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What is Papaverine
Papaverine is a smooth muscle relaxant that has been available for over 60 years. It has been marketed for the relief of cerebral and peripheral ischemia conditions secondary to arterial spasm.
These conditions include vascular spasm associated with acute myocardial infarction, angina pectoris, peripheral and pulmonary embolism, peripheral vascular disease with a vasospastic element, or certain cerebral angiospastic states; and visceral spasm causing ureteral, biliary, or gastrointestinal colic.
In 1979, a Food and Drug Administration Advisory Committee evaluated studies on papaverine and concluded that there was a lack of objective data to support the therapeutic use of papaverine for these conditions.
Papaverine remains available despite the committee’s recommendation that it be withdrawn from the market.
Papaverine is currently used for many off-label indications.
Injectable papaverine has been studied via intra-arterial, intrathecal, intraluminal, perivascular, and intercavernous routes.
In patients with severe vasospasm following aneurysmal subarachnoid hemorrhage, papaverine can be injected directly into cerebral arteries to prevent the development of delayed ischemic neurologic deficits.
Papaverine can also be used in these patients to facilitate dilation of cerebral vessels prior to balloon angioplasty.
Indications
- acute myocardial infarction
- angina
- arterial thromboembolism
- erectile dysfunction (ED)
- intravascular catheter occlusion prophylaxis
For the treatment of erectile dysfunction (ED)
Side Effects
- abdominal pain
- anorexia
- cirrhosis
- constipation
- diaphoresis
- diarrhea
- drowsiness
- flushing
- headache
- hepatitis
- hypertension
- increased intracranial pressure
- injection site reaction
- malaise
- nausea
- orthostatic hypotension
- penile fibrosis
- penile pain
- priapism
- QT prolongation
- rash
- seizures
- sinus tachycardia
- thrombocytopenia
- torsade de pointes
- ventricular tachycardia
- vertigo
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- AV block
- breast-feeding
- driving or operating machinery
- geriatric
- intracorporeal administration
- labor
- Parkinson’s disease
- pregnancy
- priapism
- QT prolongation
Interactions
- Acetaminophen; Butalbital
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Dextromethorphan; Doxylamine
- Acetaminophen; Diphenhydramine
- Alprazolam
- Amitriptyline; Chlordiazepoxide
- Amobarbital
- Anxiolytics; Sedatives; and Hypnotics
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Barbiturates
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Benzodiazepines
- Buspirone
- Butabarbital
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbidopa; Levodopa
- Carbidopa; Levodopa; Entacapone
- Chlordiazepoxide
- Chlordiazepoxide; Clidinium
- Clonazepam
- Clorazepate
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Diazepam
- Diphenhydramine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Diphenhydramine; Phenylephrine
- Doxylamine
- Doxylamine; Pyridoxine
- Droperidol
- Estazolam
- Ethanol
- Flurazepam
- General anesthetics
- Hydroxyzine
- Levodopa
- Lorazepam
- Mephobarbital
- Methohexital
- Midazolam
- Opiate Agonists
- Oxazepam
- Pentobarbital
- Phenobarbital
- Primidone
- Quazepam
- Secobarbital
- Temazepam
- Thiopental
- Triazolam
