The use of suppositories with papaverine for uterine tone. Reasons for prescribing medication can vary. Side effects of taking papaverine

22.07.2019

Many pregnant women try to refrain from taking any medication for fear of harming the baby. However, uterine hypertonicity is not one of those conditions that can be ignored. Excessive muscle activity during pregnancy often leads to miscarriage or premature birth. To avoid such troubles, doctors prescribe papaverine suppositories for women. It is believed that this drug does not harm the child and mother, despite the fact that clinical studies on its safety during the period of gestation have not been conducted.

Is papaverine hydrochloride harmful during pregnancy

The instructions for the drug states that there have been no clinical studies on its effect on the body of expectant mothers, so it is contraindicated during the period of bearing a child. However, the situation is not so clear cut.

Medicines based on papaverine have been successfully used for six decades. During this time, the drug was used by several generations of pregnant women who gave birth to more than one million absolutely healthy babies.

Thus, long-term observations of obstetrician-gynecologists and pediatricians show that rectal suppositories with papaverine, if indicated and appropriately used, have a positive effect on the condition of expectant mothers and do not affect the intrauterine development of the fetus.

The composition and action of rectal suppositories

The action of papaverine is based on relaxation of the smooth muscles of the internal organs: the stomach, intestines, bronchi, lungs, blood vessels and uterus. The relaxing effect does not apply to the striated muscles, which means that the muscles of the skeleton and heart will work as before.

Papaverine was first isolated in the middle of the 19th century from the opium poppy. This alkaloid gained considerable popularity in the fifties of the last century, when its industrial production was established.

Thus, papaverine suppositories have a complex effect on the female body:

relieve excessive tone and suppress contractions of the uterus and other muscular organs;
have a vasodilating effect;
lower blood pressure.

Candles with papaverine - the most effective form of medicine for pregnant women

In addition to suppositories, many manufacturers produce papaverine hydrochloride preparations in the form of tablets and solutions for intravenous administration. However, doctors most often prescribe rectal suppositories for pregnant women, considering them to be a safer and more effective dosage form.

Indications

Due to hormonal changes in the female body during pregnancy, the amount of progesterone, a hormone involved in muscle relaxation, decreases. As a result of this, the uterus can actively contract and even be constantly in an increased tone. This condition is a serious threat to the development and life of the fetus. Usually, papaverine suppositories are prescribed for pregnant women with high uterine tone, threatening spontaneous miscarriage or premature birth.

In addition, doctors prescribe this antispasmodic in the complex treatment of conditions such as:

inflammation of the gallbladder;
renal colic;
diseases of the gastrointestinal tract (colitis, flatulence, functional bowel disorders);
inflammation of the urinary tract (urethritis and cystitis);
preeclampsia (a complication of pregnancy, accompanied by swelling, convulsions, high blood pressure).

Candles with papaverine also have a sedative effect, normalize the heart rhythm. However, such an effect is noted only after prolonged use of the drug.

Contraindications

Medicines with papaverine in any dosage forms are prohibited for diseases and conditions such as:

intolerance to the components of the drug;
atrioventricular blockade (heart rhythm disturbances);
liver failure;
increased intraocular pressure.

With extreme caution, papaverine suppositories should be used for women who have been diagnosed with hypothyroidism, tachycardia, disorders in the work of the adrenal glands and kidneys. Be sure to report these problems to your doctor.

Constipation and other possible side effects

Undesirable consequences from taking suppositories with papaverine are quite rare and, as a rule, depend on the individual characteristics of the pregnant woman. Among the side effects are noted:

allergic reactions;
nausea;
drowsiness;
bowel dysfunction (constipation);
increased sweating;
arterial hypotension (lowering pressure).

Low blood pressure is one of the possible side effects when taking papaverine suppositories.

Taking the drug in trimesters

Usually candles with papaverine are not used separately. Depending on the trimester and on the severity of the disease, this antispasmodic is often prescribed in combination with other medicines.

First trimester

At the beginning of pregnancy, the list of safe drugs is very limited due to the unformed placenta. Meanwhile, papaverine is in high demand as an antispasmodic.

In the first weeks of pregnancy, some women suffer from uterine hypertonicity associated with inadequate progesterone production. That is why papaverine is prescribed along with taking hormonal medications.

Second trimester

During this period, the list of approved drugs is expanding significantly. In case of hypertonicity, the threat of miscarriage, doctors prescribe more serious medications that inhibit the contractile activity of the uterus - for example, Ginipral, Brikanil or magnesia injections.

