How to drink No-shpa: dosage for adults and children. Noshpa intramuscular instructions for use Noshpa solution for injection

Active substance

Drotaverine hydrochloride (drotaverine)

Release form, composition and packaging

Solution for intravenous and intramuscular administration in the form of a transparent liquid of greenish-yellow color.

Excipients: sodium disulfite (sodium metabisulfite) - 2 mg, ethanol 96% - 132 mg, water for injection - up to 2 ml.

2 ml - dark glass ampoules (hydrolytic class, type I) with an applied breaking point (5) - cellular contour plastic packaging without coating (pallets) (1) - cardboard packs.
2 ml - dark glass ampoules (hydrolytic class, type I) with an applied breaking point (5) - cellular contour plastic packaging without coating (pallets) (5) - cardboard packs.

pharmachologic effect

Drotaverine is an isoquinoline derivative that exhibits a powerful antispasmodic effect on smooth muscle due to inhibition of the phosphodiesterase (PDE) enzyme. The enzyme PDE is necessary for the hydrolysis of c-AMP to AMP. Inhibition of PDE leads to an increase in the concentration of c-AMP, which triggers the following cascade reaction: high concentrations c-AMP activates c-AMP-dependent phosphorylation of myosin light chain kinase (MLCK). Phosphorylation of MLCK results in a decrease in its affinity for the calcium (Ca2+)-calmodulin complex, resulting in an inactivated form of MLCK that maintains muscle relaxation. c-AMP, in addition, affects the cytosolic concentration of Ca 2+ by stimulating the transport of Ca 2+ into the extracellular space and the sarcoplasmic reticulum. This Ca 2+ -lowering effect of drotaverine through c-AMP explains the antagonistic effect of drotaverine towards Ca 2+ .

In vitro, drotaverine inhibits the PDE4 isoenzyme, without inhibiting the PDE3 and PDE5 isoenzymes. Therefore, the effectiveness of drotaverine depends on the concentrations of PDE4 in tissues, the content of which varies in different tissues. PDE4 is most important for the suppression of smooth muscle contractility, and therefore selective inhibition of PDE4 may be useful for the treatment of hyperkinetic dyskinesias and various diseases accompanied by a spastic state of the gastrointestinal tract.

The hydrolysis of c-AMP in the myocardium and vascular smooth muscles occurs mainly with the help of the PDE3 isoenzyme, which explains the fact that with high antispasmodic activity, drotaverine has no serious side effects from the heart and blood vessels and pronounced effects on the cardiovascular system.

Drotaverine is effective against smooth muscle spasms of both neurogenic and muscular origin. Regardless of the type of autonomic innervation, drotaverine has a relaxing effect on the smooth muscles of the gastrointestinal tract, biliary tract, and genitourinary system.

Pharmacokinetics

Distribution

In vitro, drotaverine has a high protein binding (95-97%), especially albumin, γ- and β-globumin, as well as α-HDL.

Drotaverine and/or its metabolites may slightly penetrate the placental barrier.

Metabolism

In humans, drotaverine is almost completely metabolized by O-desethylation. Its metabolites quickly conjugate with glucuronic acid. The main metabolite is 4"-desethyldrotaverine, in addition to which 6-desethyldrotaverine and 4"-desethyldrotaveraldine have been identified.

Removal

In humans, a two-chamber mathematical model was used to assess the pharmacokinetics of drotaverine. The final T1/2 of plasma radioactivity was 16 hours.

T1/2 is 8-10 hours. In 72 hours, it is almost completely eliminated from the body, more than 50% through the kidneys (mainly in the form of metabolites) and about 30% through the intestines. Unchanged drotaverine is not detected in urine.

Indications

- spasms of smooth muscles associated with diseases of the biliary tract (cholecystolithiasis, cholangiolithiasis, cholecystitis, pericholecystitis, cholangitis, papillitis);

- spasms of smooth muscles of the urinary tract (nephrolithiasis, urethrolithiasis, pyelitis, cystitis, bladder tenesmus).

