The Author

Joachim Zuther, Lymphedema Specialist. Read more
Lohmann Rauscher
MediUSA

Tactile Medical

Pharmaceutical Options in the Treatment of Lymphedema

 

The use of drugs in the treatment of lymphedema in the Western Hemisphere is generally limited to antibiotics, which are used to prevent and treat infections commonly associated with lymphedema. As stated in the Position Paper of the National Lymphedema Network, lymphedema should not be treated exclusively with drugs or dietary supplements.
Following is a list of medications, which are mentioned for possible use in the treatment of lymphedema.

Diuretics
These drugs promote excess fluid in the body to be excreted. Although diuretics may be beneficial in the short-term, and may be indicated in those cases when lymphedema is associated with systemic conditions (ascites, hydrothorax, protein-loosing enteropathy), they may be harmful and contribute to the worsening of lymphedema-related symptoms if used long-term.

Here is why: Lymphedema is an abnormal accumulation of water and protein molecules in the body’s soft tissues, which is caused by a dysfunction of the lymphatic system. Swelling (edema) other than lymphedema may be caused by a variety of conditions, such as congestive heart failure, renal diseases, or venous insufficiencies. These swellings do not contain a higher level of proteins in the accumulated fluid, and are defined as edemas.

Diuretics used for lymphedema are limited to remove the water content of the swelling, while the protein molecules remain in the soft tissues. The dehydration effect of diuretics causes a higher concentration of the protein mass in the edema fluid, which may cause the tissues to become more fibrotic and increase the potential for secondary inflammations. In addition, the remaining proteins characteristically draw more water to the swollen areas as soon as the diuretic looses its effectiveness and may cause the volume of the lymphedema to increase.

The 2009 Consensus Document of the International Society of Lymphology states: “Diuretic agents are occasionally useful during the initial treatment phase of complete decongestive therapy (CDT). Long-term administration, however, is discouraged for its marginal benefits in treatment of peripheral lymphedema and potentially may induce fluid and electrolyte imbalance”

Benzopyrones
These drugs include Coumarin, Hydroxyethylrutin and flavonoids (Diosmin) and have been shown to promote the breakdown of proteins present in lymphedema. Research has shown that their practical usefulness in the treatment of lymphedema is questionable. The United States and Australia abandoned the use of Coumarin due to liver toxicity and lack of effectiveness.

Diethylcarbamazine (DEC) and Albendazole
These medications are used in the treatment of lymphatic filariasis, which is very rare in the United States, but endemic in more than 80 countries in the

Lymphatic Filariasis

tropics and subtropics. Filariasis is caused by threadlike, parasitic filarial worms that live almost exclusively in humans. It is estimated that over 120 million individuals are affected by this disease, which is transmitted when a mosquito bites an infected person and then goes on to bite others, thus infecting them with the parasites. During the worms lifetimes inside the host’s lymphatic system they produce dilation and damage to the lymphatics, restricting the normal flow of lymph, causing swelling, fibrosis and infections to lymph vessels and nodes (lymphangitis, lymphadenitis), leading to often extreme swellings. The goal of these drugs is to eliminate the parasitic worms, so the transmission of the disease by mosquitoes can be interrupted.

  
 

 

Endemic Countries for Filariasis

 

 

Antibiotics and Antimycotics
Bacterial (dermato-lymphangio-adenitis [DLA]) and fungal infections of the skin and nails are common in patients with lymphedema. These complications can be treated effectively with broad spectrum antibiotics and antimycotic drugs. In cases where cellulitis is a frequent complication, prophylactic antibiotic treatment may be indicated.

 

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37 comments to Pharmaceutical Options in the Treatment of Lymphedema

  • Amy

    I had never heard of filariasis before reading this post. Thank you for this information! I had wondered, and have been asked by family and friends, why I wasn’t taking a diuretic to treat my lymphedema. Your explanation will become my argument to the naysayers who don’t believe that it’s not just “water” buildup.

  • Rhonda

    Like Amy, thank you for publishing this. Some people just think we are retaining too much fluid “water” and it will just go away. I have been dealing with this for almost 5 years now and people always ask how long it lasts. They look at me like I’m nuts when I say it is a lifelong thing.

  • Tracy Daugherty

    Thanks, Joachim, for the important information. I’ve heard of people using Horse Chestnut as a supplement to traditional therapy for lymphedema, but I’ve never tried it. I wonder what you think of it.

  • Maria Winters

    I have been using Boswellia for LE. I am currently on Femara 2.5mg. for cancer recurrence and am limited as to which I can use for the LE. Does Boswellia have any effect on the protiens or does it only effect the water within the system?