Papaverine suppositories in the second trimester are most often used to relieve pain in renal colic, in diseases of the gastrointestinal tract and urinary system, accompanied by spasms, as well as to reduce pressure.

third trimester

In late pregnancy, rectal suppositories with papaverine are prescribed in the following situations:

If the tension of the uterine muscles is too strong, and the expected date of birth is still far away. In this case, steroid hormones are additionally prescribed.
Before childbirth, candles are used as indicators of "false" contractions. If, after the administration of the drug, the contractile activity of the uterus has stopped, it means that the birth has not yet begun.
At the 39th week of pregnancy, candles are used to prepare the cervix for labor.
With real contractions, the drug is prescribed to reduce pain.

Instructions for safe use

Candles with papaverine during the period of bearing a child are prescribed only by the attending doctor after a complete examination and clarification of the diagnosis. He also determines the dosage and duration of the course of therapy.

Pregnant women are usually prescribed one papaverine suppository several times a day at regular intervals. They are introduced into the rectum, in the supine position on the side. This must be done with clean hands or sterile gloves to avoid pathogenic microbes entering the body.

The action of the active substance begins almost immediately after the dissolution of the rectal suppository. But for a sustainable effect, you need to complete the full course of treatment prescribed by your doctor. Sometimes it can be quite long (up to a month).

How can I replace suppositories with papaverine, including in the early stages

Papaverine in the form of rectal suppositories does not have analogues containing the same active ingredient. If a woman is intolerant to papaverine, the doctor may prescribe antispasmodic medications that contain other active ingredients, but have a similar therapeutic effect.

Substitutes for papaverine suppositories are also preparations consisting of several active ingredients, one of which is papaverine.

Table: papaverine analogs prescribed during pregnancy

Name	Dosage forms	Active substance	Indications	Contraindications	Application during pregnancy
	Tablets; solution.	Drotaverine hydrochloride	Renal colic; biliary colic; intestinal colic; spastic constipation; endarteritis; spasms of the uterus, threatening premature birth and miscarriage.	Intolerance to components; cardiogenic shock; arterial hypotension; glaucoma; severe renal and hepatic failure.	According to the doctor
	Solution; tablets.	Drotaverine hydrochloride	Hypertension of the uterus; spasms of smooth muscles in diseases of the biliary tract; spasms of smooth muscles of the urinary system; spasms of the gastrointestinal tract; headache.	severe renal failure; severe liver failure; severe heart failure; hypersensitivity to the drug; galactose intolerance.	According to the doctor
	Tablets	papaverine hydrochloride; dibazol.	Arterial hypertension; spasms of peripheral arteries and cerebral vessels; spasm of smooth muscles of internal organs; polio.	Disorders in the conduction system of the heart; epilepsy; component intolerance.	Allowed with caution
	Tablets; solution; concentrate.	Hexoprenaline sulfate	Hypertension of the uterus; inhibition of labor pains during childbirth; prevention of preterm birth.	thyrotoxicosis; tachyarrhythmia; myocarditis; arterial hypertension; cardiac ischemia; severe kidney and liver diseases; angle-closure glaucoma; intrauterine infection; hypersensitivity to components.	Can be used from the second trimester

Photo gallery: antispasmodic drugs used during pregnancy

No-shpa is a popular drug for relieving spasms, including in pregnant women.
Drotaverine is a synthetic drug that reduces the tone of smooth muscles of internal organs and helps to reduce pain during spasms of various organs. Ginipral - a drug that helps reduce the tone and contractile activity of the uterus Papazol, like papaverine suppositories, contains papaverine hydrochloride

During pregnancy, any woman is wary of taking any medications. Even a common cold is treated with herbal teas and raspberry jam. Do not harm the child - this is inherent in nature in the very nature of the expectant mother. Unfortunately, sometimes you still have to resort to certain medications. But what about those means, in the annotation to which it is written that the safety and effectiveness of their use during this difficult period has not been established? It is this group of drugs that includes candles "Papaverine", during pregnancy they are recommended quite often.

How papaverine suppositories work

Papaverine hydrochloride - the main active substance of the drug - is an opium alkaloid, a derivative of isoquinoline. It has excellent antispasmodic properties. Once in the blood, this substance is carried to all body systems.

Candles Papaverine or Papaverine hydrochloride, refers to drugs of the antispasmodic group, the purpose of which is to relax smooth muscle cells

In this case, the agent acts on the smooth muscles of internal organs, such as:

gastrointestinal tract;
urinary tract;
uterus;
bronchi and lungs.

