papaverine (Papanerine, Pavabid)
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Indications
- peripheral vascular disease
- relieve cerebral & peripheral ischemia associated with arterial spasm
- used in combination with anticoagulants to increase collateral circulation in acute vascular occlusion
- injection into the corpus cavernosum of the penis for the treatment of impotence
- to relieve myocardial ischemia complicated by arrhythmia
Contraindications
Dosage
- 30 mg IV/IM every 3 hours PRN
- dosages up to 120 mg every 3 hours have been used in adults
- children: 1.5 mg/kg QID
Injection: 30 mg/mL (2 mL, 10 mL)
Pharmacokinetics
- readily absorbed from GI tract
- plasma protein binding 90%
- metabolized by liver, excreted in urine
- elimination 1/2life is 6 hours
elimination via liver
elimination via kidney
1/2life = 6 hour
Adverse effects
- not common (1-10%)
- flushing of the face, sweating, tachycardia, hypotension, arrhythmias with rapid IV use, depression, dizziness, vertigo, drowsiness, sedation, lethargy, headache, pruritus, dry mouth, nausea, constipation, hepatic hypersensitivity, thrombosis at the site of IV administration, apnea with rapid IV use
- other
- hypertension
- intercavernous injection may cause priapism & transient pain
Drug interactions
- synergistic activity with morphine
- papaverine interferes with therapeutic effect of L-dopa
Mechanism of action
- alpha adrenergic receptor antagonist
- spasmolytic effect on coronary, cerebral, pulmonary & peripheral arteries
- relaxes muscles of bronchi, GI tract, ureters & biliary system