Yes

Vasodilator

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

C

Hypersensitivity to papaverine or its components

Use with caution in patients with glaucoma; administer I.V. cautiously since apnea and arrhythmias may result; may, in large doses, depress A-V and intraventricular cardiac conduction leading to serious arrhythmias (eg, premature beats, paroxysmal tachycardia); chronic hepatitis noted with jaundice, eosinophilia, and abnormal LFTs

<1%: Flushing of the face, tachycardias, mild hypertension, vertigo, drowsiness, sedation, lethargy, headache, nausea, constipation, abdominal distress, anorexia, diarrhea, hepatic hypersensitivity, chronic hepatitis

Symptoms of acute overdose include nausea, vomiting weakness, gastric distress, ataxia, drowsiness, nystagmus, diplopia, incoordination, lethargy, and coma with cyanosis, and respiratory depression

After gastric decontamination, treatment is supportive with conventional therapy (ie, fluids, positioning and vasopressors for hypotension)

CYP2D6 enzyme substrate

Increased toxicity: Additive effects with CNS depressants

Protect from heat or freezing; refrigerate injection at 2°C to 8°C (35°F to 46°F); solutions should be clear to pale yellow; precipitates with lactated Ringer's

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

Onset of action: Oral: Rapid

Protein binding: 90%

Metabolism: Rapidly in the liver

Half-life: 0.5-1.5 hours

Elimination: Primarily as metabolites in urine

Adults: Oral, sustained release: 150-300 mg every 12 hours; in difficult cases: 150 mg every 8 hours

May be administered with food

May cause drowsiness or dizziness

May decrease the effects of levodopa

No information available to require special precautions

No effects or complications reported

Oral: Take as directed; do not alter dosage without consulting prescriber. Do not chew, crush, or dissolve extended release tablets. Avoid alcohol while taking this medication. May cause dizziness, confusion, or blurred vision (avoid driving or engaging in tasks that require alertness until response to drug is known). Increased fiber in diet, exercise, and adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake) may help if you experience constipation. Report rapid heartbeat or palpitations, CNS depression, persistent sedation or lethargy, or acute headache. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Breast-feeding is not recommended.

Rapid I.V. administration may result in arrhythmias and fatal apnea; administer slow I.V. over 1-2 minutes

Capsule, sustained release, as hydrochloride: 150 mg

Erwin WG, "Senile Dementia of the Alzheimer Type," Clin Pharm, 1984, 3:497-504.

Heulitt MJ, Farrington EA, O'Shea TM, et al, "Double-Blind, Randomized, Controlled Trial of Papaverine-Containing Infusions to Prevent Failure of Arterial Catheters in Pediatric Patients," Crit Care Med, 1993, 21(6):825-9.

Ilan Y and Gemer O, "Papaverine-Induced Coma," Eur J Clin Pharmacol, 1988, 33(6):651.

Sillanpää M and Koponen M, "Papaverine in the Prophylaxis of Migraine and Other Vascular Headache in Children," Acta Paediatr Scand, 1978, 67(2):209-12.

Vaziri ND, Stokes J, and Treadwell TR, "Lactic Acidosis, A Complication of Papaverine Overdose," Clin Toxicol, 1981, 18(4):417-23.

Waters C, "Cognitive Enhancing Agents: Current Status in the Treatment of Alzheimer's Disease," Can J Neurol Sci, 1988, 15:249-56.

Yesavage JA, Tinklenberg JR, Hollister LE, et al, "Vasodilators in Senile Dementias: A Review of the Literature," Arch Gen Psychiatry, 1979, 36:220-3.