In addition, papaverine has a pronounced vasodilating effect, which provides a hypotensive effect. Thus, the drug relieves spasms of the smooth muscles of the abdominal cavity and lowers blood pressure.

With repeated administration, a sedative effect is noted, the heart rate normalizes, and uterine blood flow improves. It does not affect the myocardium and muscles of the body, but only the internal organs.

Reasons for prescribing pregnant women

The doctor can prescribe papaverine suppositories during pregnancy both in the initial stages and in the last months. There are no exact data on the safety of using the drug in the gestational period. This is due to the fact that clinical studies on this issue simply have not been conducted. However, for many decades this drug has been successfully used in all trimesters of gestation. Practical experience shows that papaverine does not have any negative effects on the fetus. Naturally, it is necessary to follow the recommended dosages and frequency of use, which are determined by the doctor.

Threat of miscarriage due to uterine hypertonicity. It is this reason that is most often the basis for prescribing Papaverine during pregnancy.

The reasons for prescribing the drug can be different:

First trimester.

During this period, many expectant mothers experience uterine hypertonicity. Muscles are in constant overstrain, which can lead to miscarriage. In urgent cases, intravenous administration of the drug is practiced, which quickly and effectively removes all signs of excessive stress on the female organ. If the condition is not so critical, then Papaverine candles are used. In early pregnancy, the appointment of any drugs is controversial, since the placental barrier has not yet been formed. However, if we are talking about the possible loss of the fetus, then the use of the drug is not disputed.

Second trimester.

Release forms and application features

The pharmaceutical industry offers three options for papaverine:

injection;
tablets;
rectal suppositories.

Injections can be carried out both intramuscularly and intravenously. The medicine has a high degree of penetration, so it is possible to make even injections under the skin. The introduction of papaverine into a vein should be carried out exclusively in a polyclinic, using the services of experienced medical staff. The fact is that this drug must be administered very slowly, and this requires a certain skill. Intramuscular and subcutaneous injections can be done at home.

During pregnancy, the doctor may prescribe not only suppositories with papaverine, but also an injection solution

The effect of the drug in tablets occurs somewhat later than when using suppositories. Physicians and patients agree that the most convenient and appropriate form of application of the drug is precisely "Papaverine" suppositories. Pregnant women in the vast majority of cases are recommended this form of release of the drug.

Many expectant mothers are wondering where to insert Papaverine candles during pregnancy. These are rectal suppositories, and there can be no question of any vaginal application. The agent is effectively absorbed through the walls of the anus and begins to act after 3-4 minutes.

Using suppositories for hemorrhoids

Quite often, the course of pregnancy is accompanied by signs of hemorrhoidal disease. The drug will have an effective effect in the fight against such symptoms:

spasms of the lower rectum;
sphincter spasm;
spastic constipation;
acute pain in the rectal region.

Side effects

Candles "Papaverine" for pregnant women are often the main means to prevent a possible miscarriage.

Each drug has side effects, as well as prohibitions and restrictions on use.

Using the drug, you run the risk of encountering the following undesirable problems:

lowering blood pressure;
extrasystole;
nausea;
increased drowsiness
yellowness of the skin;
allergic rashes, itching;
an increase in eosinophils in the blood;
sweating;
allergic reactions;
difficulty with defecation.

When treating with papaverine, in no case should you drink alcohol. The fact is that it enhances the hypotonic effect of the drug, and this is fraught with loss of consciousness. It is also forbidden to smoke - nicotine can suppress the effect of the drug. In this case, the desired effect may not occur at all.

Strictly speaking, smoking and drinking alcohol during gestation is strictly prohibited, as this causes irreparable harm not only to the body of the expectant mother, but also to the expected offspring.

More complex problems can arise with an overdose:

failure of cardiac activity;
vomit;
fainting;
excessive sedation.

Among the side effects most often observed: dizziness, darkening in the eyes when changing body position

Ointments for hemorrhoids for pregnant women

During gestation, the female body undergoes a powerful restructuring. During this period, some, even the most harmless products or medicines, can cause a completely unpredictable reaction. The same can be said about papaverine, for which, during pregnancy, it is worthwhile to identify intolerance to the drug in advance, if any.

