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Papaverine (Monograph)

Brand name: Para-Time SR
Drug class: Central alpha-Agonists
VA class: CV900

Medically reviewed by on Apr 10, 2024. Written by ASHP.


Vasodilating agent; benzylisoquinoline alkaloid prepared synthetically or obtained from opium.

Uses for Papaverine

Cardiac and Vascular Uses

Relief of cerebral and peripheral ischemia associated with arterial spasm and myocardial ischemia complicated by arrhythmias.

Has been used IV and intra-arterially in treatment of acute vascular occlusion in conjunction with anticoagulants.

Treatment of angina pectoris; results not impressive at usual dosages. Not recommended as a substitute for nitroglycerin in anginal attacks.

Has been used in the treatment of other cardiovascular or vascular conditions including vascular encephalopathy associated with hypertensive disease, certain cerebral angiospastic states, and chronic peripheral vascular diseases (i.e., Raynaud’s syndrome, Buerger’s disease); however, use in these conditions has been superseded by more effective agents.

Erectile Dysfunction

Self-treatment of erectile dysfunction [off-label] (ED, impotence).

Has been used alone or in combination with phentolamine and/or alprostadil in patients with neurogenic and/or limited vasculogenic impotence or those with psychogenic impotence, but efficacy in patients with a vasculogenic component of their impotence may be variable depending on the extent and type of vascular dysfunction.

The goal of therapy is to provide an erection of adequate rigidity and duration to be sexually functional while avoiding prolonged erection or priapism.

Some experts (American Urological Association [AUA]) recommend that selective phosphodiesterase (PDE) type 5 inhibitor therapy (sildenafil, tadalafil, vardenafil) be offered as first-line erectile dysfunction treatment unless contraindicated.

Intracavernosal therapy with papaverine and/or other drugs generally reserved for patients who do not respond to psychotherapy/behavioral therapy, vacuum constriction devices, and/or selective PDE type 5 inhibitors and in whom attempts at identifying and modifying any drug-related (e.g., certain antihypertensive agents) or other potential reversible medical cause of erectile dysfunction have proved inadequate.

Some clinicians currently prefer alprostadil, alone or combined with other agents, when intracavernosal treatment of impotence is indicated because of possible improved efficacy and decreased adverse effects (e.g., priapism, fibrotic changes) compared with papaverine therapy.

Choice of therapy for erectile dysfunction should be individualized taking into account differences in response, tolerability and safety, administration considerations, cost and patient reimbursement factors, experience and judgment of the clinician, and individual patient and partner preference, expectations, and satisfaction.

Do not use for enhancing erections in men who are not impotent.

Other Uses

Has been used in the treatment of GI spasms, dysmenorrhea, biliary or ureteral colic, bronchial asthma, cardiac arrhythmias, and other pathologic conditions [off-label]; however, insufficient evidence to establish therapeutic value.

Papaverine Dosage and Administration


Administer orally, or by IM or slow IV injection.

Has been used intra-arterially in treatment of acute vascular occlusion in conjunction with anticoagulants.

Has been administered by intracavernous [off-label] injection for the treatment of erectile dysfunction.

IV Administration

Slow IV injection preferred when an immediate effect is desired.

Rate of Administration

Inject slowly over a 1- to 2-minute period to minimize serious adverse effects (e.g., arrhythmias, fatal apnea). (See Cardiovascular and Respiratory Effects under Cautions.)


Available as papaverine hydrochloride; dosage expressed in terms of salt.

Pediatric Patients

Cardiac and Vascular Use† [off-label]
IV or IM

6 mg/kg daily (as 4 divided doses).


Cardiac and Vascular Use

Usually, 150 mg (extended-release capsules) every 8–12 hours.

Alternatively, 300 mg (extended-release capsules) every 12 hours.

75–300 mg (conventional tablets [no longer commercially available in US] 3–5 times daily, also has been used.

IV or IM

Usually, 30 mg; may repeat 30–120 mg every 3 hours as necessary.

Cardiac extrasystoles: May administer 2 doses 10 minutes apart.

Erectile Dysfunction† [off-label]
Intracavernosal Self-injection†

2.5–37.5 mg. Usually, titrated up to 30 mg in combination with phentolamine mesylate 0.5–1 mg (range: 0.08–1.25 mg).

Tolerance with long-term use may require dosage increase.

Prescribing Limits


Cardiovascular Use

960 mg daily.

Special Populations

No special population dosage recommendations at this time.

Cautions for Papaverine




Cardiovascular and Respiratory Effects

Administer IV slowly with caution; rapid injection may result in arrhythmias and fatal apnea.

