Version July 2025
Dosage guidance:
Dosage form information: Multiple concentrations of sodium tetradecyl sulfate exist (eg, 1%, 3%); use caution; verify appropriate product concentration is selected.
Vascular malformation: Limited data available: Infants, Children, and Adolescents: 3% solution: Intralesional: Dose is dependent upon the size/volume, location, and morphology of the lesion and sodium tetradecyl sulfate preparation method (eg, whether product is foamed or diluted with contrast media); reported doses highly variable (Ref).
Maximum dose: 0.5 mL/kg per session (Ref); maximum reported doses per procedure were variable and ranged from 5 to 20 mL. Dose is commonly divided into multiple injections per procedure. Procedure may be repeated (eg, in weeks to months) if deemed necessary (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Sodium tetradecyl sulfate: Drug information")
Sclerosing agent: IV: Note: The strength of solution required depends on size and degree of varicosity; in general, the 1% solution is used most often, with the 3% solution being reserved for larger varicosities.
Test dose: 0.5 mL followed by several hours of observation is recommended before larger doses are administered.
Usual dose: 0.5 to 2 mL (preferred maximum: 1 mL) in each vein; maximum dose: 10 mL per treatment session of the 3% solution (Ref).
The following concentrations have been recommended based upon size of affected vein (Ref):
Vessel diameter <1 mm: 0.1% to 0.3% concentration.
Vessel diameter 1 to 3 mm: 0.5% to 1% concentration.
Vessel diameter 4 to 6 mm: 1% to 2% concentration.
Branch varicosities: 2% to 3% concentration.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided the in manufacturer's labeling.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Postmarketing:
Cardiovascular: Acute myocardial infarction, cardiac insufficiency, cardiomyopathy (takotsubo) (Potter 2010)
Gastrointestinal: Nausea, vomiting
Hypersensitivity: Hypersensitivity reaction (including anaphylactic shock, anaphylaxis)
Local: Local pain (Schwartz 2011), local skin discoloration (bruising and ecchymoses) (Schwartz 2011), local skin hyperpigmentation (Schwartz 2011), local swelling (Schwartz 2011)
Nervous system: Cerebrovascular accident, headache, transient ischemic attacks
Hypersensitivity to sodium tetradecyl sulfate or any component of the formulation; acute superficial thrombophlebitis; valvular or deep vein incompetence; phlebitis migrans; acute cellulitis; acute infections; allergic conditions; bedridden patients; patients with uncontrolled systemic disease such as diabetes, toxic hyperthyroidism, tuberculosis, asthma, neoplasm, sepsis, blood dyscrasias, and acute respiratory or skin diseases; huge superficial veins with wide open communications to deeper veins; allergic conditions; varicosities caused by abdominal and pelvic tumors (unless tumor has been removed)
Canadian labeling: Additional contraindications (not in US labeling): Recent superficial or deep thrombophlebitis (6 months to 2 years); potential underlying arterial disease; renal or cardiac insufficiencies accompanied by venous stasis and dilatation; angina pectoris; hyperthyroidism
Concerns related to adverse effects:
• Anaphylaxis: Observe for hypersensitivity/anaphylactic reaction; emergency resuscitation equipment should be available.
• Arterial embolism: Stroke, transient ischemic attack, myocardial infarction, and impaired cardiac function have been reported with use. May be caused by air embolism when using sodium tetradecyl sulfate foamed with room air or thromboembolism. Avoid using sodium tetradecyl sulfate foamed with room air; safety and efficacy has not been established.
• Thromboembolism: Deep vein thrombosis (DVT) and pulmonary embolism (PE) have occurred following treatment.
Disease-related concerns:
• Arteriosclerosis: Use with caution in patients with peripheral arteriosclerosis.
• Thromboangiitis obliterans: Use with caution in patients with thromboangiitis obliterans.
Other warnings/precautions:
• Appropriate use: Valvular and venous competency should be evaluated prior to use.
• Extravasation: Avoid extravasation.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as sulfate:
Sotradecol: 1% (2 mL); 3% (2 mL) [contains benzyl alcohol]
Generic: 3% (2 mL)
Yes
Solution (Sodium Tetradecyl Sulfate Intravenous)
3% (per mL): $46.20
Solution (Sotradecol Intravenous)
1% (per mL): $46.88
3% (per mL): $46.88
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous, as sulfate:
Tromboject: 1% (2 mL); 3% (2 mL, 5 mL)
Note: Should be administered by clinicians who are trained and experienced in treating venous malformations; practice varies; see institutional protocols (Ref).
Parenteral: Intralesional: Typically administered directly into vascular lesion using a 20 to 26 gauge needle under imaging guidance (eg, ultrasound, fluoroscopy). Has been administered directly, mixed with contrast media, or foamed with air using a 3-way stopcock (Ref).
IV: For IV injection only. Administer Tromboject [Canadian product] with a 0.22 micrometer pore size and 25 or 33 mm diameter polyethersulfone in-line filter.
Store at controlled room temperature.
Treatment of small, uncomplicated varicose veins of the lower extremities that show simple dilation with competent valves (FDA approved in adults); has also been used for the treatment of vascular malformations.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
There are no known significant interactions.
Reproduction studies have not been conducted.
Kidney function; hemoglobinuria. Monitor for thrombosis (eg, deep vein thrombosis) (up to 4 weeks after injection), skin ulceration or necrosis, and hypersensitivity reaction including anaphylaxis (Ref).
Acts by irritation of the vein intimal endothelium and causes thrombosis formation leading to occlusion of the injected vein