In some cases, suppositories can only be used with caution, and this category includes not only pregnancy, but also a violation of the adrenal glands, the functions of the pituitary gland, as well as hypothyroidism

Terms of sale and substitutes

An inexpensive and popular antispasmodic is included in a group of drugs that are sold in pharmacies without a prescription. You need to store candles at a temperature not higher than 15 degrees, for this the door of a home refrigerator is best suited. Shelf life 2 years.

In pharmacies, you can offer many analogues of drugs:

"Dolce";
"Drotaverine";
"Nokhshaverin";
"Nosh-bra";
"Spazoverin".

Not all of them are available in the form of suppositories. Before replacing the drug with an analogue, it is imperative to consult a doctor, especially this advice applies to pregnant women.

Thank you

Papaverine(Latin - papaverine) is a widely used medicinal substance with antispasmodic, vasodilating and hypotensive effects. By origin and chemical structure, papaverine is alkaloid opium poppy, that is, it is obtained from poppy straw, but is not a narcotic substance.

Varieties, names, forms of release and composition of Papaverine preparations

Papaverine is both the trade name of some drugs and the international name (INN) of the active substance that is part of many drugs. Preparations with the trade name "Papaverine" are the same with the active substance "papaverine". This substance is called either simply papaverine, or papaverine hydrochloride. Moreover, papaverine hydrochloride is the chemical name of papaverine, and from the point of view of a doctor or patient, there is no difference between these terms.

Currently, in the countries of the former USSR, drugs that contain only papaverine as an active ingredient are usually called simply "Papaverine". In some cases, letters or abbreviations can be added to the word Papaverine, which encrypt the name of the manufacturer of the drug, for example, "Papaverine MS", "Papaverine Bufus", etc. However, in all cases we are talking about the same drug manufactured by different factories , but containing the active ingredient papaverine.

In addition, there are multicomponent drugs with other names containing several active substances at the same time, among which there is papaverine. These are drugs such as Papazol, Andipal, Teodibaverin, etc. However, in this article we will consider exclusively monocomponent drugs containing only papaverine as an active substance and having the same name, respectively. In order to distinguish and not confuse the active substance and the name of the drug, we will write the first with a small letter, and the second with a capital letter.

Monocomponent preparations containing only papaverine as an active substance are currently available under the following commercial names:

Papaverine;
Papaverine Bufus;
Papaverine MS;
papaverine hydrochloride.

All four drugs are synonymous and are available in three dosage forms - tablets for oral administration, rectal suppositories and solution for injection. Suppositories are often called "papaverine suppositories", and the solution is called "papaverine injections", "papaverine in ampoules" or "papaverine injections".

Accordingly, the composition of the three dosage forms contains papaverine hydrochloride as an active substance in the following dosages:

Tablets for adults - 40 mg;
Tablets for children - 10 mg;
Solution for injection - 20 mg per 1 ml;
Rectal suppositories - 20 mg per suppository.

The composition of auxiliary components for the same dosage form, for example, tablets, may vary depending on the manufacturer, so it should always be carefully read in the attached leaflet with instructions for use.

Since the pharmacological action of papaverine is multidirectional, it is simultaneously referred to two groups of drugs, such as vasodilators (vasodilators) and antispasmodics. Accordingly, as an antispasmodic, Papaverine is used to treat functional disorders of the gastrointestinal tract, and as a vasodilator, in the treatment of erectile dysfunction.

Therapeutic effects of papaverine

Papaverine, by blocking the work of a number of enzymes, reduces the tone and relaxes the smooth muscles of all internal organs. The fact is that the internal organs (stomach, intestines, blood and lymphatic vessels, bronchi, lungs, urethra, etc.) are equipped with exclusively smooth muscles, due to the work of which their overall tone increases or decreases. With an increase in tone, the organ contracts, that is, its spasm occurs, and when it decreases, on the contrary, relaxation and expansion of the existing lumen occurs.

For example, with an increase in the tone of the smooth muscles of the intestine, bronchi or gallbladder, the organs are strongly compressed, characteristic spastic pains appear, and the movement of the contents through their lumens is disturbed. That is, the progress of the food bolus is delayed in the intestines, bile stops flowing from the gallbladder, and the required amount of air cannot pass through the bronchi. In addition, any spasm of the internal organs is accompanied by pain of varying intensity. Papaverine relieves spasm, relaxes organs, thereby restoring their function and stopping pain. Since the drug is not selective, it effectively relieves spasm and pain of any internal organ, and therefore is used very widely. In principle, Papaverine has the same properties and therapeutic effects as the more widely known No-Shpa.

