Monday, December 15, 2008

Diosmin-Hesperidin, Angin Segar untuk Pasien Hemoroid



Penderitaan akibat hemoroid, sebenarnya telah dikenal sejak zaman baheula. Beberapa sejarah budaya dunia seperti Babylonia, Hindu, Yunani, Egypt, dan Hebrew bahkan telah menggambarkan serta mencatat berbagai kesusahan dan ketidaknyamanan akibat hemoroid. Anehnya, hingga kini tak banyak pasien yang berupaya mencari pengobatan untuk penyakit ini secara medis. Padahal, hemoroid adalah kasus yang sangat banyak dijumpai. Di Amerika Serikat saja, diperkirakan sekitar separuh dari individu diatas 50 tahun mengalami gejala penyakit ini. Dan, hanya sekitar 500 ribu pasien yang mencari pengobatan.
Setelah diamati, ternyata beberapa opini yang berkembang di tengah masyarakat disinyalir menjadi biang dari keengganan tersebut. Salah satu diantaranya adalah banyak masyarakat menganggap enteng hemoroid. Penyakit ini kerap dianggap sebagai penyakit ringan dan bersifat sementara. Artinya, penyakit ini bisa sembuh dengan sendirinya atau membaik dengan melakukan berbagai upaya pencegahan.
Meski hemoroid tidak mematikan seperti penyakit jantung, kanker, dan stroke, tapi penyakit ini sangat berpotensi mengurangi kualitas hidup seseorang. Rasa nyeri dan ketidaknyamanan akibat bengkak pada anus bisa mengurangi produktivitas seseorang. Oleh karena itu, pemberian terapi awal hemoroid sangatlah membantu untuk meningkatkan kualitas hidup serta menghindari komplikasi. Untuk derajat tertentu, jika telah terjadi perdarahan dan prolaps, tindakan invasif menjadi pilihan terakhir.
Hingga kini, memang belum ada obat yang benar-benar bisa menyembuhkan hemoroid. Namun kehadiran obat seperti diosmin dan hesperidin cukup memberi angin segar bagi penderita hemoroid. Pasalnya, bentuk mikronisasi kedua obat ini terbukti efektif mengatasi berbagai gejala hemoroid. Bahkan sebuah studi menemukan, pemberian keduanya sama efektif dengan rubber band ligation. Malah dengan efek samping yang lebih kecil.
1. Diosmin-Hespiridin
Farmakologi
Keduanya biasa diformulasi sebagai micronized purified flavonoid fraction (MPFF) unik yang mengandung 90% diosmin dan 10% hesperidin. Hesperidin diekstrak dari genus citrus dengan spesies Rutaceae aurantieae, suatu tipe jeruk kecil yang biasa ditemukan di daratan Spanyol, Afrika Utara, dan China. Sementara diosmin yang merupakan senyawa flavonoid diperoleh melalui proses sintesa, mulai dari bahan baku.
Melalui mikronisasi, kedua bahan aktif tersebut mengalami proses penggilingan dengan teknologi tinggi. Sebuah jet of air at supersonic velocities mampu mengurangi ukuran partikel standar dari 37 µm hingga kurang dari 2 µm. Akibatnya, penyerapan keduanya jadi lebih cepat dan lebih baik, sehingga bisa meningkatkan bioavailabilitas. Implikasinya tentu mengarah pada efikasi klinis yang lebih cepat dan superior.
Kedua senyawa tersebut memiliki mekanisme kerja yang unik. Layaknya noradrenalin, obat ini mengakibatkan kontraksi vena, menurunkan ekstravasasi dari kapiler dan menghambat reaksi inflamasi terhadap prostaglandin (PGE2, PGF2). Detailnya, diosmin-hesperidin dengan tepat bisa memerangi secara simultan semua aspek patologik dari penyakit pembuluh darah, lymphatic, dan mikrosirkulasi.
1. Pembuluh darah
Diosmin-hesperidin memperpanjang efek vasokonstriktor noradrenaline pada dinding pembuluh darah, bahkan didalam kondisi panas dan asam, serta bisa juga meningkatkan tonus venous. Aksi tersebut akhirnya bisa mengurangi venous capacitance, distensibility, dan stasis. Hal ini akan berujung pada peningkatan pengembalian vena dan mengurangi venous hyperpressure yang biasa dijumpai pada penderita chronic venous disease. Sedangkan pada tingkat mikrosirkulatori, diosmin-hesperidin terbukti melindungi venous valves dari perusakan yang diinduksi leukosit dan mencegah timbulnya refluks. Hal ini akan berdampak baik untuk mencegah terjadinya komplikasi pada progresi chronic venous disease.

2. Lymphatic
Diosmin-hesperidin bisa memperbaiki aliran limfatik dengan meningkatkan frekuensi dan intensitas kontraksi limfatik, serta meningkatkan jumlah total functional lymphatic capillaries. Keduanya juga mampu mengurangi diameter kapiler limfatik dan tekanan intralimfatik.