As an adjuvant therapy (when the tablet form cannot be used):

- for spasms of smooth muscles of gastrointestinal origin ( peptic ulcer stomach and duodenum, gastritis, spasms of the cardia and pylorus, enteritis, colitis);

- for gynecological diseases (dysmenorrhea).

Contraindications

- severe liver failure;

- severe renal failure;

- heavy chronic failure;

— childhood(use of drotaverine in children in clinical studies not studied);

- lactation period ( breastfeeding);

- hypersensitivity to sodium disulfite;

- increased sensitivity to active substance or to any of the excipients of the drug.

Carefully The drug should be prescribed for arterial hypotension (risk of collapse) and during pregnancy.

Dosage

Average daily dose at adults is 40-240 mg of drotaverine hydrochloride (divided into 1-3 doses/day), IM.

At acute colic (renal or cholelithiasis)- 40-80 mg IV slowly (duration of administration approximately 30 seconds).

Side effects

Below are the adverse reactions observed in clinical studies, divided by organ system, indicating the frequency of their occurrence in accordance with the following gradations: very often (≥10%), often (≥1% and<10%); нечасто (≥0.1% и <1%); редко (≥0.01% и <0.1%), очень редко, включая отдельные сообщения (<0.01%), неизвестная частота (по имеющимся данным частоту определить нельзя).

From the cardiovascular system: rarely - increased heart rate, decreased blood pressure.

From the nervous system: rarely - headache, dizziness, insomnia.

From the digestive system: rarely - nausea, constipation.

From the immune system: rarely - allergic reactions (angioedema, urticaria, rash, itching); unknown frequency - with the use of the drug, the development of anaphylactic shock with and without fatal outcome has been reported.

Local reactions: rarely - reactions at the injection site.

Overdose

Symptoms: overdose of drotaverine has been associated with cardiac rhythm and conduction disturbances, including complete bundle branch block and cardiac arrest, which can be fatal.

Treatment: in case of overdose, patients should be under close medical supervision; carry out symptomatic therapy and treatment aimed at maintaining the basic functions of the body.

Drug interactions

Phosphodiesterase inhibitors, like , weaken the antiparkinsonian effect of levodopa. When prescribing drotaverine simultaneously with levodopa, increased rigidity and tremor may occur.

Drotaverine enhances the antispasmodic effect of papaverine and other antispasmodics, including m-anticholinergics.

Increases hypotension caused by tricyclic antidepressants, quinidine and procainamide.

Reduces the spasmogenic activity of morphine.

Phenobarbital enhances the antispasmodic effect of drotaverine.

special instructions

This medicine contains disulfite, which may cause allergic-type reactions, including anaphylactic symptoms and bronchospasm in sensitive individuals, especially those with a history of asthma or allergic diseases. In case of hypersensitivity to disulfite, parenteral use of the drug should be avoided.

When administering drotaverine intravenously, patients with low blood pressure should be in a horizontal position due to the risk of collapse.

Impact on the ability to drive vehicles and operate machinery

During the treatment period, it is necessary to refrain from driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Pregnancy and lactation

As shown by studies on reproductive toxicity in animals and retrospective studies of clinical data, the use of drotaverine during pregnancy had neither teratogenic nor embryotoxic effects. Despite this, when prescribing drotaverine to pregnant women, caution should be exercised and it should be used only in cases where the expected benefit to the mother outweighs the potential risk to the fetus, and the injection dosage form of No-shpa should be avoided

The use of the drug is contraindicated in severe liver failure.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

The drug should be stored out of the reach of children, protected from light at a temperature of 15-25°C. Shelf life - 5 years. Do not use after the expiration date stated on the package.

No-spa is an antispasmodic drug.

Release form and composition

No-shpu is produced in the following dosage forms:

• Tablets: biconvex, round, yellow with an orangish or greenish tint, with “spa” engraved on one side (6 or 24 pcs in polyvinyl chloride/aluminum blisters, 1 blister in a cardboard box; 20 pcs in blisters made of aluminum/aluminum (laminated with polymer), 2 blisters in a cardboard box; 60 or 100 pieces in polypropylene bottles, 1 bottle in a cardboard box);
• Solution for intravenous and intramuscular administration: greenish-yellow, transparent (2 ml in dark glass ampoules, 5 ampoules in blister plastic packages, 1 or 5 packages in a cardboard box).