Papaverine has a relaxing effect only on the internal organs, since it affects smooth muscles and does not affect the striated ones. The fact is that on the human body and in the heart there are only striated muscles that have different properties and react to completely different stimuli and substances. Therefore, antispasmodics acting on smooth muscles do not affect the contractility of skeletal and cardiac muscles. Thus, Papaverine is able to relieve spasm and relax the muscles of internal organs without affecting the myocardium and muscles of the body.

Summing up the described effects, the following main therapeutic effects of Papaverine can be distinguished:

Relaxes smooth muscles and relieves spasms of smooth muscles of blood vessels, organs of the digestive, respiratory and genitourinary systems;
By relaxing the muscles of the blood vessels and their subsequent expansion reduces blood pressure;
High doses reduce the excitability of the heart muscle and slow down the conduction of the impulse through the heart;
In high dosages, it has a sedative effect on the central nervous system.

Thus, Papaverine has two main pharmacological effects - antispasmodic (stops spasm and relaxes smooth muscles) and hypotensive (lowers blood pressure).

Papaverine is rapidly absorbed into the bloodstream by any route of administration (tablets, rectal suppositories, intramuscular injections) and excreted by the kidneys. Half of the administered dose of the drug is excreted after 0.5 - 2 hours.

Papaverine (tablets and injections) - indications for use

Indications for the use of tablets, injections and rectal suppositories of Papaverine are exactly the same, since, regardless of the dosage form, the drug is absorbed into the blood and has systemic therapeutic effects.

Tablets, injections and suppositories of Papaverine are indicated for use in the following diseases and conditions:

Spasms of smooth muscle elements of the organs of the gastrointestinal tract in various diseases, such as pylorospasm, colitis, cholecystitis, cholangitis, etc.;
Spasmodic pain (for example, with colitis, flatulence, menstruation, irritable bowel syndrome (IBS), constipation, etc.);
As part of the complex therapy of cholecystitis and renal colic as an anesthetic and anti-spasm drug;
Spasms and pains in the organs of the genitourinary system (cystitis, pyelitis, stones in the kidneys or in the urethra, etc.);
Bronchospasm;
Spasm of cerebral vessels;
Spasm of peripheral vessels, for example, with endarteritis and other diseases;
As part of the complex therapy of angina pectoris;
As an auxiliary preparation for pre-narcotic preparation (premedication).

Papaverine (papaverine hydrochloride) - instructions for use

Consider the rules and nuances of using each dosage form of Papaverine (tablets, suppositories and injections) separately.

Papaverine tablets - instructions for use

Tablets should be taken orally, swallowed whole, not chewed, not crushed or crushed in other ways, but with a sufficient amount of water (approximately 200 ml). Papaverine can be taken regardless of food, but as needed, that is, when spastic pains or painful spasms occur. However, if there are spastic pains in the organs of the gastrointestinal tract, then it is better to take Papaverine 15 to 30 minutes before meals so that the drug stops the symptoms, and the person can eat and drink calmly.

For spasms and spastic pains of the internal organs, adults and adolescents over 15 years of age are advised to take Papaverine 40-60 mg (1-1.5 tablets) 3-4 times a day. Children should be given tablets with a special children's dosage of 10 mg. Moreover, the dosage of Papaverine for children is determined by age:

6 - 24 months - 5 mg (1/2 children's tablet) 3 - 4 times a day;
2 - 4 years - 5 - 10 mg (1/2 - 1 children's tablet) 3 - 4 times a day;
5 - 6 years - 10 mg (1 children's tablet) 3 - 4 times a day;
7 - years - 10 - 15 mg (1 - 1.5 children's tablets) 3 - 4 times a day;
10 - 14 years old - 15 - 20 mg (1.5 - 2 children's tablets) 3 - 4 times a day.

The duration of therapy depends on the rate of disappearance of spastic pain or relief of organ spasm. In acute conditions, Papaverine is usually taken for 2 to 5 days, and in chronic conditions, 1 to 3 weeks.

Papaverine in ampoules - instructions for the production of injections

The ampoules contain a sterile 2% solution of Papaverine, ready for administration, containing 20 mg of the active substance in 1 ml. Since the ampoule contains 2 ml of solution, the total dosage of Papaverine in the whole ampoule is 40 mg, which is equivalent to one adult tablet. The solution can be administered in whole form subcutaneously or intramuscularly, and after dilution - intravenously.

