thrombophlebitis, valvular or deep vein incompetence, phlebitis migrans, acute cellulitis or acute infection.
- Large superficial veins with wide communications to deep veins, varicosities caused by unremoved abdominopelvic tumors, or confinement to bed.
- Uncontrolled systemic diseases, including diabetes, toxic hyperthyroidism, tuberculosis, asthma, neoplasm, sepsis, blood dyscrasias and acute respiratory or skin diseases.
Clinical warnings
- Major warning · Administer only by personnel experienced in venous anatomy and sclerotherapy, with resuscitation equipment available. Fatal anaphylaxis may occur: first inject 0.5 mL into a varicosity and observe for several hours before administering a subsequent or larger dose. — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
- Major warning · Extravasation may cause necrosis; carefully confirm intravenous placement and use the smallest effective volume. Assess valvular competence and deep venous patency before injection. — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
- Major warning · Deep vein thrombosis and pulmonary embolism have been reported up to four weeks later; ensure adequate follow-up and appropriate post-treatment compression. — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
- Major warning · Avoid foam prepared with room air: its safety and effectiveness have not been established, and arterial embolism, stroke, transient ischemic attack, myocardial infarction and impaired cardiac function have been reported. — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
- Injection-site pain, urticaria or ulceration have been reported with no established frequency; permanent discoloration may remain along the sclerosed vein segment. — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
- Major warning · Use particular caution in patients with underlying arterial disease, including marked peripheral atherosclerosis or thromboangiitis obliterans (Buerger disease). — https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
Drug interactions
- ModerateHeparin in the same syringe
Mechanism: Sodium tetradecyl sulfate and heparin are incompatible in the same syringe.
Recommendation: Do not mix in the same syringe.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
- ModerateHormonal contraceptives
Mechanism: There are no well-controlled studies and thrombotic risk factors may coexist.
Recommendation: Assess the patient individually before starting sclerotherapy.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=997394e1-ec1f-4093-e053-2a95a90a0ea0
Adverse events
Rare but serious
Anaphylaxis or anaphylactic shock, including fatal cases · Deep vein thrombosis or pulmonary embolism · Tissue necrosis after extravasation · Stroke or myocardial infarction
Pregnancy and lactation
During pregnancy, administer only if clearly needed and the benefit outweighs the risk. It is unknown whether it is excreted in human milk; use caution while breastfeeding.
Recent literature (PubMed)
Venous malformation (VM) stands as the most prevalent form of vascular malformation, characterized by its diverse morphology. These lesions can manifest in any part of the body, affecting different tissue planes and giving rise to symptoms such as pain, swelling, or physical dysfunction. In the realm of treatment, direct puncture VM sclerotherapy holds its place as the primary approach. This technique involves the administration of a sclerosing agent into the VM channels during contrast phlebography while simultaneously managing the outflow veins through different methods. The process of VM sclerotherapy induces endothelial damage, thrombosis, and fibrosis, resulting in symptom relief through lesion shrinkage. It is crucial to exercise caution techniques and sclerosing agents during VM sclerotherapy to minimize procedural complications, enhance clinical outcomes, and ultimately improve the patient's overall quality of life.
Overgrowth syndromes, particularly within the PIK3CA-related overgrowth syndrome (PROS) spectrum, are commonly associated with venous anomalies. The anomalies include spongiform venous malformations and persistent embryonic veins, such as the lateral marginal vein (of Servelle). The anomalous veins pose a significant risk of thromboembolic disease and should be occluded, preferably earlier in life. A thorough understanding of the conditions, anatomy, and interdisciplinary treatment of these complex anomalies is essential for optimal management. This review explores the clinical and imaging diagnosis of overgrowth syndromes and techniques for assessing and treating associated venous anomalies, particularly the endovenous closure of anomalous veins.
Sclerotherapy for venous malformation has been widely used; however, no guidelines are available to assess the effectiveness of different sclerotherapy agents. We conducted a systematic review and network meta-analysis to investigate the effectiveness of sclerotherapy agents for venous malformations. Three electronic databases were searched from their inception (1950) to April 29, 2021. Studies comparing the effectiveness of different sclerotherapy agents were included. The risk of bias within and across studies was assessed. Pairwise meta-analyses were conducted, followed by a network meta-analysis. We also assessed inconsistency and publishing bias using various approaches. Seven studies with 547 patients in six arms were included in the present study. We defined the response and complete response as two separate outcomes. Significant differences were observed in four comparisons with respect to the response (ethanol vs bleomycin, ethanol vs polidocanol, ethanol vs sodium tetradecyl sulfate, polidocanol vs sodium tetradecyl sulfate). No statistically significant differences were found in the other comparisons. The evidence network revealed that for the response outcome, ethanol ranked first, followed by pingyangmycin, polidocanol, sodium morrhuate, bleomycin, and, finally, sodium tetradecyl sulfate. For the complete response outcome, pingyangmycin had the best results, followed by sodium morrhuate, polidocanol, ethanol, bleomycin, and, finally, sodium tetradecyl sulfate. Major complications, such as facial nerve palsy, serious local swelling, and necrosis, had occurred mostly in the ethanol group and rarely in the other groups. Because of the limited data, no further analysis of major complications was conducted. Our confidence in the comparisons and rankings was low. We found no verified inconsistency or publishing bias in the present study using the existing approaches. Ethanol showed a significantly better response statistically compared with the other agents.
Hereditary hemorrhagic telangiectasia (HHT) is a common inherited condition characterized by mucosal telangiectasias, recurrent epistaxis, and arteriovenous malformations. HHT results in detriment to quality of life. Morbidity and mortality result from severe anemia. Conventional interventions for HHT-related epistaxis include nasal packing, diathermy, lasers, coblation, microdebridement, bevacizumab (topical and systemic), as well as septodermoplasty and nasal closure. Sclerotherapy has been recently described in the literature as a novel approach to HHT-related epistaxis. We hypothesize that sclerotherapy is an effective treatment for HHT-related epistaxis and improves upon the current standard of care for this disease. A systematic review was conducted to study sclerotherapy for treating HHT-related epistaxis. Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science were searched. Articles were evaluated and excluded according to PRISMA guidelines and reviewed by 2 authors. Reported variables included number of injections, months of follow up, changes in Epistaxis Severity Score, previous treatments used to control epistaxis, and post-injection side effects. Seven studies with a total of 196 patients met inclusion criteria. Three studies reported significant improvement as measured by the Epistaxis Severity Score scale. One reported improvement through subjective patient surveys and others used the Bergler-Sadick scale to measure frequency and intensity of epistaxis. All studies reported improvement in HHT-related epistaxis. The lack of uniform reporting measures however precluded formal meta-analysis. Based on limited data, sclerotherapy appears to be effective for treating HHT-related epistaxis and offers promise for treating this recalcitrant condition. However, larger, prospective, multi-centered studies using universally validated instruments for epistaxis are needed to definitively evaluate outcomes from sclerotherapy.