1 tablet contains:

• Auxiliary components: magnesium stearate – 3 mg; talc – 4 mg; povidone – 6 mg; corn starch – 35 mg; lactose monohydrate – 52 mg.

1 ampoule (2 ml) contains:

• Active substance: drotaverine hydrochloride – 40 mg;
• Auxiliary components: sodium disulfite (sodium metabisulfite) – 2 mg; 96% ethanol – 132 mg; water for injection – up to 2 ml.

Indications for use

• Spasms of smooth muscles in diseases of the biliary tract: papillitis, cholangiolithiasis, cholecystolithiasis, cholecystitis, cholangitis, pericholecystitis;
• Spasms of smooth muscles of the urinary tract: urethrolithiasis, nephrolithiasis, pyelitis, bladder spasms, cystitis;
• Spasms of smooth muscles of the gastrointestinal tract: gastritis, peptic ulcer of the stomach and duodenum, colitis, spasms of the cardia and pylorus, enteritis, spastic colitis with irritable bowel syndrome with flatulence and constipation (simultaneously with other drugs);
• Dysmenorrhea (simultaneously with other drugs);
• Tension headaches (tablets, along with other drugs);
• The period of stretching during physiological labor in order to shorten the dilatation phase of the cervix and reduce the total duration of labor (injection solution).

Contraindications

• Severe heart failure (low cardiac output syndrome);
• Severe liver or kidney failure;
• Lactase deficiency, hereditary galactose intolerance, galactose-glucose malabsorption syndrome (tablets, due to the presence of lactose monohydrate in their composition);
• Age up to 6 years (tablets);
• Breastfeeding period (due to the lack of necessary clinical data confirming the safety and effectiveness of No-shpa for this group of patients);
• Hypersensitivity to the components of the drug.

No-shpa should be used with caution against the background of arterial hypotension, in children and during pregnancy.

When administering an injection solution intravenously, due to the risk of collapse, the patient must lie down.

Directions for use and dosage

Pills

• Adults: single dose – 1-2 tablets, frequency of administration – 2-3 times a day (maximum – 240 mg);
• Children from 12 years of age: single dose – 1-2 tablets, frequency of administration – 1-4 times a day (maximum – 160 mg);
• Children 6-12 years old: single dose – 1 tablet, frequency of administration – 1-2 times a day.

The recommended duration of taking No-shpa without consulting a doctor is usually 1-2 days. If the drug is used for auxiliary therapy, the duration of the course without medical advice can be increased to 3 days. If there is no improvement, you should consult a doctor.

If the patient can independently diagnose the symptoms of his illness, since they are well known to him, he can also evaluate the effectiveness of therapy (disappearance of pain). If, within several hours after taking No-shpa at the maximum single dose, the pain decreases moderately or does not decrease at all, or if there is no significant improvement in the condition after taking the maximum daily dose, you should consult a doctor.

Injection solution

No-shpa solution is administered intravenously or intramuscularly.

The average adult daily dose is 40-240 mg of drotaverine hydrochloride (divided into 1-3 doses) intramuscularly.

For acute stone colic (cholelithiasis and/or kidney stones), the solution is administered intravenously at a dose of 40-80 mg.

In order to shorten the dilatation phase of the cervix at the beginning of the stretching period during physiological labor, 40 mg of No-shpa is administered intramuscularly; within 2 hours, if the effect is unsatisfactory, the solution can be re-administered.

Side effects

During the use of No-shpa in any dosage form, the following disorders may develop (>10% - very common; >1% and<10% – часто; >0.1% and<1% – нечасто; >0.01% and<0,1% – редко; <0,01%, включая отдельные сообщения – очень редко; с неизвестной частотой – при невозможности определить частоту развития побочных действий по имеющимся данным):

• Nervous system: rarely - dizziness, headache, insomnia;
• Digestive system: rarely - constipation, nausea;
• Cardiovascular system: rarely - palpitations, decreased blood pressure;
• Immune system: rarely - allergic reactions (in the form of angioedema, itching, urticaria, rash).

special instructions

1 tablet contains 52 mg of lactose monohydrate, which is why patients with lactose intolerance may experience problems with the digestive system. No-shpa in this dosage form should not be taken by patients with lactase deficiency, galactosemia, or galactose/glucose malabsorption syndrome.