For adults and adolescents over 10 years old, the solution is administered 2 to 4 times a day, and for children under 10 years old - 2 times a day. A single dosage of Papaverine is determined by age:

6 - 24 months - 0.25 ml of solution 2 - 4 times a day;
2 - 4 years - 0.25 - 0.5 ml of solution;
5 - 6 years - 0.5 ml of solution;
7 - years - 0.5 - 0.75 ml of solution;
10 - 14 years - 0.75 - 1 ml of solution;
15 years and older - 1 - 2 ml of solution.

That is, in the indicated dosages, the solution is administered 2 times a day to children under 10 years of age, and 2 to 4 times a day to adolescents over 10 years of age and adults.

For subcutaneous or intramuscular administration, the injection site is first chosen. Intramuscularly, it is optimal to inject the solution into the upper lateral outer surface of the thigh or the outer upper part of the shoulder, and subcutaneously into the area around the navel. Before performing the injection, the skin is wiped with an antiseptic, after which the required amount of solution is drawn into the syringe and injected into the prepared area. For intramuscular injection, the needle is inserted deep into the tissue perpendicular to the surface of the skin. And for a subcutaneous injection, first they capture about 1 cm of skin with the thumb and forefinger, making a fold out of it. After that, the syringe needle is set approximately at an angle of 45 o to the surface of the skin and injected into this fold. The solution is released into the tissues and the needle is carefully removed, after which the injection site is again wiped with an antiseptic. Each time, the solution should be injected at a point that is at least 1 cm away from other traces of past injections.

For intravenous administration, you must first dilute the required amount of Papaverine in 10-20 ml of saline. Then this mixture is administered intravenously, slowly. Intravenous injections should be made only in a hospital setting, and subcutaneous or intramuscular injections can be done at home on their own if a person has mastered their technique and is not afraid.

Papaverine - instructions for the use of candles

Candles are inserted into the rectum, gently pushing the index finger through the anus. Suppositories should be administered with clean, freshly washed hands with soap or with sterile gloves. The dosage of suppositories for various diseases accompanied by spasms and spastic pains is determined by age and is 1-2 suppositories 2-3 times a day for adults, and 1 suppository 2 times a day for children over 10 years old. For children under 10 years of age, the suppositories are cut into 2 or 4 equal parts and injected with these pieces containing the required amount of the active substance. So, children under 4 years old are injected with a quarter or half a candle, and from 5 to 10 years old - half a suppository 2 times a day.

Dosage for various diseases

The dosage of Papaverine in all dosage forms is the same for various diseases and conditions, and differs only depending on the age of the person using the drug. So, single dosages of the solution, suppositories and Papaverine tablets for people of different ages are as follows:

6 - 24 months - 5 mg;
2 - 4 years - 5 - 10 mg;
5 - 6 years - 10 mg;
7 - years - 10 - 15 mg;
10 - 14 years - 15 - 20 mg;
Over 14 years old - 20 - 60 mg.

At the same time, Papaverine in the indicated dosages is taken a different number of times a day, depending on the dosage form - tablets 3-4 times, the solution is administered 2-4 times a day, and suppositories - 2-3 times. Moreover, children under 6 years of age should use Papaverine the smallest of the allowable amounts once a day, and at the age of over 6 years, the frequency of taking the drug is determined by the state of the person, and can be maximum.

The maximum allowable single dosage of Papaverine is the highest dose indicated for each age, multiplied by four. That is, for an adult, the maximum allowable single dosage is 60 * 4 = 240 mg, for a child from 10 to 14 years old - 20 * 4 = 80 mg, etc. The maximum allowable daily dosage is equal to the maximum single, multiplied by three.

special instructions

For any diseases that are an indication for the use of Papaverine, you can choose the dosage form that seems most convenient at the current time. For example, if it is most convenient for a person to take pills, then this form should be chosen.

If it is necessary to quickly achieve a therapeutic effect, especially in the first days of an exacerbation of the disease, then injections should be used. After 2 to 3 days, if a person can swallow, injections should be replaced with tablets or rectal suppositories. It is not recommended to perform the entire course of therapy with subcutaneous or intramuscular injections, since this entails greater risks compared to taking tablets. Therefore, injections should be given only if suppositories and tablets cannot be used for any reason. In general, doctors recommend following a simple rule in choosing the form of the drug - always use either suppositories or tablets, and use injections only if necessary to obtain a quick therapeutic effect, but replace them with tablets or suppositories as soon as possible.

