Maximum daily dose of noshpa. "No-spa" intramuscularly: instructions for use, purpose, dosage, composition, indications and contraindications

No-spa is an antispasmodic with myotropic action. The drug reduces the tone of smooth muscles, dilates blood vessels, and reduces the motor activity of the muscles of internal organs. In terms of duration of action and effectiveness, no-spa surpasses all other similar drugs, including papaverine. At the same time, the medicine does not have any negative effects on the autonomic nervous system and the central nervous system.

During the treatment process, no-spa acts directly on the smooth muscles of the internal organs. Due to this, the drug can be used as an antispasmodic in cases where drugs from the group of anticholinergic drugs are contraindicated for the patient.

The positive effect of no-shpa appears within 2-4 minutes after administration, and the maximum effect develops after 30 minutes.

Release form and composition of the drug

No-spa is available in the form of capsules, enteric-coated tablets, and a solution for intravenous injection. Regardless of the release form, the drug contains the main active ingredient - drotaverine hydrochloride and various auxiliary elements: talc, magnesium stearate, corn starch, lactose, povidone.

No-shpa - indications and contraindications

• chronic gastroduodenitis or peptic ulcer of the stomach and duodenum;
• spasms of smooth muscles of internal organs;
• hypermotor biliary dyskinesia;
• chronic cholecystitis;
• intestinal colic, regardless of what causes it;
• spasm of cerebral vessels;
• pyelitis, colitis and proctitis;
• urolithiasis of the kidneys;
• during pregnancy, to relieve cervical spasms and weaken its contractions during childbirth;
• for relieving smooth muscle spasms after surgery

Taking no-shpa is contraindicated in case of hypersensitivity to the components of the drug and glaucoma.

No-spa during pregnancy

Pregnancy is the most beautiful, but also the most crucial period in the life of any woman. The main difficulty when carrying a child is related to the correct selection of medications that would not harm the health of the unborn baby and would not provoke the occurrence of various pathologies.

It has been proven that the use of no-spa during pregnancy does not pose any threat to the child and is recommended in all cases where it is necessary to quickly and painlessly relieve increased uterine tone.

Doctors advise pregnant women to carry no-shpa with them and drink the medicine for any pain in the abdominal area. Of course, taking the drug does not cancel regular visits to the doctor, but, nevertheless, no-spa will be effective where many other drugs fail, without negative effects on the fetus in the womb.

No-spa - application and dosage Injection. For adults, the daily dose of the drug is 40-240 mg, which are administered into the body in equal portions 2-3 times a day. In the presence of acute renal failure or biliary colic, no-spa is administered intravenously.

Dosage – 40-80 mg. During childbirth, pregnant women are recommended to take 40 mg of the drug intramuscularly. If there is no effect, the procedure is repeated, but not earlier than 2 hours after the first dose.

Pills. For adults, the daily dose of no-shpa is 2-3 tablets 3 times a day (120-140 mg of the drug). Children aged 1 to 6 years are prescribed 40-120 mg of the drug 2-3 times a day, over 6 years - 80-200 mg (2-5 tablets) in 4-5 doses.

Attention: The presented material does not constitute a recommendation for the use of drugs. Before using any of the medications described on the site, be sure to consult your doctor!

Instructions

No-Spa is a widely used antispasmodic, which can be found in many home medicine cabinets. The drug is effective for various pathologies accompanied by spasms and spastic pain.

Composition and action

The drug has an antispasmodic effect. The drug also relieves spastic pain. The pharmacological effect of the drug is due to the presence of drotaverine hydrochloride in the composition. This is the active ingredient of No-Shpa.

Release form

1. The medication is offered in two dosage forms:
2. Injection. 1 ml of the medicinal composition contains 20 mg of the active ingredient. The ampoules contain 2 ml of solution, i.e. 40 mg of the main substance. The color of the solution is greenish with a yellow tint. 5 ampoules are packed in a cardboard box.

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Pharmacological properties of No-Shpa

The drug reduces spasms and pain of varying intensity.

Pharmacodynamics

The medicine is effective for spasms of the smooth muscles of internal organs: the gastrointestinal tract, urinary and reproductive systems, biliary tract. Drotaverine has another ability - to moderately dilate the vessels of the circulatory system.

The medication does not have a negative effect on the functioning of the nervous system.

Pharmacokinetics

The medicine is absorbed from the gastrointestinal tract. The highest concentration in the blood is achieved after 50-60 minutes. Metabolism occurs in the liver. The half-life of the active component is about 10 hours.

What does it help with?

No-Shpa has many indications for use. The drug is recommended to be taken for renal and hepatic colic, for pain that occurs when stones pass through the bile ducts, and for the development of inflammatory processes in the gastrointestinal tract.

The medicine is widely used in urology and gynecology. It is taken by patients suffering from cystitis and other inflammatory diseases of the urinary tract. Injections and tablets are used as an analgesic and antispasmodic drug. Gynecologists often recommend No-Shpu for dysmenorrhea - painful periods, if the cause of the pain is associated with uterine spasms. The medicine helps during labor, promoting the opening of the uterus.