The injection solution contains bisulfite, which can lead to the development of allergic-type reactions, including anaphylactic symptoms and bronchospasm, especially in patients with a history of asthma or allergic diseases. In case of hypersensitivity to sodium metabisulfite, parenteral use of No-shpa is not recommended.

If any adverse reactions develop while taking the drug orally, the question of the ability to drive vehicles and operate machinery requires individual consideration. If dizziness occurs after taking No-shpa, it is recommended to avoid performing potentially hazardous types of work. After parenteral, especially intravenous administration, you should refrain from working on machines and driving a vehicle for 1 hour after using the drug. 4.91 Rating: 4.9 - 22 votes

Update: October 2018

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.

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 creates 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, distributed evenly 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 decrease 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.

No-spa has a pronounced antispasmodic effect on the smooth muscles of internal organs.

It is used for spasms of the gastrointestinal tract, biliary tract, angina pectoris, urolithiasis, and peripheral vessels. The active ingredient is drotaverine.

The effect of taking this medicine occurs within a few minutes. After half an hour, the phase of maximum effect from taking this antispasmodic begins.

Can be used orally (tablets) and pre-enterally (solution for injection).

Clinical and pharmacological group

Myotropic antispasmodic.

Conditions for dispensing from pharmacies

Dispensed without a doctor's prescription.

Prices

How much does No-shpa cost in pharmacies? The average price is 75 rubles.

Release form and composition

No-shpa tablets are small in size, round in color and yellow in color.

1. Tablet composition: 40 mg drotaverine (in the form of hydrochloride), magnesium stearate, povidone, talc, corn starch, lactose (in the form of monohydrate).
2. Forte tablets have an identical composition. The only difference is the higher concentration of the active substance (80 mg/tablet).
3. Composition of No-Shpa in ampoules: drotaverine hydrochloride at a concentration of 20 mg/ml, 96% ethanol, sodium metabisulfite, water for injection.

No-shpa tablets are packaged in blister packs of 6 and 24 pieces, as well as in glass bottles of 60 and 100 pieces. A cardboard pack contains one blister or bottle with the appropriate number of tablets, as well as instructions for use of the drug.

Pharmacological effect

The main active component of No-shpa is drotaverine hydrochloride, an antispasmodic that has a positive effect on the smooth muscles of the genitourinary and biliary tract, as well as the gastrointestinal tract. The substance helps effectively relieve swelling, normalizes blood circulation and eliminates inflammation in muscle tissue.

The main advantage is the absence of negative effects of the drug components on the functioning of the nervous system. After taking the tablets, the result is felt after 20 minutes, a greater effect is achieved after 1 hour. When the solution is administered intravenously, after 2-5 minutes, the maximum effect is after 30 minutes. Complete elimination of drotaverine from the body occurs 72 hours after administration.

Indications for use

What does it help with? No-spa can be used both as a primary and as an auxiliary therapeutic agent for a number of pathological conditions:

1. Colic;
2. Spasm of the arteries;
3. Spastic constipation;
4. Pielite;
5. Tenesmach;
6. Proctitis;
7. Endarteritis;
8. Spasm of cerebral vessels.

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

No-Shpa for children

It is advisable to give the medicine to children for cystitis and nephrolithiasis, sudden spasms of the duodenum or stomach, gastritis, enteritis, colitis, flatulence, constipation, spasm of peripheral arteries, high fever and severe headaches.

40 mg tablets are prescribed to children from the age of six. Clinical studies of the safety and effectiveness of Forte tablets in children have not been conducted.

Contraindications

1. Lactase deficiency, hereditary galactose intolerance, galactose-glucose malabsorption syndrome (tablets, due to the presence of lactose monohydrate in their composition);
2. Age up to 6 years (tablets);
3. Breastfeeding period (due to the lack of necessary clinical data confirming the safety and effectiveness of No-shpa for this group of patients);
4. Severe heart failure (low cardiac output syndrome);
5. Severe liver or kidney failure;
6. Hypersensitivity to the components of the drug.