3. Mikrosirkulasi
Pada tingkat mikrosirkulasi, diosmin-hesperidin mengurangi permiabilitas kapiler dan meningkatkan resistensi kapiler dengan melindungi mikrosirkulasi dari proses perusakan. Obat ini juga bisa mengurangi pengeluaran dari molekul adhesi pada sel endotelial (ICAM1, VCAM1) dan pada leukosit (L-selectin, VLA-4, CD 11b), serta menghambat adhesi, migrasi, dan aktivasi leukosit pada tingkat kapiler. Hal ini akan berujung pada pengurangan pelepasan mediator inflamatori, radikal bebas dan prostaglandin (PGE2, PGF2a).

Aksi proteksi dan memperkuat vena serta sistem limfatik tersebut, dikaitkan dengan efek vasculoprotective pada makro dan mikrosirkulasi. Hal ini menjelaskan bagaimana efikasi penyembuhan dan protektif dari diosmin-hesperidin pada chronic venous disease dan hemorrhoidal disease, penyakit yang dikaitkan dengan inflamasi perivascular dan edema.
Indikasi
*Pada serangan hemoroid akut, diosmin-hesperidin sangat efektif, mengatasi semua tanda dan gejala seperti pendarahan, nyeri, discharge, tenesmus, dan proctitis.
*Efikasi diosmin-hesperidin bersama dengan fiber supplement lebih superior ketimbang fiber supplement saja, dan ekivalen dengan rubber-band ligation plus fiber supplement dalam menghentikan pendarahan karena hemoroid.
*Ardium dikombinasikan dengan infrared photocoagulation technique (IRP) lebih efektif menghentikan pendarahan secara cepat ketimbang dengan IRP saja.
* Diosmin-hesperidin dikombinasikan dengan hemorrhoidectomy secara signifikan mengurangi risiko pendarahan pasca bedah dan mempercepat waktu penyembuhan.

*Pengobatan jangka panjang untuk chronic hemorrhoidal disease, Diosmin-hesperidin terbukti mengurangi kekambuhan secara signifikan, durasi, intensitas dan keparahan dari serangan hemoroid.
Dosis
Serangan hemoroid akut: 6 tablet sehari selama 4 hari diikuti dengan 4 tablet per hari selama 3 hari.
Hemoroid kronik: 2 tablet per hari.
Efek Samping
Gangguan saluran cerna minor
Peringatan
Hati-hati penggunaan pada wanita yang menyusui
Nama dagang
Ardium
2. Kombinasi Bismuth
Farmakologi
Kombinasi bismuth subgallate, bismuth resorcin, bismuth subiodide, dan Zn oxide bisa meredakan gejala pada hemoroid eksterna dan interna tanpa komplikasi & fisura ani. Kombinasi obat ini juga bisa ditambahkan dengan suatu kortikosteroid (hidrokortison) yang bisa memperkuat efikasi dengan mengurangi gatal, bengkak, dan kemerahan pada inflamasi.
Indikasi
Meredakan gejala hemorrhoid, termasuk mengurangi nyeri minor, gatal, bengkak, dan ketidaknyamanan karena hemoroid.
Kontraindikasi
Hipersensitif
Dosis & Cara Pemberian
Satu suppositoria pada pagi dan malam hari, serta satu suppositoria tiap kali sesudah buang air besar.
Cara aplikasi: bersihkan area aplikasi dengan sabun ringan dan air, bilas lalu keringkan. Masukkan suppositoria dengan menggunakan aplikator ke dalam anus (setengah atau satu inci). Kemudian aplikasikan pada dan sekitar anal sesuai petunjuk. Jangan memasukkan jari atau bagian manapun dari kontainer obat ke anus. Selain itu, tidak dibenarkan memasukkan ujung aplikator lebih dari 1 inchi ke anus.
Efek Samping
Iritasi lokal mencakup kulit memerah, rasa terbakar, atau gatal pada sisi aplikasi. Jarang terjadi efek samping yang serius, seperti pendarahan rektal, perubahan penampilan kulit(warna, ketebalan), dan infeksi.
Peringatan
Penggunaan harus hati-hati untuk pasien yang alergi dengan hidrokortison, kehamilan, menyusui, dan pasien anak.
Nama dagang
Anusol, Anusol HC (kombinasi dengan hidrokortison)
3. Polidocanol
Farmakologi
Polidocanol merupakan sclerosing agent yang efektif. Obat ini mengandung 95% hydroxypolyethoxydodecane dan 5% ethyl alcohol. Polidocanol juga dikenal sebagai obat yang memiliki risiko komplikasi yang rendah.
Indikasi
Sklerosis dari varises untuk semua ukuran, dilatasi vena kutaneus dan wasir.
Dosis & Cara Pemberian
Maksimal 2 mg/kg/BB/hari. Sklerosis hemoroid: 0,5-1,5 ml/simpul yang mengalami dilatasi. Maksimal 2,5/bagian.
Kontraindikasi
Peradangan vena atau sel jaringan, atrofi, dermatitis, arteriosklerosis, vasokontriksi diabetik, endokarditis, miokarditis, kondisi demam, penyakit hati dan ginjal, asma bronkial, gangguan otonomik berat pada usia tua, setelah minum alkohol.
Efek Samping
Hiperpigmentasi
Peringatan
Jangan diberikan secara intra arteri
Nama dagang
Aethoxysklerol-Kreussler

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