Taking No-Shpa has a positive effect on the condition of the blood vessels in the brain, so the indication for using the tablets is headache.

But in this case, the medicine should be used only after consultation with a specialist.

You should not rely on the healing effect of No-Shpa for toothache. Drotaverine is effective for spastic pain, but the cause of pain in the teeth is completely different factors.

How to take No-Shpu

There is no need to chew the tablet; it is taken whole. But you will have to take the medicine with water: you will need at least 100 ml of liquid.

A patient who is indicated for intravenous administration of a medicinal solution should take a supine position. In a sitting or standing position, the patient may lose consciousness at the time of injection.

In some cases, doctors prescribe No-Shpu in the form of a dropper.

Permissible dosage:

1. Patients 6-12 years old are allowed to take no more than 80 mg per day. The daily dose should be divided into 2-3 times.
2. Teenagers are not recommended to take more than 160 mg per day. The daily dose is divided into 2 times.
3. Adults should not take more than 240 mg per day. Tablets should be taken 2-3 times a day with an interval of 8 hours.

When No-Shpa is administered intramuscularly, the daily dosage for an adult patient ranges from 40 to 240 mg. The prescribed volume is administered 2-3 times.

Before or after meals

Most often, the medicine is taken as a quick relief when cramping pain occurs. In such an acute situation, there is no time to debate whether to take a pill or give an injection before or after meals. The use of No-Shpa does not depend on food intake.

For kidney pain

If pain occurs in the kidneys, No-Shpu should be used as first aid. If there are no special recommendations from a doctor, then a single dose is 2 tablets. The procedure is repeated 3 times a day, it is advisable to do this at the same interval.

With stones

No-Shpu can be used for acute and chronic forms of urolithiasis. To eliminate acute colic that occurs when stones pass, you can take 1-2 tablets up to 3 times a day.

It is necessary to ensure that the daily dose does not exceed 240 mg.

For kidney inflammation

In this condition, the patient suffers from severe pain. They can be relieved with No-Spa: for moderate pain, it is enough to take 40 mg, for severe pain - 80 mg. Then you need to call a doctor.

How long does it take for No-Spa to work?

The patient can feel the therapeutic effect 10-15 minutes after taking the tablet and 3-5 minutes after the injection. In rare cases, this time increases to half an hour.

How long does it last?

3-4 hours - during this time you can hope for a therapeutic effect. After this, you can take the medicine again if necessary.

Contraindications

It is forbidden to take pills or give injections to people suffering from severe forms of heart or kidney failure.

The drug may harm patients who are sensitive to any of the substances that make up the drug.

If you can take No-Shpu with high blood pressure, then those who have low blood pressure should use the medication with caution or completely abandon it.

Side effects

A person taking No-Shpu may develop the following negative reactions:

• nausea, constipation;
• insomnia, dizziness, headaches;
• tachycardia, decreased blood pressure;
• allergies, Quincke's edema.

If a person experiences unpleasant symptoms, he should stop taking the medicine.

Overdose

In case of overdose, symptomatic treatment and medical supervision are necessary.

special instructions

Before using the drug, you must carefully read the instructions.

While taking No-Shpa, you can engage in hazardous activities, including driving a car.

But if side effects from the nervous system occur, such as dizziness, then such activities should be abandoned.

During pregnancy and lactation

Pregnant women should not take antispasmodics without a doctor's prescription. The specialist prescribes the medicine if there are special indications.

In some cases, gynecologists prescribe No-Shpu in the early stages of pregnancy, since drotaverine reduces uterine spasm, which prevents miscarriage. Before childbirth, increased uterine tone is considered normal: due to slight spasms, the abdomen lowers and the fetus takes the position required for childbirth.

Is No-Shpu allowed for children?

The medicine in the form of an injection solution is not prescribed to children of any age. Newborns and patients under 6 years of age are not prescribed tablets. At an older age, a doctor may prescribe a tablet form of No-Shpa for stomach pain, spasms in the gastrointestinal tract, high fever, constipation, flatulence and some other pathological conditions.

Alcohol compatibility

But narcologists can prescribe the drug to treat a hangover.

Therapy is carried out under the supervision of a specialist.

Drug interactions

The simultaneous use of No-Shpa and other antispasmodics enhances the antispasmodic effect of the drugs.

No-Shpu can be used simultaneously with Analgin. This combination is considered classic and is used for diseases that require rapid relief of the painful condition.

The simultaneous use of No-Shpa and Diphenhydramine is indicated at high temperatures, which are accompanied by the development of inflammatory processes or swelling of the mucous membranes. Diphenhydramine can be replaced with a more modern drug - Suprastin.

In case of fever and high temperature, No-Shpu and Nurofen can be used simultaneously.

Analogs

Drugs with a similar effect: Drotaverine hydrochloride (much cheaper), Papaverine, Ple-Spa, Spazmalgon.