No-shpa should be used with caution against the background of arterial hypotension, in children and during pregnancy.

When administering an injection solution intravenously, due to the risk of collapse, the patient must lie down.

Use during pregnancy and lactation

During pregnancy, the use of No-shpa is possible only in cases where the expected benefit is several times greater than the possible danger to the development and health of the fetus. In this case, the dosage is selected strictly individually.

Dosage and method of administration

The instructions for use indicate that when taking No-Spa without consulting a doctor, the recommended duration of taking the drug is usually 1-2 days. In cases where drotaverine is used as an adjuvant therapy, the duration of treatment without consulting a doctor may be longer (2-3 days). If pain persists, the patient should consult a doctor.

The effectiveness of No-Shpa is three to four times higher than the effectiveness of Papaverine. In addition, the drug is characterized by 100% bioavailability. When taking a tablet, drotaverine is very quickly absorbed from the gastrointestinal tract: the half-absorption period of the substance is 12 minutes.

Dosages of No-shpa:

• Adults are prescribed 1-2 tablets. per dose 2-3 times/day. The maximum daily dose is 6 tablets. (which corresponds to 240 mg).
• Clinical studies with the use of drotaverine have not been conducted in children. If the drug No-shpa is prescribed for children aged 6 to 12 years - 40 mg (1 tablet) 1-2 times a day, for children over 12 years old - 4 mg (1 tablet) 1- 4 times/day or 80 mg (2 tablets) 1-2 times/day. The maximum daily dose is 160 mg (4 tablets).

If the patient can easily independently diagnose the symptoms of his disease, because... They are well known to him, then the effectiveness of treatment, namely the disappearance of pain, is also easily assessed by the patient. If within a few hours after taking the drug at the maximum single dose there is a moderate decrease in pain or no decrease in pain, or if the pain does not decrease significantly after taking the maximum daily dose, it is recommended to consult a doctor.

When using a bottle with a polyethylene stopper equipped with a piece dispenser: before use, remove the protective strip from the top of the bottle and the sticker from the bottom of the bottle. Place the bottle in your palm so that the dispensing hole on the bottom does not rest against your palm. Then press on the top of the bottle, causing one tablet to fall out of the dispensing hole at the bottom.

Side effects

Side effects associated with the use of No-shpa occur quite rarely. The most common ones are:

• feeling of increased heart rate;
• nausea;
• itchy skin rash;
• feeling of restlessness;
• insomnia;
• decreased blood pressure;
• constipation;
• headache;
• Quincke's edema;
• dizziness.

Overdose

Significantly exceeding the recommended therapeutic dose of No-shpa tablets can lead to disturbances in the rhythm of heart contractions (arrhythmia), as well as to disruption of intracardiac conduction, up to complete blockade with cardiac arrest.

Treatment of overdose consists of gastric and intestinal lavage, taking intestinal sorbents (activated carbon), as well as symptomatic therapy in a medical hospital.

special instructions

The 40 mg tablets contain 52 mg of lactose monohydrate, as a result of which complaints from the digestive system are possible in patients with lactose intolerance. This form is not intended for patients with lactase deficiency, galactosemia or impaired glucose/galactose absorption syndrome.

If any adverse reactions occur, the issue of driving and operating machinery requires individual consideration. If dizziness occurs after taking the drug, you should avoid engaging in potentially hazardous activities, such as driving vehicles and working with machinery.

Drug interactions

PDE inhibitors like papaverine reduce the antiparkinsonian effect of levodopa. When No-shpa is prescribed simultaneously with levodopa, rigidity and tremor may increase.

With the simultaneous use of drotaverine with other antispasmodics, including m-anticholinergics, a mutual enhancement of the antispasmodic effect occurs.

No-spa is an antispasmodic, the injection of which is effective when administered intravenously. To administer into a vein, the drug is pre-mixed with sodium chloride. The medicine is also administered intramuscularly. The ampoule contains 40 mg of drotaverine hydrochloride. The instructions provide for the use of painkillers after operations in the form of droppers. In this case, a prolonging effect of no-shpa is achieved. Next, we will consider when injections are prescribed, how quickly an intramuscular injection works, and how to use ampoules for administration according to the instructions.

