Papaverine (Injection)

Papaverine is a vasodilator which works to relax and widen blood vessels in order to increase blood flow in the treatment of erectile dysfunction and heart or circulation problems.

Overview

Papaverine is a vasodilator which is prescribed to men with erectile dysfunction in order to induce an erection. It works by relaxing the smooth muscles in the blood vessels which causes them to dilate and widen in order that blood can flow more easily throughout the veins and arteries. As well treating erectile dysfunction, papaverine may also treat other conditions relating to the heart and blood vessels, such as heart attack, angina (chest pain), and circulation problems. Sometimes it is also used to relieve disorders of the gallbladder or stomach.

When used to treat erectile dysfunction, papaverine is injected just underneath the skin. When used for another purpose, it may be injected into the muscle, or directly into a vein via an IV. The drug is only available with a doctor's prescription and depending on the condition being treated, it may be administered at home by the patient themselves, or by a doctor or nurse in a clinic or hospital environment.

Conditions Treated?

Type Of Medicine?

  • Vasodilator

Side Effects

Alongside its needed effects, papaverine may cause a number of unwanted side effects. While it is unlikely that all side effects will occur, some of them are serious and it's important that patients are able to recognize symptoms which require urgent medical attention.

The following side effects should be reported to a doctor straight away:

  • Rapid heart rate
  • Low fever
  • Nausea
  • Stomach pain
  • Jaundice (yellow skin or eyes)
  • Skin rash
  • Severe tingling, numbness, pain
  • Muscle weakness
  • Loss of appetite
  • Clay-colored stools
  • Dizziness
  • Erection continuing for more than four hours
  • Lumps in the penis
  • Swelling, pain, or irritation around the needle (if administered via IV)

The following side effects are less serious and do not require medical attention unless they become very severe or persistent. They may dissipate when the body adjusts to the medicine.

  • Bruising or bleeding at injection site
  • Swelling at injection site
  • Mild skin rash
  • Mild nausea or stomach discomfort
  • Constipation
  • Diarrhea
  • Headache
  • Increase sweating
  • Tired feeling
  • Mild burning along the length of the penis
  • Difficulty ejaculating
  • Tingling at the tip of the penis

If you notice any other side effects not listed here, consult your doctor. You could also report new side effects to the FDA, or your doctor may do this on your behalf.

Dosage

The amount of papaverine you take and the frequency at which you take it will be determined by your doctor and will depend on a number of factors, such as the condition being treated and your medical history. Always follow your doctor's dosage instructions carefully to ensure that papaverine is as effective as possible with minimal risk of side effects.

How to administer papaverine injections

If papaverine is to be administered into a vein or into a muscle, a doctor, nurse, or other healthcare professional will usually perform the injection in a hospital setting. When injected into a vein, the drug will be injected slowly over one or two minutes in order to prevent irritation to the vein and other side effects.

If you will be self-administering papaverine for erectile dysfunction, your doctor or nurse will show you how to perform the injection for the first time.

A new syringe and needle should be used for each papaverine injection. This will help to prevent infection. It is vital that you do not reuse this equipment and never share it with other people. You will also be instructed on how to safely dispose of used needles and syringes so that they do not come to harm other people.

You should only administer papaverine if you plan to have intercourse within the next two hours. It takes around 10 minutes to work. Begin by cleansing the injection site with alcohol. Then, take a sterile needle and examine it for signs of damage. Never use a bent needle to administer injections.

Papaverine is provided in individually sealed ampules which contain the appropriate dose. Do not use the medicine if the ampule is damaged or the liquid inside appears cloudy or colored, or if it appears to have particles in it. Draw the papaverine solution into the syringe.

Inject the medicine underneath the skin at the base of the penis. If uncircumcised, the foreskin will need to be pulled back in order to do this. The solution should then be injected slowly over one to two minutes to prevent irritation or discomfort. Once complete, remove the needle and put pressure on the injection site to prevent bruising. Then, massage the penis, as instructed by your doctor, to ensure the medicine spreads throughout the tissues and is most effective. It is normal for the tip of the penis to tingle after injecting papaverine.

The effects of papaverine usually last for around two hours, but sometimes they can last up to four hours. You should not attempt to have intercourse more than two hours after administering the injection. If your erection lasts for more than four hours, consult your doctor immediately.

You should not inject papaverine more than once in one day. You also should not use it for more than two days in a row, or more than three times in a week.

Papaverine should never be used as a sexual aid by men who have not been diagnosed with erectile dysfunction. Doing so could cause severe damage to the tissues of the penis, which may result in the permanent loss of ability to achieve an erection.

Interactions

Papaverine can interact with other medicines and cause worsened side effects or other complications. Tell your doctor about the prescription and over-the-counter medicines you take, as well as any herbal supplements or vitamins that you take.

It is particularly important to tell your doctor if you are taking other medicines that make you drowsy, as they could worsen the drowsiness associated with use of papaverine. Medicines which commonly have this effect include:

  • Cold, flu, and allergy medicines
  • Sleeping aids
  • Muscle relaxants
  • Seizure medicines
  • Antidepressants
  • Anxiety medicines

The following medicines should never be taken at the same time as papaverine. Your doctor will either avoid prescribing papaverine, or they will change some of the medicines you already take.

