sodium tetradecyl sulfate: clinical use

Prescribing considerations

• Administration requires expertise in venous anatomy, diagnosis and injection technique, with resuscitation facilities immediately available.
• Assess thromboembolic risk, mobility, deep-vein patency and valvular competence before treatment.
• Consider patent foramen ovale assessment before foam treatment in patients with migraine with aura, previous serious cerebrovascular events or pulmonary hypertension.
• Use duplex ultrasound where needed to identify non-visible veins and reduce the risks of extravasation or arterial injection.
• Safety and efficacy have not been established in children or adolescents.

Contraindications and cautions

• Hypersensitivity to the active substance or excipients, or significant allergic conditions
• Inability to walk or being bedridden; high thromboembolic risk; recent superficial thrombophlebitis, deep-vein thrombosis or pulmonary embolism
• Recent surgery, acute infection or cellulitis, evolving cancer or specified uncontrolled systemic disease
• Significant deep-vein valvular incompetence, occlusive arterial disease or major superficial-to-deep venous communications
• Known symptomatic patent foramen ovale when administered as foam

Monitoring

• Observe during and after injection for hypersensitivity, respiratory or neurological symptoms.
• Confirm intravenous placement and monitor the treated site for extravasation, ischaemia or tissue injury.
• Arrange clinical and, where appropriate, ultrasound follow-up to assess efficacy and detect deep-vein thrombosis or embolic complications.

Clinical pharmacology

A detergent sclerosant that causes endothelial inflammation, local thrombus formation and subsequent fibrotic occlusion of the injected vein. Foam displaces blood and prolongs endothelial contact but is associated with more migraine and visual effects than liquid treatment.

Formulation and product differences

• Supplied as clear, colourless, sterile solutions for injection in several strengths.
• The lower-strength presentations are used as liquid; selected higher-strength presentations may also be converted to foam for suitable larger veins.
• The product contains benzyl alcohol and small amounts of sodium and potassium.
• Containers are single use: use immediately after opening and discard unused solution.
• Do not use solutions containing visible particles; do not freeze and protect from light.