Could papaverine give subileus or ileus as a side effect?/nThe question concerns a man with colosto

Fråga: Could papaverine give subileus or ileus as a side effect?

The question concerns a man with colostomy who is treated for a unknown time with papaverine 120 mg/day.

Sammanfattning: Papaverine is a non-specific smooth muscle relaxant. Its pharmacological effect appears to be greater with exaggerated smooth muscle tone than with normal tone. Ileus has not been reported as a side effect of papaverine.

Svar: Papaverine is an alkaloid which, although present in opium (1 per cent), is chemically and pharmacologically distinct from morphine and the other phenanthrene alkaloids. Papaverine produces nonspecific relaxation of smooth musculature (cardiac, intestinal, ureteric, vascular). However, the relaxant effect on the intestinal musculature is relatively weak (1). The relaxant activity appears to be greater with exaggerated smooth muscle tone than on normal tone (2).

Although "gastrointestinal disturbances" have been listed as side effects (3), no details have been provided on the nature and duration of these effects.

No reports of papaverine induced ileus were found in a search of the Medline database. Moreover, no reports of papaverine- associated gastrointestinal side effects have been filed with the Swedish Adverse Drug Reactions Advisory Committee.

Considering the weak relaxant effect of papaverine on intestinal smooth muscle and the brevity of the effects, it is not probable that the use of papaverine was related to the ileus in this patient. 1 Goodman and Gilman, The pharmacological basis of therapeutics. 1965; 3rd ed: 278-280 2 Giroud JP, Mathe G, Meyniel G: Pharmacologie clinique. Bases de la therapeutique. Paris: Expansion Scientifique Francaise, 1978, p 504-506 3 Martindale, The extra pharmacopoeia, 1982; 28th ed: 1059