  • Amifampridine
  • Amisulpride

The following medicines are not recommended for use at the same time as papaverine, but if both medicines are deemed necessary they may still be prescribed. Your doctor may adjust the dosages of your medicines or the frequency at which you take them instead.

  • Amiodarone (Cordarone, Pacerone)
  • Dabrafenib (Tafinlar)
  • Efavirenz (Sustiva)
  • Hydroxyzine (Vistaril, Atarax, Hyzine, Vistaject-50, Rezine, Vistacon, Vistacot, Vistazine)
  • Pimavanserin (Nuplazid)
  • Pitolisant
  • Quetiapine (SEROquel)
  • Sotalol (Betapace, Sorine, Sotylize)
  • Sulpiride
  • Vemurafenib (Zelboraf)
  • Vinflunine
  • Zuclopenthixol (Clopixol)

The following medicines may increase the risk of certain side effects. If both drugs are deemed necessary, your doctor may adjust dosages or the frequency at which you take the medicines.

  • Gingko

Warnings

Risk of priapism when used to treat erectile dysfunction

Priapism is the term given when an erection lasts for longer than four hours. When this occurs, there is a risk of the blood supply to the penis being cut off, which could result in tissue damage. In some cases, the tissue damage may be irreversible, and patients may permanently lose the ability to achieve an erection in future.

To minimize the risk of priapism, only use the amount of papaverine prescribed to you and use it only as often as instructed by your doctor. If you feel that the drug does not provide you with the results you were hoping for, consult your doctor before administering higher doses.

Men who do not have erectile dysfunction should not attempt to use papaverine as a sexual aid, because they will be at a higher risk of priapism.

Interaction with medical conditions

Make sure your doctor knows your full medical history and is aware of all the conditions you currently suffer from as well as those you have suffered from in the past.

Papaverine should not be given to people who are allergic to the drug, or who have AV heart block, which is a heart condition.

People with bleeding and blood clotting problems may be an in increased risk of bleeding at the injection site when papaverine is administered.

Patients with a history of priapism or sickle cell disease are at an increased risk of priapism while using papaverine.

People with liver disease may not be able to use papaverine because the drug can cause liver damage when it is administered in ways which allow it to enter the bloodstream. If it is being used for erectile dysfunction, the risk of liver damage is greatly reduced because the medicine is injected just under the skin and it therefore enters the bloodstream very slowly.

Patients with com/health/coma/">glaucoma or Parkinson's disease may also be unable to take papaverine due to an increased risk of side effects or potential risk of worsening of their condition.

Overdose

If you think you have used too much papaverine, seek emergency medical attention. Symptoms of overdose include:

  • Weakness
  • Nausea and vomiting
  • Drowsiness
  • Blurred vision
  • Sweating
  • Warmth
  • Redness of the skin
  • Rapid heart rate
  • Seizures

Problems at injection site

When using papaverine for erectile dysfunction, you should examine the penis regularly for lumps or curvature. These are signs of scar tissue growth in the penis (fibrosis) and should be referred to a doctor.

If after injecting you notice bleeding, put pressure on the area until it stops. If the bleeding does not stop, consult your doctor as soon as possible.

Pregnancy and breastfeeding

Papaverine may be harmful to the fetus if taken by pregnant women. You should tell your doctor if there is a chance you are pregnant before taking the drug. In some instances, papaverine may still be administered to pregnant women but only if potential benefits of the drug outweigh potential risks to the fetus.

It is not known whether papaverine is excreted into breast milk, but if it is, it could be harmful to nursing infants. Tell your doctor if you are currently breastfeeding before papaverine is administered. You may be advised to discontinue breastfeeding in order that you can safely receive papaverine injections.

Storage

Papaverine should be stored at room temperature in the packaging it is provided in. It should not be allowed to freeze, and should be kept away from heat, direct light, and moisture. Always keep it out of reach and sight of children.

If you have leftover or expired papaverine, ask your healthcare provider how to safely dispose of it. There may be a local medicine take-back program you could use. Do not simply throw it in the trash or pour it down the toilet as it may cause harm to other people or the environment.

You should also avoid throwing used needles and syringes in the trash as they could be very dangerous to others. Your healthcare provider should provide you with information as to how to dispose of used needles. Never reuse needles or syringes, even if they have only been used by you.

Summary

Papaverine is a vasodilator which works to relax blood vessels in order to improve blood flow. It may be used to treat erectile dysfunction, heart and blood vessel conditions, and sometimes disorders affecting the gallbladder and stomach. When papaverine is administered via injections, it may be administered under the skin, into the muscle, or directly into a vein depending on the medical condition being treated.

Injections of this drug commonly cause drowsiness, bruising, bleeding, or swelling at the injection site, diarrhea or constipation, mild nausea, and, when used for erectile dysfunction, mild burning along the penis, difficulty ejaculating, and tingling at the tip of the penis. These side effects are minor and don't usually require medical attention. Serious side effects which require medical attention include stomach pain, rapid heart rate, muscle weakness, clay-colored stools, and priapism (erection lasting more than four hours) or lumps in the penis when used for erectile dysfunction.

Papaverine should be used with caution in people with Parkinson's disease, glaucoma, bleeding or clotting disorders, sickle cell disease, liver disease, and history of priapism. The drug should not be used by patients with AV heart block or an allergy to the drug, or by pregnant or breastfeeding women.