No-Spa (Drotaverine Hydrochloride)

Drotaverine is employed as an antispasmodic to alleviate smooth‑muscle contractions in several gastrointestinal and urological conditions.

• Abdominal pain: Reduces painful cramping by relaxing intestinal smooth muscle.
• Menstrual cramps (dysmenorrhea): Alleviates uterine muscle spasms, decreasing pain during menstruation.
• Biliary colic: Relaxes biliary tract smooth muscle, facilitating bile flow and easing pain.
• Renal colic: Relaxes ureteral smooth muscle, helping to relieve kidney stone‑related pain.
• Other smooth muscle spasm: Provides symptomatic relief in various smooth‑muscle spasm situations such as gallbladder or intestinal disorders.

• Drotaverine acts as a selective phosphodiesterase‑4 (PDE‑4) inhibitor, which prevents the breakdown of cyclic adenosine monophosphate (cAMP) within smooth‑muscle cells. Elevated intracellular cAMP leads to reduced calcium influx and decreased contractile activity, resulting in relaxation of smooth‑muscle fibers in the gastrointestinal, biliary, urinary and uterine tracts. The drug does not significantly affect cholinergic receptors, allowing it to act without major anticholinergic side effects.

Drotaverine may cause a range of adverse reactions, varying from mild to serious.

Common Side Effects

• Headache: mild to moderate headache that may improve with rest.
• Dizziness or vertigo: transient sensation of light‑headedness or spinning, usually brief.
• Nausea or gastrointestinal discomfort: mild upset stomach, occasional vomiting.
• Dry mouth: reduced salivation causing a feeling of thirst.
• Blurred vision: temporary visual disturbances that resolve spontaneously.

Serious or Rare Side Effects

• Allergic reactions: rash, itching, swelling of face or throat, or anaphylaxis requiring immediate medical attention.
• Cardiovascular effects: hypotension or tachycardia that may need monitoring.
• Hepatic dysfunction: elevated liver enzymes, jaundice, or hepatitis‑like symptoms.
• Severe gastrointestinal bleeding: rare but possible, presenting with blood in stool or vomiting.

When using Drotaverine, certain precautions should be observed to ensure safe therapy.

• Pregnancy: Use only if clearly needed; safety data are limited, and benefits must outweigh potential risks.
• Breastfeeding: Caution advised; assess risk versus benefit before administration, as drug may pass into milk.
• Liver impairment: Dose adjustment may be required; monitor hepatic function tests regularly during therapy.
• Renal impairment: Use with caution; monitor renal function especially in severe cases, and consider dose modification.
• Concomitant antihypertensives: May enhance hypotensive effect; observe blood pressure and adjust therapy as needed.
• Store at ambient temperature: Keep below 25 °C, in original packaging, protected from moisture and light.

Drotaverine can interact with other medicines, influencing its efficacy or safety.

Major Interactions (Avoid)

• MAO inhibitors: Concurrent use may cause a marked drop in blood pressure due to additive vasodilatory effects.
• Anticholinergic drugs: Combined effect may lead to excessive smooth‑muscle relaxation and increased risk of gastrointestinal stasis.
• Strong CYP450 inhibitors: Potentially raise drotaverine plasma concentrations, heightening the likelihood of adverse reactions.

Moderate Interactions (Monitor Closely)

• Antihypertensive agents: Drotaverine may potentiate the blood‑pressure‑lowering effect, requiring closer monitoring of blood pressure.
• Diuretics: Co‑administration can enhance hypotensive response, especially in volume‑depleted patients.
• Other antispasmodics: Additive smooth‑muscle relaxation may increase risk of side effects, so dose adjustments may be necessary.