Drotaverine

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Drotaverine
Drotaverine.svg
Drotaverine ball-and-stick.png
Systematic (IUPAC) name
(Z)-1-(3,4-diethoxybenzylidene)-6,7-diethoxy-1,2,3,4-tetrahydroisoquinoline
Clinical data
Trade names No-Spa
AHFS/Drugs.com International Drug Names
Legal status
  • OTC (tablets), ℞-only (solution for injection) (RU)[1]
Routes Oral, intravenous, intramuscular
Pharmacokinetic data
Bioavailability Highly variable (~65%), peak at 45–60 min
Protein binding 95–98%
Metabolism Hepatic
Half-life 7–16 hours
Excretion >50% in urine and ~30% in bile[1]
Identifiers
CAS number 985-12-6 YesY
ATC code A03AD02
PubChem CID 1712095
DrugBank DB06751
ChemSpider 1361582 YesY
UNII 98QS4N58TW YesY
KEGG D07879 YesY
ChEMBL CHEMBL551978 YesY
Chemical data
Formula C24H31NO4 
Mol. mass 397.507 g/mol
 YesY (what is this?)  (verify)

Drotaverine (INN, also known as drotaverin) is an antispasmodic drug, structurally related to papaverine. Drotaverine is a selective inhibitor of phosphodiesterase 4, and has no anticholinergic effects.[2] Drotaverine has been shown to possess dose-dependant analgesic effects in animal models.[3] Drotaverine is sold under the brand name “No-Spa” (Chinoin Pharmaceutical and Chemical Works, Hungary, a member of the Sanofi S.A.)[2] and under many other names in the states of former Soviet Union (such as Russia and Kazakhstan), mainly “Но-шпа” (pronounced NOSH-pa).

Studies[edit]

A few small 2003 studies found drotaverine to be nearly 80% effective in treating renal colic.[4][5] It has also been studied in accelerating labor by speeding up cervical dilation, but the results have been conflicting.[6][7][8] Drotaverine has been shown to be effective in paracervical block in managing pain during hysteroscopy and endometrial biopsy when administered together with mefenamic acid.[9] Irritable bowel syndrome patients presenting with predominant diarrhea are more likely to benefit from “Buscopan” (butylscopolamine).[10] Drotaverine has also been tested in combination with rimantadine for antiviral activity against A and B type influenza.[11]

One small-sample study found drotaverine is eliminated mainly non-renally and found that "the high variation in the bioavailability of drotaverine hydrochloride after oral administration may result in significant interindividual differences in therapeutic response".[12] Drotaverine has an adverse effects frequency of 0.9%, side effects being relatively uncommon.[13]

A study at the R. G. Kar Medical College and Hospital concluded that drotaverine is highly effective in reducing the duration of active phase of labour by hastening cervical dilatation, more effective when given in more dilated cervix than with less dilatation and more effective in multigravida than in primigravida. There was no interference with uterine contractility and no increase in operative delivery. It reduces the incidence of traumatic postpartum haemorrhage by reducing the incidence of cervical tear. It is a safe drug for the mother as well as for the baby.[14]

Patents[edit]

In 2010 Sanofi Aventis filed a patent with the European Patent Office for drotaverine use in "the preparation of a medicament intended for the treatment or amelioration of benign prostatic hyperplasia, urinary disorders, disorders related to bladder dysfunction, lower urinary tract symptoms associated or not associated with benign prostatic hyperplasia, urinary incontinence, bladder outlet obstruction associated or not associated with benign prostatic hyperplasia, interstitial cystitis and overactive bladder."[15]

See also[edit]

References[edit]

