Although there remains some significant controversy regarding the use and benefits of
coumarin (5,6-benzo-alpha pyrone), it would seem that targeted appropriate and monitored use of the
drug does have a significant role in the treatment of
lymphedemas. The particular benefits are its cost and ease of administration. Given today's demands for high level investigative clinical trials, it would be virtually impossible to conduct a study large enough to make any significant conclusions about hepatotoxic effects. However, it seems without doubt that the majority of studies conducted thus far suggest that
coumarin (and other benzopyrones, i.e., the ruto-sides, which do not have hepatotoxic effects and which are often discussed in aggregate with
coumarin) is effective in treating
lymphedema, particularly when used in conjunction with complex
physical therapy. The use of pharmacogenomics could significantly lower the risk of
coumarin-associated hepatotoxicity, by targeting the use of
coumarin to those with functional CYP2A6. Further research in this area will be required to re-evaluate the cost- benefit ratio and to determine the potential for the reintroduction of
coumarin as a potent treatment for
lymphedema. The perceived negative image of
coumarin should not be allowed to carry across to the other benzopyrones, as they still confer a significant benefit in the management of
lymphedemas.