Papaverine in pregnancy

Papaverine is widely used during pregnancy as an antispasmodic and analgesic, but for its safe use it is necessary to know some features of the pharmacological properties of this drug. It carries out its action under certain conditions and does not affect the pain syndrome of an inflammatory nature directly, therefore it is necessary to clearly differentiate the indications for prescribing the drug. The question of the benefits or harm of papaverine during pregnancy also comes from many factors, one of which is the individual characteristics of the female body.

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Indications for the use of papaverine during pregnancy

The main indications are limited to its antispasmodic effect. Therefore, the drug can be used in the complex therapy of arterial hypertension, hepatic and renal colic, acute spasmodic pains of the intestine, cerebrovascular accident in the form of headache. During pregnancy, the indication for the use of the drug may be the threat of termination of pregnancy with uterine hypertonicity; papaverine can be used as a complex tocolytic therapy. Headaches caused by vascular spasm or arterial hypertension can also be treated with papaverine.

Pharmacodynamic properties of the drug

The drug is available in tablets, rectal suppositories, and injection solution. Due to the wide range of pharmacological forms, the drug has many possibilities for use, both for systemic administration and for local treatment. The drug has a myotropic antispasmodic property, which is realized by acting on muscle fibers. The mechanism of action of the drug is as follows: papaverine hydrochloride, when entering the cell, blocks the synthesis of cyclic adenosine monophosphate. This enzyme is responsible for normal muscle contraction and when it is blocked, the amount of calcium that enters the myocyte decreases, and this in turn does not allow the muscle fiber to contract, which is the antispasmodic effect of the drug. Due to this, it acts not only on the smooth muscles of the internal organs, but also on the blood vessels, which causes their relaxation. It has a pronounced effect mainly on the arteries, which causes a decrease in blood pressure. If the dose of the drug is exceeded, it can affect myocardiocytes and disrupt their function, which causes conduction disturbances in the heart muscle.

The method of using papaverine and the doses used depend on the pharmacological form. Papaverine tablets are dosed at 10, 20, 40 milligrams. Ampoules are available in a concentration of 2% and a volume of 2 milliliters. Rectal suppositories are 20 milligrams. Papaverine should be administered during pregnancy in case of using suppositories at night, after evening toilet. The course of treatment is at least five days.

Pharmacokinetic properties of the drug

As a result of taking the drug orally, the active substance is rapidly absorbed in the duodenum, and the maximum concentration of the drug in the blood is determined one hour after taking it. The bioavailability of the drug is from 30 to 50% and its half-life is about two hours. After entering the blood, papaverine binds to blood proteins by 90%. Then papaverine enters the liver, where it is metabolized. The active substances that are part of papaverine are excreted by the kidneys after metabolism and in a higher concentration in an unchanged form. Part of the drug can be stored as a depot in adipose tissue and the liver. The drug can pass through the blood-brain and fetoplacental barrier, but the drug does not have a harmful teratogenic effect.

Basic principles of using papaverine during pregnancy

Can papaverine hydrochloride be used and is this drug harmful during pregnancy? This question is asked by many women who use this drug, but the purposes of its use may be different and, accordingly, the recommendations are also different. The instructions for papaverine say that papaverine is not harmful during pregnancy, since its active substances and metabolites do not have a direct toxic effect. Therefore, in this case, there is no talk about the harm of the drug, moreover, it is often prescribed to pregnant women. Why is papaverine prescribed during pregnancy? Due to its myotropic antispasmodic effect, papaverine has a wide range of indications for prescription. Papaverine in early pregnancy is most often prescribed as an antispasmodic agent in the event of early gestosis. In this case, a pregnant woman may be bothered by nausea, vomiting, abdominal pain, and there may also be spastic pains that respond well to antispasmodics, such as papaverine. Therefore, papaverine can be taken for this purpose. Also, one of the complications in the early stages of pregnancy may be the threat of miscarriage, which requires immediate tocolytic therapy. Therefore, together with topical hysterotropic tocolytic drugs, papaverine is administered, which additionally affects the vessels and relieves not only uterine spasm, but also improves blood flow in its vessels and the vessels of the fetus. In this case, papaverine is prescribed in ampoules and administered by injection or drip, which increases the speed of onset of the effect. A drip with papaverine can also be used for a more prolonged effect.