  1. ^ a b "Инструкция по применению препарата Но-шпа® // No-Spa® (tablets) Full Prescribing Information". National Register of Drugs (in Russian). Chinoin Pharmaceutical and Chemical Works. pp. 3–8. 
  2. ^ a b "The DrugBank database: Drotaverine". DrugBank Version 4.1. The Metabolomics Innovation Centre. Retrieved 9 August 2014. 
  3. ^ Stepaniuk AG, Stepaniuk NG, Stoliarchuk AA, Stepaniuk GI, Chernobrovyĭ VN (1998). "[The characteristics of the analgesic action of nitrosorbide and no-shpa]". Eksperimental'naia I Klinicheskaia Farmakologiia (in Russian) 61 (4): 17–9. PMID 9783101. 
  4. ^ Romics I, Molnár DL, Timberg G, et al. (July 2003). "The effect of drotaverine hydrochloride in acute colicky pain caused by renal and ureteric stones". BJU International 92 (1): 92–6. doi:10.1046/j.1464-410X.2003.04262.x. PMID 12823389. 
  5. ^ Garmish OS, Zabashnyĭ SI, Smirnova EV, Kobeliatskiĭ IuIu (February 2003). "[Preparation no-shpa forte for the treatment of renal colic]". Klinichna Khirurhiia (in Russian) (2): 47–50. PMID 12784437. 
  6. ^ Singh KC, Jain P, Goel N, Saxena A (January 2004). "Drotaverine hydrochloride for augmentation of labor". International Journal of Gynaecology and Obstetrics 84 (1): 17–22. doi:10.1016/S0020-7292(03)00276-5. PMID 14698825. 
  7. ^ Madhu C, Mahavarkar S, Bhave S (July 2009). "A randomised controlled study comparing Drotaverine hydrochloride and Valethamate bromide in the augmentation of labour". Archives of Gynecology and Obstetrics 282 (1): 11–5. doi:10.1007/s00404-009-1188-8. PMID 19644697. 
  8. ^ Gupta B, Nellore V, Mittal S (March 2008). "Drotaverine hydrochloride versus hyoscine-N-butylbromide in augmentation of labor". International Journal of Gynaecology and Obstetrics 100 (3): 244–7. doi:10.1016/j.ijgo.2007.08.020. PMID 18031745. 
  9. ^ Sharma JB, Aruna J, Kumar P, Roy KK, Malhotra N, Kumar S (June 2009). "Comparison of efficacy of oral drotaverine plus mefenamic acid with paracervical block and with intravenous sedation for pain relief during hysteroscopy and endometrial biopsy". Indian Journal of Medical Sciences 63 (6): 244–52. doi:10.4103/0019-5359.53394. PMID 19602758. 
  10. ^ Khalif IL, Quigley EM, Makarchuk PA, Golovenko OV, Podmarenkova LF, Dzhanayev YA (March 2009). "Interactions between symptoms and motor and visceral sensory responses of irritable bowel syndrome patients to spasmolytics (antispasmodics)". Journal of Gastrointestinal and Liver Diseases 18 (1): 17–22. PMID 19337628. 
  11. ^ Zhilinskaya IN, Konovalova NI, Kiselev OI, Ashmarin IP (2007). "No-Spa and Remantadin are the novel complex preparations that inhibit effectively reproduction of the avian influenza viruses". Doklady Biological Sciences 414 (1): 249–50. doi:10.1134/S0012496607030234. PMID 17668635. 
  12. ^ Bolaji, OO; Onyeji, CO; Ogundaini, AO; Olugbade, TA; Ogunbona, FA (July–September 1996). "Pharmacokinetics and Bioavailability of Drotaverine in Humans". European Journal of Drug Metabolism and Pharmacokinetics 21 (3): 217–221. doi:10.1007/BF03189716. PMID 8980918. 
  13. ^ Tar, A; Singer, J (March 17, 2002). "Safety profile of No-Spa". Orvosi Hetilap 143 (11): 559–62. PMID 12583325. 
  14. ^ Roy, A; Patra, KK; Mukhopadhyay, S; Guha, S (August 2007). "Study of Drotaverine on First Stage of Labour and Pregnancy Outcome". Journal of the Indian Medical Association 105 (8): 450, 452. PMID 18236908. 
  15. ^ https://data.epo.org/publication-server/pdf-document?pn=2156835&ki=A1&cc=EP