Terms and conditions of storage

The shelf life of a medicinal product depends on the dosage form: tablets last 5 years, solution - 3 years from the date of release of the drug.

The medicine retains its medicinal qualities if storage conditions are met: the room temperature must be maintained from +15 to +25°C, the storage location must be protected from sunlight.

Conditions for dispensing from pharmacies

Manufacturer

No-Shpu is produced by the Hungarian company Chinoin Pharmaceutical and Chemical Works Co.

Price

For a box with 5 ampoules of 2 ml each you will have to pay about 100 rubles.

The cost of 100 tablets packed in a plastic bottle is about 200 rubles.

There are medications that should be in any family's medicine cabinet. One of these drugs is No-shpa, which has established itself as a highly effective antispasmodic used to relieve pain of various types. Due to the fact that the medication is available without a prescription, it is often used uncontrolled, without taking into account the contraindications and side effects that No-shpa has, like any other medication.

The active substance of this drug is drotaverine, which has an antispasmodic effect on smooth muscles and is therefore able to cope even with severe pain of a spastic nature.

How to use No-shpa correctly, and in what cases will the drug bring real benefits?

Properties and action of No-shpa

The drug No-shpa is a myotropic antispasmodic. It contains the active substance drotaverine, which has an effect on the smooth muscles of the genitourinary, gastrointestinal, cardiovascular, and biliary systems.

Drotaverine relaxes muscles, as a result of which spasms weaken, which allows the drug to be used to relieve pain in gastrointestinal diseases and diseases that are accompanied by motor hyperfunction. The active ingredients of No-shpa accelerate blood circulation in tissues, which leads to vasodilation, i.e. relieves headaches and relieves fevers.

Better absorption of the medicine is facilitated by the excipients included in No-shpa: talc, starch, stearate, polyvidone, lactose monohydrate.

Forms of release of the drug: ampoules for intramuscular injections and more popular tablets.

Analogues of the drug:

• Drotaverine;
• Spasmonet;
• Papaverine;
• Spasmol;
• Nokhshaverin.

In their composition and action, No-shpa tablets resemble Papaverine, but have a more pronounced effect. No-spa relieves pain of various origins, prevents the penetration of ions into organs, reduces the tone of smooth muscles, but does not have a negative effect on the state of the nervous system.

The most popular analogue of No-shpa is Drotaverine tablets, which have the same principle of action and composition, have the same effect, and are also much cheaper. Does it make sense to purchase No-shpa if there is an inexpensive drug with a similar effect?

No-spa is a patented, original drug, and the presence of a patent imposes special obligations on the manufacturer - production control and compliance of raw materials with quality and safety must be ensured. Before hitting the shelves, the drug undergoes a series of clinical trials, where it is subject to strict requirements.

Drotaverine is a generic drug, i.e. is a non-patented drug that has much lower requirements. This does not mean that Drotaverine may be ineffective and have a negative impact on health, but it explains the great popularity of No-shpa and justifies its high cost.

How long does No-shpa last? No-spa copes best with spasms, i.e. with involuntary muscle contraction causing pain. If you use conventional analgesics (for example), to relieve such pain, the effect will be short-lived, while No-Shpa acts directly on the cause of the pain, as a result of which unpleasant symptoms do not return for a long time.

What does No-shpa help with?

The drug can be used both as a primary and as an auxiliary therapeutic agent for a number of pathological conditions:

• Spastic;
• Pielite;
• Tenesmach;
• Proctitis;
• Colic;
• Algodismenorrhea;
• Spasm of the arteries;
• Endarteritis;
• Dyskinesia of biliary organs;
• Spasm of cerebral vessels.

In addition, No-shpa is used for certain conditions to alleviate and relieve unpleasant symptoms.

For headaches

The instructions do not indicate that No-shpa eliminates headaches. But, if headaches are associated with fatigue or insomnia, then the drug actively copes with the elimination of constrictive headache spasms.

Note! No-spa is not recommended for use simultaneously with other antispasmodics, but it can be used together with medications from the analgesic group (paracetamol, analgin, etc.).

If you have constant headaches, it is not recommended to use No-shpa regularly; it is better to consult a doctor to find out the cause of the painful condition.

At a temperature

At elevated temperatures, if it is accompanied by muscle spasms (convulsions), it is recommended that children and adults be given an antispasmodic, No-shpa, along with antipyretics.

No-spa is not effective as an independent remedy for reducing fever.

During pregnancy

When carrying a child, pregnant women often experience high blood pressure, which is threatening. To relieve spasms of the uterine muscles, No-shpa is often prescribed.

Before childbirth, No-shpa is often prescribed in combination with the drugs Buscopan or Papeverine in order to prepare the birth canal for the normal passage of the fetus. Gynecologists claim that this is quite effective in helping to facilitate future childbirth, both for the mother and the child.

When coughing

No-spa does not have an expectorant or antitussive effect, so it is useless for coughing.

But if the inflammation that causes it is localized in the lungs and bronchi, then coughing attacks can provoke spasms in the respiratory tract and suffocation. In such conditions, No-shpa helps to significantly alleviate the condition, but does not cure the cough.

