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Horse chestnut (aescin)

Cochrane-reviewed seed extract for chronic venous insufficiency, comparable to compression stockings for leg oedema and aching.

Why

Horse chestnut (Aesculus hippocastanum) seed extract, standardised to aescin (escin), holds an EMA Well-Established Use monograph for symptomatic treatment of chronic venous insufficiency. The Cochrane review concluded that horse chestnut seed extract is an effective short-term treatment for symptoms of CVI, with effects on leg pain and oedema comparable to compression stockings.

How it works

Aescin inhibits hyaluronidase and elastase activity, sealing venous endothelial pores and reducing transcapillary leakage. Modulates inflammatory cytokine release and has venotonic effect, increasing venous tone. The standardised extract has a sustained-release form that improves tolerability.

Expected onset · Leg pain and heaviness within 2–4 weeks; oedema within 4–8 weeks

How to take

Dosage

Standardised seed extract: 50 mg aescin twice daily (300–600 mg extract twice daily). Sustained-release forms once daily where available.

Timing

Twice daily with food

On the label

Standardised to '50 mg aescin per dose' or '~16% triterpene glycosides'. Named preparations: Venoplant, Venostasin, Aesculaforce.

Ideal for

Adults with chronic venous insufficiency (heavy, aching legs; ankle oedema; nocturnal cramps; varicose vein discomfort).

Safety

Use the standardised seed extract. Raw horse chestnut is toxic (esculin/aesculin content). Possible interaction with anticoagulants and antiplatelets. Mild GI upset, headache, dizziness. Caution in kidney or liver impairment. Pregnancy: avoid (limited data and historical concerns).

Evidence

At a glance

Cochrane 2012 SR (17 RCTs, n=1,575): horse chestnut seed extract significantly reduced leg pain, leg volume and leg oedema in chronic venous insufficiency vs placebo, with effects comparable to compression stockings in head-to-head trials. EMA classifies the seed extract as Well-Established Use, the highest regulatory tier for a botanical.

Where to get it

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