Sodium Tetradecyl Sulfate

Sodium tetradecyl sulfate, also known as sulfate sodium salt, is an anionic surfactant which is commonly used to reat varicose veins and spider veins within the legs.

Overview:

Sodium tetradecyl sulfate belongs to a group of medicines known as sclerosing agents. It is typically used to treat small varicose veins in the lower extremities (calves and feet). It is only available via prescription.

It functions by acting on the lipid molecules in the cells of the vein wall. This causes the inflammatory destruction of the interior lining of the vein and thrombus formation, leading to sclerosis of the vein. It is typically used for this purpose in concentrations ranging between 0.1 and 3 percent.

Sodium tetradecyl sulfate has been regarded as one of the leading treatments for varicose veins since 1946. It is currently marketed in Australia, the UK, Ireland, South Africa, Italy and New Zealand under the moniker Fibro-Vein. It is available in the following concentrations:

  • 0.1%
  • 0.2%
  • 0.5%
  • 1.0%
  • 3.0%

The compound is prepared by condensing methyl isobutyl ketone and 2-ethylhexanal, which is then sulfonated. This compound is then administered intravenously.

Conditions treated:

  • Varicose veins

Type of medicine:

  • Sclerosing agent

Side effects:

Along with its desired effects, sodium tetradecyl sulfate can also potentially cause some unwanted side effects. The most common side effects reported by patients undergoing treatment with this medication include the following: anxiety, a burning sensation, coughing, chest pain, difficulty swallowing, difficulty breathing, fast heartbeat, hives, hayfever, nausea, itching, noisy or disrupted breathing, dizziness or light-headedness (especially when standing up from a prone position), pain or swelling in the arms or legs, tightness within the chest, unusual weakness or tiredness, wheezing, vomiting, skin rash and/or redness of the skin.

As the patient continues treatment with sodium tetradecyl sulfate as prescribed, many (if not all) of these side effects will begin to lessen over time. If symptoms persist or get worse, the patient is advised to consult with their doctor as soon as possible. In some instances, doctors and/or healthcare providers may be able to suggest ways to alleviate certain side effects via the use of natural remedies or over the counter medicines.

The majority of patients experience only minimal side effects while undergoing treatment with sodium tetradecyl sulfate, if they observe any at all. Most healthcare professionals believe that the benefits of treating varicose veins outweigh the temporary side effects incurred due to the use of this medication.

Other side effects experienced rarely (albeit often enough to warrant a mention) include headaches, pale skin at the site of injection, ulceration at the site of injection, peeling skin, localized pain and/or redness at the site of injection. In some instances, patients have reported discoloration of the vein along the path of the sclerosed segment.

If the patient experiences major discomfort due to side effects when undergoing treatment with sodium tetradecyl sulfate, they are advised to contact their doctor or healthcare provider immediately.

Dosage:

As with all medications, it is vital that the patient is administered with sodium tetradecyl sulfate only as directed by a qualified physician. This means that patients should not receive more of the medicine than advised by a doctor, in terms of dose size or frequency. In addition to this, patients should refrain from treatment with sodium tetradecyl sulfate if they are advised to cease taking the medication by a doctor - even if they have a remaining supply of the medicine.

Sodium tetradecyl sulfate is a sclerosant, and it should be administered intravenously in small doses at multiple sites along the vein. It can be administered either as a liquid solution or a sclerosant/air mixture which creates a foam. The latter is more effective for those requiring larger concentrations of the drug (1 and 3 percent concentrations). The objective of treatment with sodium tetradecyl sulfate is to destroy the vessel walls with the very minimum amount of medication possible in order to achieve the best clinical result.

Patients suffering from varicose veins should be administered with an initial dose of between 0.5mL and 2mL per injection. As a general rule, most physicians will aim to administer a preferred dose of 1mL maximum per injection, although the patient’s condition will dictate whether this is feasible. Each session should consist of no more than 10mL in total. The advice of the manufacturer and healthcare professionals is that sodium tetradecyl sulfate dosage should be kept as low as possible.

