Papaverine in Pregnancy

Papaverin in pregnancy is widely used as an antispasmodic and anesthetic, but for the safety of its use, it is necessary to know certain features of the pharmacological properties of this drug. It performs its action under certain conditions and does not affect the inflammatory pain syndrome in a direct way, therefore, it is necessary to clearly differentiate the indications for the purpose of the preparation. The question of the benefits or harm of papaverine in pregnancy also comes from many factors, one of which is the individual characteristics of the female body.

[1], [2], [3], [4], [5], [6]

Indications for the use of papaverine in 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 bowel pain, cerebral circulation disorders in the form of a headache. In pregnancy, the indication for the use of the drug may be the threat of termination of pregnancy with hypertension of the uterus, as a complex tocolytic therapy can use papaverine. Headaches caused by vascular spasm or hypertension can also be treated with papaverine.

Pharmacodynamic features of the preparation

The form of the preparation is tablets, rectal suppositories, solution for injections. Due to a wide range of pharmacological forms, the preparation has many possibilities for use, both for systemic administration and for local treatment. The drug has a myotropic antispasmodic property, which is realized due to the action on the muscle fibers. The mechanism of action of the drug is as follows: papaverine hydrochloride upon admission to the cell blocks the synthesis of cyclic adenosine monophosphate. This enzyme is responsible for the normal contraction of muscles and when it is blocked, the amount of calcium that enters the myocyte decreases, which in turn does not allow the muscle fiber to contract, in which the spasmolytic effect of the drug is expressed. Due to this, it acts not only on the smooth muscles of the internal organs, but also on the vessels, which causes their relaxation. It has a pronounced effect primarily 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 cardiac muscle.

The method of administration of papaverine and the dose that is used depends on the pharmacological form. Tablets of papaverine are dosed at 10, 20, 40 milligrams. Ampoules are produced in a concentration of 2% and a volume of 2 milliliters. Rectal suppository of 20 milligrams. To put papaverine during pregnancy in the case of using suppositories is necessary at night, after an evening toilet. The course of treatment is not less than five days.

Pharmacokinetic features of the drug

As a result of taking the drug inside, there is a rapid absorption of the active substance in the duodenum, and the maximum concentration of the drug in the blood is determined one hour after administration. Bioavailability of the drug is 30 to 50% and the half-life of the drug is about two hours. After entering the blood papaverine binds to blood proteins by 90%. Then papaverine enters the liver, where its metabolism passes. Active substances that are part of papaverine, after metabolism are excreted by the kidneys and in greater concentration in unchanged form. Part of the drug can be stored as a depot in adipose tissue and liver. The drug is able to pass through the blood-brain and fetoplacental barrier, but the drug does not have a harmful teratogenic effect.

Basic principles of the use of papaverine during pregnancy

Can I use papaverine hydrochloride and is this drug harmful during pregnancy? This question is asked by many women who use this drug, but the purposes of its use can be different and accordingly, the recommendations are also different. The instruction to papaverine suggests that papaverine is not harmful in pregnancy, since its active substances and metabolites do not have direct toxic effects. Therefore, we are not talking about the harm of the drug in this case, moreover, it is often prescribed to pregnant women. Why do they prescribe papaverine during pregnancy? Due to its miotropic antispasmodic effect, papaverine has a wide range of indications for the appointment. Papaverin in the early stages of pregnancy is most often prescribed as an antispasmodic agent in the occurrence of early gestosis. In this case, a pregnant woman may be disturbed by nausea, vomiting, abdominal pain, and there may also be spasmodic pains that respond well to antispasmodics such as papaverine. Therefore, papaverine may be taken for this purpose. Also, one of the complications in early pregnancy may be the threat of miscarriage, which requires immediate tocolytic therapy. Therefore, together with topical hysterotropic tocolytic drugs, papaverine is introduced, which additionally acts on the vessels and removes not only the spasm of the uterus, but also improves the blood flow in its vessels and fetal vessels. In this case, appoint papaverine in ampoules and injected in pricks or drips, which increases the speed of the onset of the effect. A dropper with papaverine can also be used for a more prolonged effect.

Papaverine in late pregnancy in the second and third trimester of pregnancy also has a wide application. It can be used for the same purpose in case of threat of premature termination of pregnancy. It often happens that pregnancy is complicated by the development of late gestosis with an increase in blood pressure. In this case, not only antihypertensive agents, but also the use of papaverine, control the pressure. To this end, this preparation can also be used, since it promotes the expansion of peripheral vessels and the reduction of pressure. Also late in life, violations of the normal functioning of the gastrointestinal tract may occur in the form of constipation or acute intestinal infections. In this case, expressed spasmodic pain in the abdomen along the bowel can be removed by an additional method of papaverine, which will also remove hypertension of the uterus. Very often a problem occurs in late pregnancy - it's hemorrhoids. Hemorrhoids during pregnancy develops because of anatomical and physiological changes in the body of a woman during pregnancy. This is due to the fact that the uterus, when enlarged in size, presses on all the organs of the small pelvis - the rectum, the bladder, and also on the lower vena cava. All these changes contribute to the disruption of the normal outflow of venous blood from the rectum and form its stasis with the gradual expansion of venous sinuses. This problem brings a lot of unpleasant sensations and requires complex treatment. Papaverine is also used in hemorrhoids as an antispasmodic. In this case, preference is given to the use of suppositories of papaverine, which manifest their local action. There are features of the use of papaverine due to the period of pregnancy. Thus, papaverine on the 38th, 39th and 40th week during use can cause weakness of the labor activity, because 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, but the effect and use of papaverine in pregnancy is not limited to certain indications, but may be its wider use.

[7], [8], [9]

Contraindications to papaverine during pregnancy and side effects

Papaverin in pregnancy is contraindicated in case of acute disorders or serious pathologies on the part of the liver and kidneys, which reduces its metabolism, as well as in the presence of allergic reactions in the anamnesis or in case of allergies to additional constituent components of the drug. Local forms of papaverine in the form of rectal suppositories can not be used if there are erosions or other inflammatory damage in the rectum. In the case of external hemorrhoids without fistulas this drug is used. Also, a contraindication to its reception is a violation or inhibition of the respiratory act, a violation of the heart, in particular its conductivity in the form of atrioventricular blockade. With caution should be used with concomitant hypotension.

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

Overdose of the drug is possible when the therapeutic dose is exceeded, which is manifested by dizziness, arterial hypotension, weakness, drowsiness, double vision, dying of the heart. There are no specific measures, it is necessary to carry out general detoxification measures.

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

Reviews about papaverine during pregnancy say that it is used most often in the form of suppositories for hypertension of the uterus. He very well helps in this case to keep a pregnancy with its availability and a small price. There are also reviews of its pronounced effects on renal colic, which allows it to be used in this case. The price of papaverine in tablets and ampoules does not exceed, on average, thirty hryvnia for the whole pack of 10 pieces.

Papaverin during pregnancy can be used in the presence of different indications and thanks to different forms of release it can be used for different purposes. Most often during pregnancy, it is prescribed for the purpose of tocolytic therapy in the form of candles, which shows high efficiency. Also, the drug shows itself well and as an antispasmodic, which makes it possible to use it in colic and spasmodic pains in the abdomen as a symptomatic agent.

[10], [11], [12]