    • Joachim Zuther

      Dear Maria: Boswellia is used as an anti-inflammatory and does not have any effect on interstitial protein or water

  • i have found that physical therapy and decongestive massage is most helpful. Light exercise, low sodium and low carb diet are also helpful. I think drugs are not the answer.

    What are your comments on that?

  • Tennisha

    off the the subject of Pharmaceutical options, but I have a patient that recently found out that she was pregnant and her biggest worry is her lymphedema in her right arm. I completed my lymphedema training 7 years ago and remembered that swelling will increase with pregnancy. I looked for more information concerning MLD during this time, but found out very little. Please advice. thank you for such great information. i encourage all my patient to read this blog and I make copies of all the articles for patients to reference. Look forward to hearing from you.

    • Joachim Zuther

      Dear Tennisha: Increase in volume of lymphedema during pregnancy may be expected in lower extremity lymphedema. It is unlikely that the swelling in upper extremity lymphedema will increase due to pregnancy, provided that the lymphedema is well taken care of.
      Thank you for spreading the word!

  • Les Kyles

    Joachim,
    I think many people including the doctors who work in and treat lymphedema realize that there is a lack of a centralized repository for information concerning the disease, treatment and support.
    This article talks about a system being developed by University of Missouri researchers.
    http://www.dailyrx.com/news-article/virtually-well-3847.html
    The new system will enable immediate access to data, best practices, literature and research from around the world as it is posted online, all in a single, searchable online database.
    Do you know if this project is still moving forward?

  • Traci

    I am just curious (with wishful thinking) as to an opinion on the link listed below. Everything I read on hundreds of web sites is that there are no actual medications or surgeries for lymphedema…and now I have come across the info linked. Maybe I am reading it incorrectly but it seems to say surgery can be performed for lymphedem.
    It’s odd since this is, as they noted, the only person offering these surgeries. Of course we would all love a miracle drug,surgery or even treatment if it worked. Thank you for your time.
    http://www.lymphedemasurgeon.com/

    • Joachim Zuther

      Dear Traci: Surgery is rarely used in the treatment of lymphedema. As stated in the 2009 Consensus Document of the International Society of Lymphology for the diagnosis and treatment of peripheral lymphedema (see link on left), surgical approaches for this condition are not curative and should be reserved for those cases when conservative treatments, i.e. complete decongestive therapy (CDT) has clearly been unsuccessful. The National Lymphedema Network states in its Position Statement (also link on left) that the potential benefits of surgery need to be weighed against the significant risks associated with these procedures, the individual medical needs of the patient, and the expertise of the surgical team

  • Sharon Suess

    I have had LE for 5 years now, and the doctors I’ve seen are clueless as to what to do. I have my legs bandaged sometimes 24/7. Now I keep them bandage for the support they give my legs. I use a walker to walk, stay mainly in the house, and just recently started urinating alot. Is this from the Lymphedema or am I just getting old, (61). I’m getting very depressed, The bottom of my feet hurt most of the time. Haven’t had shoes on in years. I wear to pair of footies. The bottom of my feet get so dried along with my whole body lately. Some people say don’t drink alot of fluids and some say to drink alot to flush out the protien. Who is right.

    • Joachim Zuther

      Dear Sharon: It is possible that the increase in urination is a result from you wearing the bandages more than usual. However, you may want to consult with your primary physician on this issue. You should certainly continue to drink a sufficient amount of fluids, it will assist the decongestion process. Lymphedemateous tissue tends to be dry and sufficient moisturization is important. I would like to refer you to a previous article on this site: http://www.lymphedemablog.com/2011/04/13/skin-and-nail-care-in-lymphedema-management/

  • I am from South-Africa,Modified Radical Mastectomy was done in 2009,on both arm (lymhnodes) remove.While in chemo treatment my lymphedema start,some times in both arms very painfull!We got a virus breakout of pink eyes,somehow i got it,on the second day my arm on the same side of my one eye start to swell,heavy and sore.I went to my oncology doc and was diagnosed with Cellulitis.I was put on Antibiotic after 15days i was fine again.My point is if i got a infection lymphedema start.

  • Rosalva Galamay

    I really like the taste of horse chestnut. I use it on my special diet. They really taste great and they are full of vitamins and minerals too. :`::”

    Till next time http://www.foodsupplementdigest.com/magnesium-benefits/

  • Pamela Piazza

    Having LE for nearly 14 years,I live with constant ongoing fungal or bacteria infections. Resulting in further swelling. I tend to have most doctors initially tell me that I dont have cellulitis, only to end up later a week or so be diagnosed with yeast or cocci infection. I use sleeve, compression, massage, diet, low sodium, low carb. I’ve been perscribed diuretics, told i need to lose weight. I tried to sleep with my arm above me head, not sure my hand and no matter what i do continue to do I only get mild relief and reduction of swelling. After nearly 30 days of being on antibiotics did I see improvement. But as soon as I am off antibiotics, my hand, arm and trunk begins swelling and I get another infection.