Large parenteral doses can depress atrioventricular and intraventricular conduction; may result in serious arrhythmias.

Vasoactive Therapy

While some manufacturers have stated that papaverine hydrochloride injection is not indicated for the treatment of impotence via intracorporeal injection, the drug has been employed effectively via intracavernosal injection.

Do not use vasoactive therapy for impotence in patients who might have conditions predisposing to priapism (e.g., sickle cell anemia or trait, multiple myeloma, leukemia), in those with anatomic deformation of the penis (e.g., angulation, cavernosal fibrosis, Peyronie’s disease), or in men in whom sexual activity is inadvisable or contraindicated. Discontinue vasoactive therapy in patients who develop penile angulation, cavernosal fibrosis, or Peyronie’s disease during therapy.

Intracavernosal therapy (administered by self-injection) may be problematic in those receiving anticoagulants, who cannot tolerate transient hypotension, and those with poor manual dexterity, poor vision, or severe psychiatric disease.

Priapism Associated with Intracavernosal Injection

Consider possibility of persistent priapism (a medical emergency) associated with intracavernosal injection; may require immediate medical and/or surgical intervention. (See Advice to Patients.)

The risk of priapism can be reduced by careful patient instruction and dosage titration.

Management of priapism includes aspiration of cavernosal blood and/or intracavernous injection of an α-adrenergic agonist (e.g., metaraminol, phenylephrine) or dopamine. Rarely, more radical therapy for priapism (e.g., cavernospongiosus or Winter’s shunt) may be necessary, such as in patients with persistent priapism (e.g., longer than 24 hours).

Sensitivity Reactions

Hepatic Hypersensitivity

Hepatic hypersensitivity with GI symptoms, jaundice, eosinophilia, and altered hepatic function tests results reported.

If such hypersensitivity occurs, discontinue the drug.

General Precautions

Adequate Patient Monitoring

Administer papaverine injection only under the supervision of qualified clinician.


Use with caution in patients with glaucoma.

Abuse and Dependence

Potential abuse and dependence to papaverine reported.

Specific Populations


Category C.


Not known whether papaverine distributes into human milk. Use with caution in nursing women.

Pediatric Use

Safety and efficacy of papaverine in pediatric patients not established.

However, children have received papaverine hydrochloride dosages of 6 mg/kg daily, divided into 4 IM or IV doses.

Common Adverse Effects

Following oral administration: Nausea, abdominal distress, anorexia, constipation, malaise, drowsiness, vertigo, sweating, headache, diarrhea, rash, flushing of the face, increased heart rate, increased depth of respirations, slight increase in BP, sedation.

Following IV administration: General discomfort, nausea, abdominal discomfort, anorexia, constipation, diarrhea, skin rash, malaise, headache, flushing, sweating, sedation, hepatitis, hypotension, hypertension, thrombosis at IV injection site.

Following intracavernosal administration: Priapism, transient pain, referred glans pain, burning, paresthesia.

Drug Interactions

Specific Drugs




CNS depressants

Possible increased papaverine effects


Papaverine may block dopamine receptors and interfere with the therapeutic effects of levodopa

Avoid concomitant use; do not use in patients with Parkinson's disease


Possible synergism

Papaverine Pharmacokinetics



Readily absorbed from GI tract.


Fairly rapid.

Following intracavernosal injection, erectile response usually occurs within 10 minutes.


Oral administration of extended-release capsules may provide continuous drug release over a 12-hour period.

Following intracavernosal injection, erectile response may persist for 1 to several hours.

Plasma Concentrations

Constant plasma concentrations can be maintained with oral administration at 6-hour intervals.



Distributed throughout the body, with highest concentrations in fat deposits and liver.

Not known if papaverine distributes into human milk.

Plasma Protein Binding




Rapidly metabolized in the liver.

Elimination Route

Excreted in urine, principally as inactive metabolites.





15–30°C. Protect from moisture.



15–30°C. Protect from light; keep in the original carton until time of use.



Solution Incompatibility

Do not add papaverine hydrochloride injection to lactated Ringer’s injection because a precipitate would result.


Advice to Patients


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Papaverine Hydrochloride


Dosage Forms


Brand Names





Capsules, extended-release

150 mg*

Papaverine Hydrochloride Capsules ER


Para-Time SR




30 mg/mL*

Papaverine Hydrochloride Injection (with chlorobutanol 0.5% in multiple-dose vials or preservative-free in single-dose vials)

American Regent

AHFS DI Essentials™. © Copyright 2024, Selected Revisions April 10, 2024. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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