During menstruation

Pain during menstruation can be so intense that it resembles labor pains. The cause of such pain is contractions of the uterus - the antispasmodic No-Spa has a relaxing effect on the muscles of the uterus and neutralizes pain.

During painful periods, you can take up to six tablets of the drug per day.

For cystitis

No-spa can be prescribed as an auxiliary treatment for pain relief. The medicine quickly relieves heaviness in the lower abdomen and relieves pain that occurs in the lumbar region.

After taking No-shpa, the bladder muscles relax, as a result of which the organ begins to function more efficiently.

Under pressure

If the increase is associated with vasospasm, then No-spa can reduce blood pressure, because the drug improves blood circulation and has a beneficial effect on blood vessels.

When reducing blood pressure with the help of No-shpa, the dosage of the drug must be observed, because uncontrolled use can reduce blood pressure to critical levels.

For pain in the intestines

If intestinal spasms are not associated with pathologies, but are caused by poisoning, motility disorders, or long-term use of medications, then No-shpa will help cope with pain of any intensity.

However, if you have prolonged pain in the intestinal area, you should not try to relieve the pain with an antispasmodic, but rather consult a doctor immediately.

For colic

Sharp cramping pain may occur in the abdominal or retroperitoneal space. Colic can be hepatic, renal, pancreatic, or intestinal, depending on its location. Their appearance can be caused by uncontrolled alcohol intake, abuse of fatty foods and other reasons.

No-spa in this case quickly neutralizes the pain, but does not eliminate its cause. Therefore, in such conditions, after pain relief, it is better to seek medical advice.

How to drink No-shpa correctly

You can drink antispasmodic tablets 1-2 pieces at a time, two or three times a day. In the form of injections (in ampoules), the medication is injected into a vein in a dosage of 40 mg to 80 mg.

Children aged 6 to 12 years should consume no more than 80 mg per day, and this amount is divided into 2-4 doses. No-spa after 12 years of age can be used by children in a dosage of up to 160 mg of the drug, also spread over several doses.

Adults should not exceed the daily dosage of the medication - 240 mg, and a single dose should not exceed 80 mg.

In some cases, the use of No-shpa is possible without medical consultation, but before doing so, you should definitely study all the contraindications to the drug and recommendations for its use. Self-administration of medications as a pain reliever should not exceed two days; after this period, you should consult a doctor to identify the causes of pain.

Who is contraindicated for No-shpa:

• When severe;
• For galactose intolerance;
• In case of severe pathologies of the liver or kidneys;
• In case of intestinal absorption disorders;
• In case of intolerance to the components of the drug.

Taking antispasmodics is not allowed for children under six years of age.

The usual average dose for adults is 40-240 mg drotaverine hydrochloride daily (divided into 1-3 doses per day) intramuscularly. For acute colic (biliary) 40-80 mg intravenously

Reviews from patients indicate that the drug is usually quite well tolerated, but in some cases the following may be observed:

• Increased sweating;
• Allergy;
• Dizziness;
• Decreased blood pressure;
• Heartbeat;
• Temperature increase.

In case of arterial hypotension, No-shpa should be used with caution, because the drug can cause breathing problems and collapse.

During the period of bearing a child, only the attending physician should decide on the advisability of using No-shpa. During breastfeeding, the use of antispasmodics is not recommended.

The overwhelming majority of reviews about the use of No-shpa are positive: women write that the drug perfectly helps cope with menstrual pain, patients indicate that it perfectly relieves stomach and intestinal spasms, and helps with headaches.

On video: NO-SHPA. What you didn't know yet. A drug that lowers blood pressure.

What scientific research says about the popular anti-spasm drug, No-shpe, what it has in common with Viagra, where autocracy reigns in our body and where is parliamentary democracy, how the medicine helps during childbirth and what does the lost chess talent have to do with it, read in the section “What are they treating us with?”

No-shpa is one of the most popular antispasmodics in Russia. However, it is practically not sold abroad anywhere except in the countries of Eastern Europe and Asia, and many English speakers write about its active ingredient only as an intravenous medicine to reduce pain during prolonged labor pains.

In Russia, No-shpa is included in the “List of Vital and Essential Medicines”. This list was created to regulate prices in pharmacies, so when choosing a medicine, you should not rely solely on it. As we already found out in the case of , this also includes medications that cannot be unambiguously recommended as having definitively proven their effectiveness, and in some years - simply quack remedies.

But in the list of the World Health Organization and on the website of the American Food and Drug Administration, the drug is more likely to be found in quotations from the guidelines of individual countries, for example Ethiopia or Afghanistan, which are unlikely to have the most exemplary level of medicine in the world.

Can No-shpa be used and for what purpose? What are the contraindications? What kind of pain is best left to non-steroidal anti-inflammatory drugs or analgin? Let's try to figure it out.

From what, from what?