  • Lauri Valdez

    I have LE I have found essential oils to help reduce the fluid in my legs. I have lowered my dosage of lasix I have been on lasix for 14+ years.
    I use Young Living Essential oils Lemongrass, Cyprus,Juniper, Lemon oil, Grapefruit Oil and Stress Away Blend. I first started with the Lemongrass my lower legs were a purplish/grey color after 3 days my legs were a pink skin tone with a slight sun burnt look do to the constant up and down with the edema.
    I hope this can help someone else!

  • Lorraine

    Hi Laurie, I am interested in your oil blend for your legs, i gather you are massaging this in, I have not been diagnosed but my legs are holding more fluid than ever, with scaly skin and bubbles of fluid

  • marina

    just wondering if diuretics remove fluid but leave protein and u body build, wouldnt that protein convert to muscle over time?? Yes i have read do not lift heavy but my arm has improved ten fold since i started weight training. My lymphodeama nurse said i could do anything i did prior to surgery that my body was used to. I had to start again weight wize but am building my strength back up.

  • Valerie Rose

    I’ve had lymphedema in R leg since 1987. For over 20 years I have be fortunate enough to attain Coumarin. Before going on it, my lymphedema was getting progressively worse no matter how well I took care of it, including custom RX compression stockings (40-50) I take 800 mg/day (higher dose) of coumarin. It changed my life, stabilizing my lymphedema (even sometimes my leg tends to improve). It took at least 6 months though before I truly saw the results. I personally believe Mayo clinic killed it in trial, because their trial was only for 3 months and everyone knows it takes about 6 months to see results. I have never had any liver problems from it. Now my Doctor who only prescribed it because I was a friend, is unavailable. Does anyone know how to attain it without an RX, even if overseas? rosevalerie40@yahoo.com

  • woo

    I was diagnosed with lymphoedma (primary Milroys) 33 yrs ago very little was known about then and my then dr gave me diuretics for water retention. For a temporary fix they were fine. The dr that suspected lymphoedma let me have a milder form for a short time and advised good skin care and support stockings. I have lived by that rule ever since as no treatment has been available to me as a primary sufferer. Cellulitis

  • Gail Vercruyssen

    Joachim, I was wondering if an herbal formula -Lymph Essentials- from Swanson would be helpful for lymphedema. Its ingredients are: Marshmallow Root, Mullein, Rutin, Capsimax plus proprietary blend,(caffeine anhydrous, capsicum annum fruit extract, black pepper fruit extract), lymphaSelect yellow sweet clover,(melilotus officinalis) (dried flowering tops).

    • Joachim Zuther

      Dear Gail: There are no studies available on the effectiveness of any of these ingredients on lymphedema.

  • Anh

    We do treat lymphodema with medication as well as taping in our office. However our office is in sydney australia our contact is 0402450056

  • Hi Joachim, I’m a lymphedema therapist as well. I have a pt. with a very resistant secondary arm edema. I’ve noticed that her edema and fibrosis reduces significantly after she’s been on antibiotics. Any thoughts or research you’ve seen in regards to this phenomenom?

  • Andrea

    I have feel like I have taken all the antibiotics and have done scolotherapy but my left leg is still swollen. I have hypothyroidism. Are there any additional meds I can take for this? I just got diagnosed with lymphodema and I do NOT want to live like my mom who has it. I do NOT relish living with a sleeve or in my case stocking (left leg is swollen one including the foot which is the worse) for the rest of my life. Thanks.

  • catherine davis

    Could you get those worms from a tick or is it strictly a mosquito bite? Also how do you get the medicine to get rid of them?

  • Helen

    I have upper limb mild lymphedema and I was looking for something as my compression garment doesn’t seem to help in hot weather. I am a cognitive scientist and hence looked and tested. I used Lioton which contains aescin, troxebutin, bromelain, menthol and boswellia. It has had a major effect and I applied it twice 2 days ago and although it’s still hot (35oC), it’s effect is still visible.

  • Rob Buttrum

    It would be much easier for me to understand if I could access a pdf format with list of prescriptions that we should avoid taking so that I can share with my doctor. I have osteoarthritis and lymphedema bilateral lower legs all the way up to the waist. I take ibuprofen and hydrocodone. I was told that ibuprofen makes the swelling in the legs so if I just have a list of prescriptions to avoid would be greatly helpful. Thank you.

  • I have a friend who has lymphedema in her legs & has been prescribed 4 diuretics. I would like your comments on this please.