No-spa in ampoules: composition of the injection

The medical product "" for intramuscular administration is produced in glass ampoules containing 2 ml of injection solution. The volume of the active element in 1 ml is 20 mg of drotaverine. Injections can be carried out through intra-arterial, intravenous and intramuscular administration. The solution has a bright yellow-green color.

One 2 ml ampoule contains:

• Active ingredient: drotaverine hydrochloride – 40.0 mg.
• Excipients: sodium metabisulfite (E223), ethanol (E1510), water for injection.

pharmachologic effect

The medication gives excellent results in the treatment of spastic syndrome of the gastrointestinal tract (gastrointestinal tract), urinary and genital areas, with spasms of the cerebral vessels of the brain, with depression and neuroses, and Raynaud's disease.

However, caution should be exercised if you have prostate disease, because relaxation of the smooth muscles of the bladder may cause problems with urination.

Pharmacodynamics and pharmacokinetics

It is quickly and completely absorbed, both after oral administration and after intramuscular administration. It is highly bound to human plasma proteins (95-98%), especially albumin, gamma and beta globulins.

Drotaverine is metabolized in the liver within 8-10 hours. Within 72 hours, drotaverine is practically eliminated from the body, more than 50% in feces. mainly excreted in the urine and about 30% from metabolites; the original compound is not found in the urine.

No-spa in the form of injections: what is the medicine for?

Sometimes oral administration is undesirable for one reason or another. For example, due to the patient’s intolerance to lactose. Then he is prescribed injections of the solution. A quick antispasmodic result is obtained. This form is effective for pancreatitis, pain in the back and internal organs.

If a person has signs of impaired glucose absorption, then no-shpa is prescribed for them in the form of injections. Intravenous or intramuscular administration of anesthetic for pancreatitis is prescribed. After all, this type of illness often manifests itself in the form of the development of signs of vomiting. Tablets for such symptoms will simply be useless. Due to the fact that injections have a quick antispasmodic effect, many people strive to use the medicine in this form, especially for pain in the back, stomach, kidneys, etc.

Indications for use

The instructions indicate the following indications for the use of No-shpa in injections:

• cholelithiasis;
• high blood pressure;
• migraine with hypertension;
• ulcerative lesions of the digestive tract;
• inflammation of the mucous membrane of the stomach or peritoneum;
• esophageal spasm;
• inflammation of the mucous membrane of the small or large intestine;
• inflammation of the wall of the gallbladder or the mucous membrane of the renal pelvis;
• infection of the bile ducts;
• enlargement and inflammation of the anal papillae;
• kidney stone disease;
• the presence of stones in the ureter;
• cystitis;
• postoperative period;
• injuries.

For women, the medicine is prescribed for painful menstruation. In rare cases, the doctor will prescribe medication for tumors to relieve pain.

Contraindications ⛔

• The main contraindication to the use of this drug, like many other drugs, is the manifestation of severe disorders of the liver, kidneys, and heart, caused by insufficiency of their functions.
• "No-spa" is not prescribed during breastfeeding, since drotaverine and other representatives of this pharmacological category can pass into mother's milk.
• The use of the drug is allowed from 6 years of age, but only in tablet form, since studies of the effects of injection solutions have not been conducted, according to which the use of the drug parenterally is contraindicated.
• Taking the medication is contraindicated if you have a high sensitivity to the active element or other substances from its composition.

Can be used only if certain precautions are observed in case of low blood pressure due to the high likelihood of collapse, as well as during pregnancy.

In what cases is it used with caution?🚫

Like any pharmacological agent, medicine requires caution in use. The main reason why the tablet form can cause problems is lactose intolerance in the patient. Even if a person does not have personal intolerance to lactose itself, it is quite possible to have a negative effect on the gastrointestinal tract, which can manifest itself as intestinal colic or vomiting.

For symptoms indicating unsatisfactory absorption of sucrose, the active substances are administered to the patient using a syringe. No-spa (solution for injection) is recommended for inflammation of the pancreas, when oral use of the drug is extremely undesirable, because vomiting quite often develops with this disease.