The main active ingredient of No-shpa is drotaverine (in the form of hydrochloride), contained in tablets in an amount of 40 mg. This substance is a modification of papaverine - an antispasmodic and analgesic, which is produced from the opium poppy. Despite this, papaverine is very different in structure and properties from substances obtained from morphine. Papaverine was invented by Georg Merck, a student of the famous chemists Justus Liebig and Albert Hoffmann and the son of the same Emmanuel Merck who founded the famous German pharmaceutical corporation.

Structure of papaverine

Public domain

Both substances are similar in their formula: in the center there are the same three aromatic “rings”. Drotaverine was registered in Hungary at the dawn of the sixties of the last century by researchers from the Hinoin company. The medicine was called No-shpa (short for the Latin no spa - “no spasm”).

Structure of drotaverine

Public domain

According to the instructions, 65% of the dose taken enters the blood. A blood test can easily show whether drotaverine is in the blood. It reaches its maximum concentration after about 45-60 minutes, and is completely eliminated from the body after three days. This allows you to find out whether a person has taken the medicine and study how it is transported throughout the body and where it is broken down. Some manufacturers write (for example, in the “Pharmacokinetics” section) that their substances are not determined in the blood by available methods, which makes us wonder whether there is any active substance there at all, or whether we are faced with yet another homeopathy.

But what should he influence there? According to drug website DrugBank, drotaverine blocks the activity of phosphodiesterase type 4 (PDE 4). This same information is listed in the instructions and in the introduction to several scientific articles as known, but there are no articles that clearly describe the mechanism by which the drug binds to this enzyme.

The group of enzymes itself got its name in honor of phosphodiester bonds. The job of the FDE is to destroy these connections. Depending on the type, each of which has its own number, PDEs specialize in different molecules. Too active PDE activity can be associated with various diseases. Phosphodiesterase 3, for example, affects the contraction of the heart muscle. Its deficiency blocks the His bundle, which carries signals to the heart, which can cause it to stop. PDE 5 is affected by drugs to increase potency (for example, Sildenafil, which is sold under the brand name Viagra). The drug to block PDE 4 must be very specific so as not to cause serious side effects.

PDE 4 itself is involved in many reactions, including inflammatory processes (which is why drugs that suppress it are prescribed for pulmonary obstruction), Parkinson's disease and even schizophrenia. The target in which PDE 4 cleaves phosphodiester bonds is called cAMP - a derivative of ATP (the main molecule for storing energy in cells). Working at the beck and call of other hormones and molecules (in this case, the substance is called a second messenger), cAMP can activate calcium channels that allow positively charged calcium ions into the cell. Normally, there are more calcium ions outside the cell than inside. When Ca 2+ rushes into the cell, sodium channels in it are also activated. As a result, the charge of the cell changes, and since muscle contractions depend on this charge, the suppression of PDE 4 ultimately affects them. There are also several scientific works in favor of the hypothesis that drotaverine can act on calcium channels directly.

All human muscles are divided into three types. Cross-striped, also known as skeletal, are often attached to bones and are responsible for our movements. In the world of striated muscles there is complete authoritarianism: we can subordinate them to our direct will: raise a leg, wave a hand.

Striated muscles

In our hearts, on the contrary, parliamentary democracy reigns. The heart muscle consists of a special type of cells that are connected in a kind of network. Their electrical signals constantly excite neighboring cells to keep them contracting. The contractions themselves occur automatically and are initiated not only “from above”, but also by the heart’s own nerve fibers, therefore power in it is given to the “people” and elected representatives.

Smooth muscles are close in degree of freedom to the myocardium: they contract against our will, although they are controlled by many electrical and chemical signals, hormones, and the autonomic nervous system. But they do not have such developed “local self-government” as the heart does: the cells of these muscles are not connected by “bridges”. It is the layer of smooth muscles in the walls of blood vessels and hollow internal organs that causes them to contract, regulating blood flow, the expansion and contraction of the bronchi, the movement of food through the intestines and many other processes.

It is spasm (involuntary contraction) of smooth muscles, or more precisely, spasm of smooth muscles of the urinary tract and biliary tract that is considered the main indication for taking No-shpa according to the instructions. The drug is also recommended as an adjuvant for tension headaches caused by the head being in one position for a long time, and its muscles (here they are no longer smooth, but striated) become numb, dysmenorrhea (menstrual pain), and spasms of the gastrointestinal tract.

Not on the lists

We've sorted out the theory, but what about clinical trials? Over more than half a century, a lot of them have been carried out. But most of them belong to the middle of the last century, when the requirements for testing new drugs before entering the market were completely different. Therefore, only a small number of articles about No-shpe and drotaverine meet the criteria that apply to modern drugs, that is, they relate to randomized, double-blind, placebo-controlled studies.

A double-blind, randomized, placebo-controlled method is a method of clinical drug research in which the subjects are not privy to important details of the study. “Double blind” means that neither the subjects nor the experimenters know who is being treated with what, “randomized” means that the assignment to groups is random, and placebo is used to show that the effect of the drug is not based on self-hypnosis and that This medicine helps better than a tablet without active ingredients. This method prevents subjective distortion of the results. Sometimes the control group is given another drug with proven effectiveness, rather than a placebo, to show that the drug not only treats better than nothing, but is superior to its analogues.

