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Papaverine

Medically reviewed by Drugs.com. Last updated on Sep 23, 2020.

Pronunciation

(pa PAV er een)

Index Terms

Papaverine HCl
Papaverine Hydrochloride
Pavabid

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection, as hydrochloride:

Generic: 30 mg/mL (2 mL, 10 mL [DSC])

Pharmacologic Category

Vasodilator

Pharmacology

Smooth muscle spasmolytic producing a generalized smooth muscle relaxation including: vasodilatation, gastrointestinal sphincter relaxation, bronchiolar muscle relaxation, and potentially a depressed myocardium (with large doses); muscle relaxation may occur due to inhibition or cyclic nucleotide phosphodiesterase, increasing cyclic AMP; muscle relaxation is unrelated to nerve innervation; papaverine increases cerebral blood flow in normal subjects; oxygen uptake is unaltered

Metabolism

Rapidly hepatic

Excretion

Primarily urine (as metabolites)

Onset of Action

Oral: Rapid

Half-Life Elimination

30 to 120 minutes

Protein Binding

~90%

Use: Labeled Indications

Various vascular spasms associated with smooth muscle spasms as in myocardial infarction, angina, peripheral and pulmonary embolism, peripheral vascular disease; cerebral angiospastic states; visceral spasms (ureteral, biliary, and GI colic). Note: Labeled uses have fallen out of favor; safer and more effective alternatives are available.

Off Label Uses

Cerebral vasospasm after mechanical thrombectomy in acute ischemic stroke

Data from a limited number of patients studied suggest that intra-arterial papaverine may be beneficial for the treatment of cerebral vasospasm resulting from mechanical thrombectomy in acute ischemic stroke ^{[Baltsavias 2015]}. Additional data may be necessary to further define the role of papaverine in this condition.

Vasospasm during harvesting mammary arteries for CABG surgery

Data from a randomized controlled trial in patients undergoing CABG surgery and harvesting of the left internal mammary artery (LIMA) supports the use of intraluminal papaverine to prevent or treat spasm after LIMA dissection when delivered to the pedicle ^{[Girard 2004]}. Additional trials may be necessary to further define the role of papaverine to treat spasm of the internal mammary artery.

Contraindications

Complete AV block

Dosing: Adult

Note: Labeled uses have fallen out of favor; safer and more effective alternatives are available. The manufacturer's labeling recommends the following dosing:

Arterial spasm: IM, IV: 30 to 120 mg; may repeat dose every 3 hours; if cardiac extrasystole occurs during use, may administer 2 doses 10 minutes apart

Cerebral vasospasm after mechanical thrombectomy in acute ischemic stroke (off-label use): Intra-arterial: 30 mg/minute; amount infused depends on response of the spastic vessel; dosage administered in clinical study ranged from 45 to 120 mg (Baltsavias 2015). Additional data may be necessary to further define the role of papaverine in this condition.

Vasospasm during harvesting mammary arteries for CABG surgery (off-label use): Intra-arterial: 10 mg (1 mg/mL in NS) injected throughout the vessel after it has been harvested; avoid vascular wall infiltration (Girard 2004). Note: Administration techniques may vary.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Peripheral arterial catheter patency: Limited data available: Infants, Children, and Adolescents: Add 30 mg papaverine to an admixture of 250 mL NS or ¹/₂NS with heparin 1 unit/mL (Heulitt 1993); infuse via peripheral arterial catheter.

Reconstitution

Solutions should be clear to pale yellow. Precipitates with lactated Ringer's.

Administration

IV: Administer by slow push (over 1 to 2 minutes). Rapid IV administration may result in arrhythmias and fatal apnea.

May be administered intra-arterially for cerebral vasospasm after mechanical thrombectomy in acute ischemic stroke (off-label use) or vasospasm during harvesting mammary arteries for CABG surgery (off-label use) once the artery has been dissected (Baltsavias 2015; Girard 2004).

Dietary Considerations

May be taken with food.

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light.

Drug Interactions

Levodopa-Containing Products: Papaverine may enhance the hypotensive effect of Levodopa-Containing Products. Papaverine may diminish the therapeutic effect of Levodopa-Containing Products. Monitor therapy

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Cardiac arrhythmia (with rapid IV use), flushing, hypertension (mild), tachycardia

Central nervous system: Headache, malaise, sedation, vertigo

Dermatologic: Diaphoresis, skin rash

Gastrointestinal: Abdominal distress, anorexia, constipation, diarrhea, nausea

Hepatic: Hepatic cirrhosis

Hypersensitivity: Hypersensitivity reaction (hepatic)

Respiratory: Apnea (with rapid IV use)

<1%, postmarketing, and/or case reports: Hepatitis

Warnings/Precautions

Concerns related to adverse effects:

• Arrhythmias: May (in large doses or with rapid infusion) depress AV and intraventricular cardiac conduction leading to serious arrhythmias (eg, premature beats, paroxysmal tachycardia).

• Hepatitis: May cause hepatic hypersensitivity; discontinue use if GI symptoms, jaundice, eosinophilia, or abnormal LFTs occur.

Disease-related concerns:

• Glaucoma: Use with caution in patients with glaucoma.

Other warnings/precautions:

• Appropriate use: Not indicated for treatment of impotence by intracorporeal injection; persistent priapism may occur.

Monitoring Parameters

Blood pressure, heart rate

Pregnancy Risk Factor

Pregnancy Considerations

Teratogenic effects have not been observed in animal reproduction studies.

Patient Education

What is this drug used for?

• It is used to treat muscle problems that lead to spasms.

• It is used to treat muscle spasms of the GI (gastrointestinal) tract, gallbladder system, or urinary system.

• It may be given to you for other reasons. Talk with the doctor.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Nausea

• Abdominal pain

• Fatigue

• Constipation

• Diarrhea

• Lack of appetite

• Loss of strength and energy

• Flushing

• Sweating a lot

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Liver problems like dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin

• Fast heartbeat

• Severe headache

• Dizziness

• Passing out

• Vision changes

• Abnormal heartbeat

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.