Pharmacology
Mechanism of Action
Morrhuate sodium causes inflammation of the vein's intima resulting in the formation of a thrombus. Occlusion secondary to the fibrous tissue and the thrombus results in the obliteration of the vein.
Use: Labeled Indications
Treatment of small, uncomplicated varicose veins of the lower extremities
Contraindications
Hypersensitivity to morrhuate sodium or any component of the formulation; arterial disease; acute thrombophlebitis; valvular or deep vein incompetence; bedridden patients; varicosities caused by abdominal or pelvic tumors; patients with systemic diseases (eg, uncontrolled diabetes mellitus, thyrotoxicosis, tuberculosis, neoplasms, asthma, sepsis, blood dyscrasias, and acute respiratory or skin diseases); continued administration following a systemic reaction or an unusual local reaction at the injection site; extensive therapy in severely debilitated or senile patients
Dosage and Administration
Dosing: Adult
Varicose veins: IV:
Note: A test dose of 0.25-1 mL of a 5% injection may be given (into a varicosity) 24 hours before full-dose treatment.
Full-dose treatment: 50-250 mg, depending on the size and degree of varicosity (50-100 mg for small or medium veins, 150-250 mg for large veins); may be given as multiple injections at one time or in single doses.
Dosing: Geriatric
Refer to adult dosing.
Administration
For IV injection into varicose vein only; avoid extravasation. Use only clear solutions; solution should become clear when warmed. Solution froths easily; use a large bore needle to fill syringe and a small bore needle for injection. Warm solutions with hot water prior to injection into small vein, if solution is cold, or if the solid matter has separated in the solution.
Storage
Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).
Drug Interactions
There are no known significant interactions.
Adverse Reactions
Frequency not defined.
Cardiovascular: Circulatory shock, pulmonary embolism, thrombosis
Central nervous system: Dizziness, drowsiness, headache
Dermatologic: Urticaria
Gastrointestinal: Nausea, vomiting
Hypersensitivity: Anaphylaxis, hypersensitivity reaction
Local: Burning sensation at injection site, extravasation (severe)
Neuromuscular & skeletal: Muscle cramps (at injection site), weakness
Respiratory: Asthma, respiratory depression
Warnings/Precautions
Concerns related to adverse effects:
- Anaphylactic/hypersensitivity reactions: Anaphylactic and hypersensitivity reactions (eg, asthma, nausea, vomiting, respiratory depression, urticaria, vascular collapse) have occurred. Immediate treatment (including epinephrine, antihistamines, corticosteroids) should be available.
- Extravasation: Sloughing and necrosis of tissue may occur following extravasation.
- Infections: Delay therapy in patients with acute local or systemic infections (eg, infected ulcers).
- Local reactions: Burning or cramping sensations may occur following administration.
Other warnings/precautions:
- Appropriate use: Valvular and venous competency should be evaluated prior to use.
- Experienced physician: This drug should only be administered by a physician familiar with proper injection techniques.
- Test dose: A test dose of 0.25-1 mL of a 5% injection may be given 24 hours before full-dose treatment.
Monitoring Parameters
Prior to use, evaluate valvular competency and deep vein patency/competency by angiography and/or by clinical tests (eg, Trendelenburg or Perthes).
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal reproduction studies have not been conducted.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience short-term pain, injection site skin discoloration or stiffness, or headache. Have patient report immediately to prescriber chest pain, coughing up blood, shortness of breath, or severe injection site pain, redness, burning, edema, or irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.
