Drotaverine

Myotropic antispasmodics

ATC code: A03AD02 (Drotaverine)

Mechanism of action

Inhibits phosphodiesterase 4 (PDE-4) in smooth muscle. Reduces intracellular calcium concentration and causes relaxation of smooth muscles in the GI tract, biliary system, urinary tract, and uterus. Does not affect skeletal muscles and has no anticholinergic activity.

Indications

Abdominal smooth muscle spasm

Adjunct

Symptomatic relief of abdominal smooth muscle spasm – intestinal colic, biliary colic, renal colic. Does not address the underlying cause. Drotaverine is not mentioned in international guidelines by WHO, NICE, or ACG. The evidence base is limited to older, low-quality studies. Widely used in Russia and CIS countries.

Dysmenorrhea

Adjunct

Adjunctive agent for dysmenorrhea. First-line is NSAIDs (ibuprofen, naproxen), which suppress prostaglandin synthesis. Drotaverine relieves uterine spasm but does not affect inflammation. Several small RCTs showed pain relief, but study quality was low.

Practical notes

Timing and administration

Take 40–80 mg 2–3 times daily. Maximum daily dose 240 mg. May be taken regardless of food. Onset of action is 15–20 minutes orally. Intramuscular injection works within 5–10 minutes.

Special situations

Not included in international guidelines (WHO, NICE). Popular in Russia and CIS but virtually unused elsewhere. Few high-quality independent studies exist. In severe abdominal pain, it is important not to mask 'acute abdomen' symptoms – rule out surgical pathology before prescribing an antispasmodic.

Safety

Contraindications

Severe hepatic or renal insufficiency
Severe heart failure (low cardiac output syndrome)
Hypersensitivity to drotaverine
Breastfeeding (insufficient data)

Serious adverse effects

Allergic reactions – urticaria, angioedema (rare)
Severe hypotension (with intravenous administration)

Common adverse effects

Headache
Dizziness
Nausea
Hypotension

Pregnancy

Safety data in pregnancy are limited. In Russian practice, it is used for threatened abortion to reduce uterine tone. This use is not described in international guidelines.