Let's consider those tests that meet these criteria. These include two studies assessing the effectiveness of drotaverine in renal colic: the first - in comparison with placebo, the second - with diclofenac. Both studies showed an approximately 50% superiority of therapy with drotaverine when tapering, but in rather modest samples: in both cases, participants included about a hundred patients.

Indian scientists investigated whether drotaverine helps with recurring lower abdominal pain in children. Scientists analyzed the condition of 132 children aged 4 to 12 years, half of whom received syrup with dissolved drotaverine, and the other - just syrup. The children who received the medicine complained of pain less often and began to miss school less, although the number of days when they were pain-free was comparable in both groups. At the same time, the children in the drotaverine group were more active, their mood improved, and they began to eat better. Doctors concluded that the medicine is safe and effective.

Drotaverine was compared with placebo and in irritable bowel syndrome. The authors noted that thanks to it, pain attacks became less frequent and weaker, as observed by both patients and doctors (and, unlike a study with a similar design, the reviews of doctors and patients coincided).

A study of the effectiveness of combining drotaverine with aceclofenac compared with aceclofenac alone for menstrual pain showed that the combination helps patients cope with pain faster and better. But how is an honest double-blind study possible when patients in the first group receive one tablet, and the second - two? Scientists have found a way to deal with this by blinding both groups.

To do this, those who received only aceclofenac were given a second placebo tablet, which in appearance was indistinguishable from the tablet with drotaverine. Although the group size was small (100 people each), and the study was sponsored by the Indian manufacturers of the drotaverine-based drug, there are no particular complaints about the study design itself.

No-shpa: from birth to death

Despite the large number of different studies, there was only one review of them by the Cochrane Collaboration, and it was devoted to the effect of antispasmodics on labor pains.

The Cochrane Library is a database of the international non-profit organization Cochrane Collaboration, which participates in the development of guidelines of the World Health Organization. The organization's name comes from its founder, the 20th-century Scottish medical scientist Archibald Cochrane, who championed the need for evidence-based medicine and good clinical trials and wrote the book Efficiency and Effectiveness: Random Reflections on Health Care. Medical scientists and pharmacists consider the Cochrane Database to be one of the most authoritative sources of such information: the publications included in it have been selected according to the standards of evidence-based medicine and report the results of randomized, double-blind, placebo-controlled clinical trials.

cases of which are described in the scientific literature. According to relatives and according to test results that were distributed in the media, it was because of an overdose of No-shpa that a very young chess player, Ivan Bukavshin, a member of the Russian youth team, who had repeatedly won prizes at world championships, died. The parents even stated that ill-wishers added No-shpa to their son’s food and drinks: a dose four times higher than the lethal dose, according to them, the athlete could not drink himself. We don’t know whether it was accidental poisoning, murder or suicide, but we know for sure that an overdose of antispasmodics does not promise anything pleasant.

The main studies available today were on small samples, but overall they show the effectiveness of the drug. But do not forget that No-Spa is intended for pain associated with spasms of smooth muscles (for example, muscles of the bladder, bile ducts, intestines). It can help with cholecystitis, renal colic and menstrual pain, but, say, with a fracture, it is very unlikely. Therefore, if you have acute pain after surgery or any other pain that is not associated with spasms, you should turn to a different type of pain reliever, such as non-steroidal anti-inflammatory drugs.

Despite the selectivity of the drug’s action, its overdose has more than once led to cardiac arrest and other serious consequences, so you should not take risks by taking large doses of No-shpa (especially if you already have heart problems). If the prescribed dose does not help within two days, you should not increase it, but consult a doctor to determine the cause of the pain and treat it, rather than suppress the symptoms. Even with renal colic, in which No-shpa can play the role of an anesthetic, the patient still needs to be hospitalized, since this syndrome is a sign of a serious dysfunction of the organ, possibly the appearance of stones in the kidneys that require removal.

Hypersensitivity to any of the components of the drug, including auxiliary ones: glucose, galactose, corn starch and others, as well as acute renal and liver failure (drotaverine is broken down in these organs) should also force you to abandon the drug. The effect of No-shpa on young children (up to six years old), pregnant and lactating women has not been fully studied, so in these cases you need to consult a doctor who will decide whether this is a necessary measure, or whether it is not worth exposing yourself or your child to danger.

No-spa also reduces the effect of levdopa (this drug is prescribed for Parkinson's disease), which should be taken into account by those who use this drug.

No-SPA (NO-SPA) is a popular drug that has a rapid antispasmodic effect on smooth muscles. It is applied for:

• etiotropic therapy to eliminate spasm of muscle tissue, which is the basis of the pathological condition;
• symptomatic treatment of smooth muscle spasm, which is a symptom of the disease without affecting its pathogenesis;
• premedication during patient preparation to some procedures (catheterization of the ureters, urethra, etc.).