If a person suffers from spasms of the gastrointestinal tract, then he can use Papaverine both in suppositories and in tablets, based solely on personal preferences. However, it should be remembered that when using Papaverine suppositories, the clinical effect occurs faster than from tablets. Therefore, if you need to get a quick effect, it is better to use candles. It is also recommended to choose suppositories if a person for some reason cannot swallow pills.

With spastic pain in the organs of the urinary system, Papaverine suppositories are the best option, since when they are introduced into the rectum, the active substance very quickly reaches the affected tissues and has a powerful therapeutic effect. If for some reason it is impossible or difficult to insert suppositories into the rectum, then they should be replaced with tablets.

In children, it is recommended to use Papaverine in the form of suppositories or special children's tablets with a low dosage of the active substance of 10 mg. Children should not be given halves or quarters of Papaverine tablets for adults, which contain 40 mg of the active substance.

Papaverine is not a drug intended for long-term course use, therefore it is used exclusively for a one-time removal of spastic pain against the background of an exacerbation of a disease or condition. This means that tablets, suppositories or injections of Papaverine can be used on their own for 2 to 3 days, after which an improvement must necessarily appear, expressed in a decrease in spastic pain and discomfort in the area of localization of the pathological process. If there is no improvement, then you should immediately consult a doctor, as this may indicate the development of severe surgical pathology, for example, appendicitis, bleeding, peritonitis, etc.

As prescribed by a doctor, Papaverine is usually used for 7 to 14 days or a little longer, up to the complete relief of painful spastic pains. If a person has been suffering from a chronic disease for a long time, for example, cholecystitis, then he is well aware of the symptoms of its exacerbation and the dynamics of improvements that occur while taking Papaverine, and therefore can independently determine the duration of taking the drug.

If a person has encountered spastic pain for the first time, then the first course of therapy should be carried out exclusively under the supervision of a doctor and independently fix their own feelings, as well as positive dynamics. In the future, with an exacerbation of the disease, spasms will also be relieved by antispasmodics, and their dynamics will not fundamentally differ from what was recorded for the first time. And a person who remembers well the dynamics of reducing spastic pain and normalizing the condition, during periods of exacerbations in the future, will be able to independently control how well and correctly the treatment is going without visiting a doctor for this and without going to the hospital. In addition, he will be able to record any distinctive manifestations of the dynamics of treatment and report them to the doctor, who, in turn, will look for their cause and deal with the problem of diagnosing a combined or atypical pathology.

Overdose

An overdose of Papaverine is possible and is manifested by the appearance of double vision, weakness, drowsiness and a decrease in pressure. To treat an overdose, gastric lavage is performed, after which sorbents (activated carbon, Polysorb, etc.) and milk are given to a person, and pressure is maintained at a normal level.

Interaction with other drugs

Papaverine reduces the therapeutic effect of Levodopa and Methyldopa.

Papaverine solution is usually administered in a hospital, and for home use only suppositories or tablets are used. To stop uterine hypertonicity, Papaverine is usually used in the form of rectal suppositories, since it is this dosage form that ensures the rapid entry of the active substance into the desired area. For any other diseases and conditions, pregnant women are usually advised to take pills. The dosages of Papaverine are the same as for all adults, that is, 1 suppository 2-4 times a day or 1-1.5 tablets 3-4 times a day. The duration of therapy is determined by the rate of normalization of the condition and is determined by the attending physician.

Candles with papaverine during pregnancy

Candles with Papaverine during pregnancy are used quite often to eliminate uterine hypertonicity, introducing them into the rectum 1 piece 2 to 4 times a day. You need to introduce candles with clean hands, washed with soap and water immediately before performing the manipulation. If for some reason it is impossible to wash your hands, then candles should be inserted with sterile gloves, since microbes from the skin of the fingers entering the rectum can provoke inflammatory processes in it, including candidiasis. Such an inflammatory process will not proceed too rapidly, and therefore hardly noticeable, but it will increase the tendency to constipation and provoke flatulence and intestinal colic.

In addition, No-Shpa with Papaverine is often used to prepare the cervix for childbirth, for which women take 1 tablet or inject 1 suppository of each drug 2 times a day for 2 weeks before the expected date of birth. This practice is widespread, but these cervical preparations do more harm than good, because just before childbirth, when the uterus should actively contract and prepare, it is artificially "slowed down" by antispasmodics, relaxing muscles and reducing tone. As a result of the use of No-Shpa with Papaverine "to prepare the cervix", the likelihood of weakness in labor activity and, accordingly, the use of labor stimulation, labor induction and the imposition of obstetric forceps or vacuum increases. That is, it is not the preparation of the cervix, but the suppression of labor activity.