Papaverine is also widely used in late pregnancy in the second and third trimesters. It can be used for the same purpose in case of a threat of premature termination of pregnancy. It often happens that pregnancy is complicated by the development of late gestosis with increased blood pressure. In this case, not only antihypertensive drugs but also the use of papaverine help control blood pressure. This drug can also be used for this purpose, since it promotes the expansion of peripheral vessels and lowers blood pressure. Also, in the later stages, disorders of the normal functioning of the gastrointestinal tract can develop in the form of constipation or acute intestinal infections. In this case, severe spasmodic pain in the abdomen along the intestines can be relieved by additional administration of papaverine, which will also relieve uterine hypertonicity. A very common problem in late pregnancy is hemorrhoids. Hemorrhoids during pregnancy develop due to anatomical and physiological changes in a woman's body during pregnancy. This is due to the fact that the uterus, when increasing in size, presses on all the organs of the small pelvis - the rectum, bladder, and the inferior vena cava. All these changes contribute to the fact that the normal outflow of venous blood from the rectum is disrupted and its stagnation with a gradual expansion of the venous sinuses is formed. This problem brings a lot of unpleasant sensations and requires complex treatment. Papaverine is also used for hemorrhoids as an antispasmodic. In this case, preference is given to the use of papaverine suppositories, which exhibit their local effect. There are features of the use of papaverine in connection with the gestational age. Thus, papaverine at 38, 39 and 40 weeks when used can cause weakness of labor, since it has a tocolytic effect. Therefore, the use of this drug at this time should be justified, taking into account the possible onset of labor, which can be complicated by irregular contractions.

Thus, although the effect of papaverine is not great, the action and use of papaverine during pregnancy is not limited to only certain indications, but may have a wider application.

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Contraindications to taking papaverine during pregnancy and features of side effects

Papaverine is contraindicated during pregnancy in case of acute disorders or serious pathologies of the liver and kidneys, which reduces its metabolism, as well as in the presence of allergic reactions in the anamnesis or allergy to additional components of the drug. Local forms of papaverine in the form of rectal suppositories cannot be used in case of erosions or other inflammatory lesions in the rectum. In case of external hemorrhoids without fistulas, this drug is used. Also, a contraindication to its use is a violation or suppression of the respiratory act, a violation of the heart, in particular its conductivity in the form of atrioventricular block. It should be used with caution in case of concomitant hypotension.

Side effects of papaverine during pregnancy are possible in the form of allergic reactions with skin rash, nausea and vomiting, bowel disorders with constipation, abdominal pain. There may also be symptoms from the cardiovascular system in the form of conduction disorders up to blockade, extrasystole, arterial hypotension. Increased sweating and drowsiness are possible, as well as a transient asymptomatic increase in the level of liver enzymes.

An overdose of the drug is possible when the therapeutic dose is exceeded, which is manifested by dizziness, arterial hypotension, weakness, drowsiness, double vision, and cardiac arrest. There are no specific measures, general detoxification measures must be taken.

The storage conditions for paracetamol are as follows: shelf life is five years. Store at a relative temperature below 25 degrees, avoiding direct exposure to high and low temperatures, and also exclude high humidity.

Reviews of papaverine during pregnancy say that it is most often used in the form of suppositories for uterine hypertonicity. It helps very well in this case to maintain pregnancy given its availability and low price. There are also reviews of its pronounced effect on renal colic, which allows it to be used in this case. The price of papaverine in tablets and ampoules on average does not exceed thirty hryvnia for the entire pack of 10 pieces.

Papaverine can be used during pregnancy for various indications and, due to its different forms of release, it can be used for various purposes. Most often, it is prescribed during pregnancy for the purpose of tocolytic therapy in the form of suppositories, which shows high efficiency. The drug also shows itself well as an antispasmodic, which allows it to be used for colic and spasmodic abdominal pain as a symptomatic remedy.

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