Since the drug acts exclusively on smooth muscles, it is practiced in situations where there are contraindications to antispasmodics from the group of anticholinergics (prostatic hypertrophy,).

Pharmacological group: myotropic antispasmodic.

Drotaverine or No-shpa

Surely each of us has had to take the famous yellow pills with a special aftertaste for certain health problems. The drug contains the active ingredient drotaverine, and it is under this name that the most popular competitor of No-shpa and an analogue in composition is produced. What is the difference between Drotaverine and No-shpa?

Having studied the instructions for the drugs, it becomes clear that the composition, the principle of action, and the effect produced are similar. Therefore, a reasonable question arises: does it make sense to overpay for No-shpu?
No-spa is an original drug, a patented dosage form. The presence of a patent is not only a justification for the high cost of the drug, but also certain obligations that are imposed on the manufacturer: the quality of raw materials, production control, and the safety of the drug must be at the highest level. In order to obtain a patent, a drug must meet a number of strict requirements and undergo the necessary clinical trials.

Drotaverine is a generic drug offered to the consumer under an international, and therefore non-proprietary, name. The clinical effectiveness of generics is not fully proven, since less stringent requirements are put forward for this group of drugs.

It turns out that a patented drug undergoes more testing before it hits the pharmacy counter. However, this does not mean that the generic drug has a negative impact on health.

Physico-chemical properties, composition, price

The drug is available in two dosage forms - tablets for internal use and solution for intramuscular and intravenous administration.

	Main substance	Excipients	Physicochemical characteristics
No-spa tablets 6, 20, 24 tablets in aluminum blisters. 60, 100 tablets in polypropylene bottles, in cardboard packs. No. 6: 50-70 rub; No. 24: 180-220 rub.	Drotaverine hydrochloride: 40 mg	Magnesium stearate 3 mg, corn starch 35 mg, talc 4 mg, povidone 6 mg, lactose monohydrate 52 mg.	Yellowish-greenish tablets, round, biconvex, engraved with “spa” on one side.
Solution 2 ml in glass ampoules made of dark glass with a break notch. 5 ampoules per package, in cardboard packs. No. 25: 450-480 rub.	Drotaverine hydrochloride: 20 mg in 1 ml or 40 mg in 1 ampoule	Sodium disulfite 2 mg, 96% ethanol - 132 mg, liquid water - up to a volume of 2 ml.	Transparent greenish-yellow solution.

pharmachologic effect

Drotaverine hydrochloride is an isoquinoline derivative with a powerful antispasmodic effect on smooth muscles. This effect is possible due to the inhibition of an enzyme called PDE (phosphodiesterase).

PDE is involved in the hydrolysis reaction of cAMP to AMP. Inhibition of phosphodiesterase is characterized by an increase in the concentration of cAMP, which triggers a chain reaction. High concentrations of cAMP are an activator of cAMP-dependent phosphorylation of MLCK (myosin light chain kinase). This leads to a decrease in the affinity of MLCK for the Ca2+-calmodulin complex, and the inactivated form of MLCK produces muscle relaxation.

cAMP affects the cytosolic concentration of Ca2+ ion, lowering it. This is due to the stimulation of Ca2+ transport into the sarcoplasmic reticulum and extracellular space.

The effectiveness of drotaverine hydrochloride depends on the concentration of the phosphodiesterase enzyme in tissues, which varies significantly.

Hydrolysis of cAMP in cardiac muscle tissue and vascular smooth muscle is carried out using the PDE3 isoenzyme. This explains the absence of serious adverse reactions from the cardiovascular system with high antispasmodic activity.

Selective PDE4 inhibitors, which is drotaverine, can reduce the sensitivity of the uterus to the action of the hormone oxytocin and lead to accelerated relaxation of the muscle tissue of the organ, which helps stop premature birth.

In addition to the antispasmodic effect, drotaverine reduces swelling and inflammation in muscle tissue. Elimination of spasm leads to improved blood supply to organs. The drug is effective for pain, and also helps restore the passage of the internal contents of hollow organs.

At the same time, drotaverine does not directly interfere with the mechanism of pain sensitivity and does not erase the symptoms of acute conditions, unlike analgesics.

The effectiveness of drotaverine is high for spasms of smooth muscle tissue of neurogenic and muscular origin. No-spa relaxes the smooth muscle fibers of the gastrointestinal tract, genitourinary and biliary tract.

Pharmacokinetics

After oral administration, the active substance is completely and quickly absorbed, evenly distributed throughout the tissues and penetrates into smooth muscle cells. About 65% of the active substance enters the blood. The maximum concentration in the blood is determined 45-60 minutes after administration. Passes slightly through the placental barrier. Does not enter the central nervous system and does not affect the autonomic nervous system.

When administered intravenously or intramuscularly, drotaverine binds to plasma proteins by 95-98%, achieving maximum effect after 30 minutes.

Metabolism of the substance occurs in liver cells through O-deethylation reactions. Drotaverine metabolites are conjugated with glucuronic acid.