The use of No-Shpa with Papaverine does not reduce the risk of ruptures, which in most cases depend only on the competent management of childbirth by a doctor. And to prepare the cervix for childbirth, which is carried out only when the pregnancy is overdue or the need for urgent delivery against the background of a threat to the life of the mother, completely different drugs are used (Prostin and others) and non-drug agents (kelp, Foley catheter, etc.).

Papaverine for children

Papaverine in any dosage form can be used in infants from three months. The instructions usually indicate that the drug is approved for use from 6 months, but practicing pediatricians, based on many years of observation of the use of Papaverine, consider it justified and safe to use it from 3 months. Indeed, the composition of the popular drug Omnopon, used for pain relief in childbirth, also includes Papaverine.

In babies of the first year of life, Papaverine is used mainly for the relief of spastic pains and intestinal colic, and in older children - to relieve bronchospasm, as well as in the complex therapy of pancreatitis, hepatic colic and urethral spasms. In addition, if a child has a high temperature and white, cold hands and feet, then Papaverine is given to dilate blood vessels 15 to 20 minutes before the antipyretic drug. In a situation where the hands and feet are cold and the temperature is very high, an antipyretic without first taking an antispasmodic (Papaverine, No-Shpy, Drotaverine, etc.) will not work, since constricted, spasmodic vessels will not give off excessive heat and cool the body .

Papaverine in children is used in all three dosage forms in dosages depending on age:

6 – 24 months- 5 mg (1/2 children's tablet, 0.25 ml solution or 1/4 suppository) 2 times a day;
24 years- 5 - 10 mg (1/2 - 1 children's tablet, 0.25 - 0.5 ml of solution or 1/4 - 1/2 suppositories) 2 times a day;
5 – 6 years- 10 mg (1 children's tablet, 0.5 ml solution or half a suppository) 2 times a day;
7 - 9 years- 10 - 15 mg (1 - 1.5 children's tablets, 0.5 - 0.75 ml of solution or 1/2 - 2/3 suppositories) 2 - 3 times a day;
10 – 14 years old- 15 - 20 mg (1.5 - 2 children's tablets, 0.75 - 1 ml of solution, 2/3 - 1 suppository) 2 - 3 times a day;
Teenagers over 14- 20 - 40 mg (1 adult tablet, 1 - 2 ml of solution or 1 - 2 suppositories) 3 - 4 times a day.

Children should be given only special children's tablets of Papaverine, which contain 10 mg of the active substance, and not broken into small pieces by adults. When using the solution, small syringes should be taken in order to accurately measure the required amount of the drug. And when using candles, they must be cut into pieces along, not across. In young children, it is recommended to use Papaverine in suppositories or solution, since they still have difficulty swallowing tablets. In older age groups, any convenient dosage form can be used.

Papaverine for pressure

Papaverine dilates blood vessels and moderately lowers blood pressure, however, it is not used as a specific antihypertensive drug for long courses of treatment. Papaverine in combination with Dibazol is usually injected with a hypertensive crisis.

Hypersensitivity to drug components;
AV block;
Liver failure;
Elderly age over 65;
Children under 6 months of age.

In addition to these contraindications, there are a number of conditions in which Papaverine should not be used until recovery or complete rehabilitation. These conditions are temporary restrictions on the use of the drug, since after their cure or stabilization of the condition, Papaverine can be used with caution. So, the restrictions on the use of the solution, suppositories and tablets Papaverine are the following conditions:

Traumatic brain injury suffered within the last 6 months;
shock conditions;
Chronic renal failure; 1. Bioshpa tablets;
2. Vero-Drotaverine tablets;
3. Droverin solution for injections, tablets;
4. Drotaverin MS, Drotaverin forte, Drotaverin-UBF, Drotaverin-Teva and Drotaverin-FPO - tablets;
5. Drotaverin-Ellara solution for injection;
6. Nikoverin tablets;
7. No-Shpa tablets and injection;
8. No-shpa forte tablets;
9. Nosh-Bra injection and tablets;
10. Papazol and Papazol-UBF tablets;
11. Platifillin with papaverine tablets;
12. Ple-Spa tablets;
13. Spazmol solution for injections and tablets;
14. Spazmonet and Spazmonet forte tablets;
15. Spazoverin tablets;
16. Spakovin solution for injections and tablets.