Interactions:

All medications have the potential to interact with other chemicals or drugs within the body, resulting in a change in the effects of one or more of the involved drugs. In some instances, interactions can cause a medication to become ineffective in treating the condition it was designed to alleviate. In other instances, interactions between medicines can cause the patient to experience dangerous or potentially fatal side effects. For these reasons, it is imperative that the patient keeps a detailed and descriptive list of all medications he or she is currently taking. This extends to over the counter remedies, vitamins, herbal supplements and complementary medicines as well as prescribed drugs.

At present, no medications are known to interact with sodium tetradecyl sulfate. However, this does not mean that no interactions exist – it simply means that there is insufficient clinical evidence to highlight any interactions. Patients should always consult with their doctor or healthcare provider prior to beginning treatment with any medication, and if they feel that a medication may be interacting with another treatment, they should contact the FDA for advice and to report their findings.

Warnings:

Sodium tetradecyl sulfate must only be administered by a doctor who is familiar with the diagnosis and subsequent treatment of conditions which affect the venous system. Proper injection techniques must be applied by the administering doctor, as extravasation can potentially result in severe adverse reactions at the location of injection, including (but not limited to) necrosis. Extreme caution, therefore, needs to be exercised when placing the needle, and minimum effective volumes should be administered at each injection site to reduce the risk of this and other potentially serious side effects.

Deep venous patency should be determined prior to the administration of sodium tetradecyl sulfate in order to avoid the development of DVT and/or pulmonary embolism. Patients who show significant signs of deep venous incompetence or valvular issues should not be treated with venous sclerotherapy, as this creates the risk of embolism which can occur up to four weeks after injection. In some patients, adequate compression treatment after administration of sodium tetradecyl sulfate can help to decrease incidences of deep vein thrombosis.

Although rare, some patients may experience an allergic reaction to sodium tetradecyl sulfate, resulting in anaphylactic shock. In patients with allergies or those otherwise at risk of going into anaphylaxis, a small dose (no larger than 0.5mL) should be injected directly into a varicosity. The patient should then be observed for several hours. If no adverse reactions occur, the patient should be suitable for treatment with the medication. Healthcare providers should take precautions to have the appropriate anti-anaphylaxis treatments to hand in the event of a patient suffering an acute reaction to sodium tetradecyl sulfate.

No data exists regarding the safety of sodium tetradecyl sulfate in pregnant women, and it is therefore assigned to pregnancy category C by the Food & Drug Administration. The FDA advises that great caution should be taken by pregnant women when taking any medication. Sodium tetradecyl sulfate should therefore only be used by a pregnant patient if the benefits outweigh the risks.

Storage:

Sodium tetradecyl sulfate is packaged in vials. These vials should be kept in the outer packaging carton to protect it from natural light. Once opened, it should be used immediately. Unopened vials have a shelf life of three years.

The manufacturer suggests that this product should be kept at room temperature, out of the reach of pets or children. Patients should avoid keeping this medicine at extreme temperatures – freezing temperatures can cause particles to form within the vial, which when injected can cause clotting.

This medicine is typically administered in a clinical setting. Patients who self-administer or have the medicine administered at home should take caution when disposing of used needles. The use of sharps bins is recommended. These containers can be handed in at a local pharmacy who will oversee the correct destruction of the needles/syringes contained within.

Summary:

Sodium tetradecyl sulfate is an effective treatment for uncomplicated varicose veins in the legs and feet. It can also be used to treat residual varicose veins after surgery, venules, reticular veins and spider veins which show non-complex dilation.

Patients who undergo treatment with this medication generally experience a better quality of life as it means they can walk easier and are at less risk of dangerous blood clots. In order for the patient to get the most out of sodium tetradecyl sulfate, they should work together with their doctor and/or healthcare provider to ascertain the optimum dosage to break down excess interior lining within the veins.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
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