It is excreted by the kidneys (more than 50%) and intestines (30%) in the form of metabolites, complete elimination occurs within 72 hours.

Indications for use

The instructions for use of No-shpa indicate the following indications for etiotropic therapy:

• Spasms of smooth muscle tissue in diseases of the biliary tract: cholangiolithiasis, cholecystolithiasis, pericholecystitis, cholecystitis, cholangitis, papillitis;
• Spasms of smooth muscle tissue in pathologies of the urinary system: nephrolithiasis, pyelitis, urethrolithiasis, cystitis, spasms and tenesmus of the bladder;

What else does No-shpa help with? As an auxiliary therapy drug (tablets or solution if it is impossible to take tablets):

• for spasms of smooth muscle tissue of the gastrointestinal tract: gastritis, peptic ulcer and duodenum, spasms of the pylorus and gastric cardia, colitis, spastic colitis with constipation, enteritis, dysfunction of the sphincter of Oddi, irritable bowel syndrome;
• for tension headaches (tablet form). No-spa is not effective for headaches associated with migraine or increased ICP;
• with dysmenorrhea.

Contraindications

• severe renal or heart failure;
• children up to 6 years of age (tablets). Nosh-pa in the form of a solution is not prescribed to children under 18 years of age;
• lactation period (due to the lack of clinical data on the penetration of the drug into mother’s milk);
• hereditary intolerance to the monosaccharide galactose, glucose-galactose malabsorption syndrome, lactase deficiency (for tablets);
• hypersensitivity to sodium disulfite (for solution).

special instructions

The drug is prescribed with caution for arterial hypotension, since there is a risk of collapse, during pregnancy and pediatrics. When administered intravenously, people with low blood pressure should be in a supine position.

There may be complaints of gastrointestinal dysfunction when using the drug in people with lactose intolerance (52 mg of lactose per 1 tablet).

The tablet form does not affect the ability to perform work that requires significant concentration and drive a car. After parenteral administration of No-shpa, you should refrain from precision work and driving.

No-spa during pregnancy

Very often, the drug is prescribed in the early stages of pregnancy when the uterus is toned to reduce the threat of spontaneous miscarriage.

Animal studies and retrospective analysis data on the clinical use of drotaverine in pregnant women indicate that the drug in therapeutic dosages had neither embryotoxic nor teratogenic effects on the fetus. But, since the drug penetrates the placenta to some extent, the prescription is justified if there is a real risk of miscarriage.

The drug should not be used during labor, as there is a risk of developing atonic bleeding in the postpartum period.

Dosage of No-shpa

The duration of treatment is individual. You can take the drug on your own for 1-3 days.

For tablets

• Adult patients: 120-240 mg per day, dividing the dose into 2-3 doses. The maximum dose for a single dose is 80 mg.
• Children 6-12 years old: 80 mg per day, divided into 2 doses.
• Children over 12 years old: 160 mg per day, divided into 2-4 doses.

For maximum effectiveness, the drug is taken 1 hour after a meal with a sufficient amount of water.

For solution

Adult patients: 40-240 mg per day, divided into 1-3 administrations. For acute spasmodic pain, the drug is administered intravenously slowly, with a dose of 40-80 mg over 30 seconds. IM injections are administered without diluting the solution with other drugs.

The patient himself can usually assess the effectiveness of the drug by observing a significant reduction or disappearance of the spasmodic pain syndrome within several hours after taking the tablet or injection.

Side effects

• CVS: tachycardia or decreased blood pressure is rarely observed;
• Nervous system: insomnia, headache and dizziness are rarely observed;
• Gastrointestinal tract: sometimes there is nausea and constipation;
• The immune system: Allergic reactions (rash, itching) occasionally develop. There have been cases of anaphylactic shock with and without fatal outcome (frequency unknown). Persons with bronchial asthma or allergies may develop bronchospasm when using a solution of the drug.
• Local reactions: swelling at the injection site.

Overdose

When the therapeutic dose is significantly exceeded, disturbances in cardiac conduction and rhythm develop up to complete blockade of the bundle branches and cardiac arrest. Treatment is only inpatient.

Drug interactions

• Levodopa – weakening of the antiparkinsonian effect, increased rigidity and tremor;
• Other antispasmodics– increased antispasmodic effect;
• Tricyclic antidepressants– increased arterial hypotension (only when combined with No-shpa solution);
• Morphine – decrease in spasmogenic activity (only when combined with No-shpa solution);
• Phenobarbital – enhances the antispasmodic effect of No-shpa;
• Drugs that bind to plasma proteins– pharmacodynamic and toxic effects of these drugs may occur.

Analogs

No-shpa forte, Drotaverin, Drotaverin-Forte, Spasmonet, Drotaverin-sti, Spasmol.

Drotaverine hydrochloride 40 mg. 20 tab. 12-20 rub.	Spasmonet 40 mg. 20 tab. 55-80 rub.	Drotaverine forte 80 mg. 20 tab. 50 rub.	Spasmol 40 mg. 20 tab. 32 rub.