Papaverine Hydrochloride

Vasodilating agent;180 181 a benzylisoquinoline alkaloid180 181 a prepared synthetically or obtained from opium.a

Cardiac and Vascular Uses

Relief of cerebral and peripheral ischemia associated with arterial spasm and myocardial ischemia complicated by arrhythmias.180 181 a

Has been used IV and intra-arterially in treatment of acute vascular occlusion in conjunction with anticoagulants.a

Treatment of angina pectoris;181 results not impressive at usual dosages.a Not recommended as a substitute for nitroglycerin in anginal attacks.a

Has been used in the treatment of other cardiovascular or vascular conditions including vascular encephalopathy associated with hypertensive disease, certain cerebral angiospastic states, and chronic peripheral vascular diseases (i.e., Raynaud’s syndrome, Buerger’s disease); however, use in these conditions has been superseded by more effective agents.a

Erectile Dysfunction

Self-treatment of erectile dysfunction† (ED, impotence).178

Has been used alone or in combination with phentolamine and/or alprostadil in patients with neurogenic103 105 106 108 110 112 113 115 116 118 119 120 128 129 132 and/or limited vasculogenic impotence 103 105 106 108 110 112 113 115 116 120 121 128 129 132 or those with psychogenic impotence,105 106 108 120 128 129 132 but efficacy in patients with a vasculogenic component of their impotence may be variable depending on the extent and type of vascular dysfunction.103 108 110 115 120 128 129

The goal of therapy is to provide an erection of adequate rigidity and duration to be sexually functional while avoiding prolonged erection or priapism.142 143 144 145 146 147

Some experts (American Urological Association [AUA]) recommend that selective phosphodiesterase (PDE) type 5 inhibitor therapy (sildenafil, tadalafil, vardenafil) be offered as first-line erectile dysfunction treatment unless contraindicated.178

Intracavernosal therapy with papaverine and/or other drugs generally reserved for patients who do not respond to psychotherapy/behavioral therapy, vacuum constriction devices, and/or selective PDE type 5 inhibitors and in whom attempts at identifying and modifying any drug-related (e.g., certain antihypertensive agents) or other potential reversible medical cause of erectile dysfunction have proved inadequate.110 130

Some clinicians currently prefer alprostadil, alone or combined with other agents, when intracavernosal treatment of impotence is indicated because of possible improved efficacy and decreased adverse effects (e.g., priapism, fibrotic changes) compared with papaverine therapy.130 149 150 151 152 153 154

Choice of therapy for erectile dysfunction should be individualized taking into account differences in response, tolerability and safety, administration considerations, cost and patient reimbursement factors, experience and judgment of the clinician, and individual patient and partner preference, expectations, and satisfaction.170 171 172 173 174 175 176 177 178

Do not use for enhancing erections in men who are not impotent.154

Other Uses

Has been used in the treatment of GI spasms, dysmenorrhea, biliary or ureteral colic, bronchial asthma, cardiac arrhythmias, and other pathologic conditions†;181 a however, insufficient evidence to establish therapeutic value.a

Specific Drugs

Storage

Oral

15–30°C.180 a Protect from moisture.180

Parenteral

15–30°C.181 a Protect from light; keep in the original carton until time of use.181

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Do not add papaverine hydrochloride injection to lactated Ringer’s injection because a precipitate would result.181 a

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name