No-Shpa ampoules: instructions for using injections for adults

No-spa in ampoules: solution for intravenous and intramuscular administration (5 ampoules of 2 ml.)

The average daily dose of drotaverine in ampoules for an adult is from 40 to 240 mg. The drug is administered intramuscularly in 1-3 separate injections.

No-Spa is administered intravenously to patients with stones in the bile or urinary tract during acute colic. Single dose - from 40 to 80 mg (the solution should be administered slowly).

Dosage in injections

Injections are given 1 to 3 times a day. The instructions indicate the daily dosage for adults and children:

• from 1 year to 6 years - 120 mg;
• from 6 to 12 years - 200 mg;
• from 12 years old - 240 mg.

How to inject No-shpa in ampoules?

If taking tablets is contraindicated, the drug is prescribed in ampoules. Injected into a muscle or venous vessel. The dosage is indicated in the instructions. Draw the required amount of liquid medicine into a syringe and treat the skin at the injection site. Injected intramuscularly slowly. Painful sensations occur during insertion. The syringe is not intended for reuse.

👨🏻‍⚕️ No-spa intravenously can only be prescribed by the attending physician. In acute conditions, incl. against the background of colitis, the pain quickly disappears after injection of 40-80 mg per day. You should not inject the medicine into a vein yourself.

When does the No-shpa injection begin to work?

🕔 When using tablets, the result appears in 10-15 minutes. Injections significantly accelerate the reduction in pain intensity, and relief occurs within 5 minutes. It is thanks to this effect that injections have become very popular and widespread.

Side effects 🤒

Side effects occur with an overdose. Frequent use of injections reduces the effectiveness of the drug, which forces you to increase the dose. But this leads to negative reactions in the body.

The instructions describe the following negative manifestations:

• decreased blood pressure;
• nausea and vomiting;
• accelerated pulse;
• skin rashes;
• swelling at the injection site;
• anaphylactic shock.

If the effect of the drug weakens, there is no need to increase the dose. This will cause overdose symptoms. It is necessary to switch to another painkiller.

Use during pregnancy and breastfeeding

For pregnant women, the form of the drug and the daily dose are selected individually. With increased uterine muscle tone in early pregnancy, the recommended dose varies from 80 to 240 mg/day.

No-Spa in ampoules is usually used to prepare for childbirth. Injections of drotaverine accelerate the process of dilation of the cervix. The medicine is injected into the muscle at a dose of 40 mg. After a few hours, the injection is repeated if necessary.

Drug interactions

When taken together with levodopa, the drug reduces the effect of the latter on the symptoms of Parkinson's disease, while increasing muscle stiffness and shaking (tremor). Shelf life: 5 years.

Do not use the drug after the expiration date indicated on the blister and cardboard box.

special instructions

Before using No-shpa in injections for intramuscular administration, you need to know:

• Clinical studies of the drug in children are not presented.
• With low blood pressure, the use of the drug requires caution.
• When administering drotaverine intravenously, due to the risk of loss of consciousness, the patient must lie down!
• In case of hypersensitivity to sodium metabisulfite, parenteral use of the drug should be avoided.
• Caution should be exercised when taking the drug parenterally by pregnant women.
• Impact on the ability to drive vehicles or other machinery
• After parenteral, and especially intravenous administration of the drug, patients are advised to refrain from driving and working on machines.

Analogs

There are few of them, mostly produced by Russian manufacturers.

• "Drotaverine". Identical to the described drug, although there are differences in bioavailability and bioequivalence. Nine Russian manufacturers produce Drotaverine.
• "Drotaverin-Ellara" - produced by Ellara LLC.
• “Nosh-Bra” is produced in tablets and ampoules by the Russian pharmaceutical manufacturer Bryntsalov V.A.
• "Spazmol" in tablet and injection forms is produced by the Russian company Pharmstandard-UfaVITA.
• "Spakovin" - ampoules and tablets. Produced by the Indian company M.J.Biopharm.
• An analogue of No-shpa is produced by the Belarusian Borisov ZMP.