No-spa is one of the most common and frequently used antispasmodics in pediatric practice. Antispasmodics are drugs that relax the smooth muscles of many internal organs, thereby relieving excess spasm (contraction) of smooth muscle cells. The mechanisms of action of these agents are different. We will not go into deep detail, but will only say that there are neurotropic and myotropic antispasmodics. Complex terms, the essence of which we will now explain. The mechanism of action of neurotropic antispasmodics is the blockade and disruption of the conduction of impulses from the nervous system to the muscles. In turn, the mechanism of action of myotropic antispasmodics is a direct effect on smooth muscle cells by changing the biochemical processes in them.
As you know, smooth muscle is found in many organs and systems of the body, for example, in the gastrointestinal tract, urinary and reproductive systems, respiratory system (especially in the bronchi) and others. Thus, the spectrum of action and indications for which antispasmodics can be used are quite extensive. One of the most common causes of pain is spasm (contraction) of muscle cells. Antispasmodics, eliminating spasms, have a pronounced analgesic effect.
In this article we will pay much attention to drotaverine, known as “No-shpa”. We will tell you about its release forms, price category, indications and contraindications, dosages, unwanted side reactions. We will also talk about other myotropic antispasmodics that can be used in children.
Release form
Forms of release of the drug:
- No-Shpa tablets, 6 or 24 pcs. in blisters, 1 blister per package, 60 pieces in polypropylene bottles equipped with a piece dispenser, 1 bottle per pack;
- No-Shpa Forte tablets No. 20, 10 pcs. in blisters, 2 blisters in a cardboard box;
- No-Shpa injections, No. 25 (5×5), 2 ml per ampoule, 5 ampoules (located in a tray), 5 trays in a cardboard box.
Tablets 40 mg are biconvex, round, yellow with an orange or greenish tint. Each tablet is engraved with "spa".
No-Shpa Forte is a biconvex, oblong-shaped tablet of yellow color with an orange or greenish tint. There is a fault line on one side and "NOSPA" is engraved on the other.
The drug in injection form has the appearance of a transparent yellow-green liquid.
Pharmacodynamics and pharmacokinetics
Drotaverine is a myotropic antispasmodic . The action of the drug is aimed at reducing the tone and motor activity of the smooth muscles of internal organs. Moreover, these effects are accompanied by a moderate dilation of blood vessels.
Compared to Papaverine, it has greater antispasmodic activity and duration of action. There are no pronounced effects on the cardiovascular, central and autonomic nervous systems.
The drug is effective for both muscle spasms and spasms of neurogenic origin. Regardless of the type of autonomic innervation, it helps to relax the smooth muscles of the biliary tract, digestive and urogenital tracts.
Since drotaverine acts directly on smooth muscles, it can be used to relieve spasms even in cases where the use of drugs from the group of anticholinergics (for example, with prostatic hypertrophy or glaucoma ).
When taken orally, absorption of drotaverine is one hundred percent. The substance is absorbed from the digestive tract very quickly. During the first passage (passage) through the liver, only 65% of the dose enters the bloodstream. TCmax - from 45 minutes to 1 hour.
Drotaverine in tissues and penetrates smooth muscle cells. Does not pass through the BBB. The substance and/or products of its metabolism can pass through the placental barrier in small concentrations.
T1/2 - from 8 to 10 hours. Within 72 hours, the substance is almost completely eliminated from the body. More than half of the drug is excreted - mainly in the form of metabolites - by the kidneys, about a third - through the gastrointestinal tract (excretion into bile). Unchanged drotaverine is not found in urine.
Feature of the drug
Before determining how quickly No-Shpa works, you need to understand exactly what this drug is. This is a drug that has an antispasmodic effect.
This medication helps to quickly eliminate smooth muscle spasms. Thanks to its vasodilating properties, No-Shpa normalizes blood supply to tissues. It has also been noted that this medicine has a pronounced effect on the functioning of the cardiovascular system.
The drug is very quickly and completely absorbed. "No-Shpa" works in 10-15 minutes. It depends on the dosage form. The maximum concentration in the blood is achieved 40-60 minutes after application.
Among the main advantages of this drug, the following should be highlighted:
- Long-lasting and intense antispasmodic activity.
- Rapid absorption of the substance.
- Absence of numerous adverse reactions.
The active component of No-Shpa is absorbed quite quickly and reaches its maximum concentration approximately an hour after taking the drug. More than half of the drug is excreted in the urine, and approximately 30% is excreted in the feces.
The active substance has the ability to bind to plasma proteins. Metabolism occurs in the liver. The substance is completely eliminated from the body after 72 hours.
Indications for use of No-Shpy
What do No-Shpy tablets help with?
Indications for use of No-Shpy:
- spasms of smooth muscles caused by diseases of the biliary tract ( cholecystitis , cholangitis , cholangiolithiasis , cholecystolithiasis , pericholecystitis , papillitis );
- spasms of smooth muscles of the urinary tract with cystitis , uro- and nephrolithiasis , pyelitis , bladder tenesmus .
As an addition to the main therapy, the drug can be used to relieve spasm of smooth muscles, which is caused by diseases of the stomach and intestines . Indications for use are: peptic ulcer , flatulent forms of spastic colitis , as well as SRCT with constipation , spasms of the pylorus and cardia .
In addition, it is advisable to take No-Shpu for headaches and dysmenorrhea . No-Spa for headaches is effective if the cause of the pain is a spasm of blood vessels (tension headache or tension pain).
Forte tablets are prescribed when it is necessary to provide a longer lasting effect and reduce the frequency of use.
What is No-Shpa for injectable form?
No-Spa in ampoules is used mainly in situations where taking pills is impossible.
The tablets contain lactose. Its content in one tablet is 40 mg - 52 mg, and in one tablet 80 mg - 104 mg. In this regard, patients with lactose intolerance may experience complaints from the digestive system.
People with glucose/galactose malabsorption syndrome, lactase deficiency and galactosemia should be prescribed only No-Shpa injections.
Parenteral administration of the drug is also indicated for pancreatitis : the disease is often accompanied by debilitating vomiting, due to which taking pills does not give the desired effect.
Does No-Spa help with toothache?
It is generally accepted that the drug does not help with toothache. And this is not surprising, since the main effect of drotaverine is antispasmodic. The cause of toothache is:
- damage to tooth enamel or dentin;
- inflammation of the tissues surrounding the tooth root;
- pulp inflammation.
Smooth muscles do not play a role in the development of pain, therefore, taking No-Shpa for toothache does not make sense. However, in some cases, tablets can still help. If you put the tablet on your tongue, you may feel that your tongue begins to quickly go numb at the point of contact with it.
While not an analgesic , the drug provides an analgesic effect, and this allows it to be used to alleviate the condition in situations where it is not possible to quickly see a doctor. To relieve pain, the tablet is applied to the diseased tooth or placed in a carious cavity.
It should be noted that the medicine will only work if the pulp chamber has already opened.
No-Spa for menstruation
According to doctors, No-Shpa is one of the best remedies for relieving pain that occurs during menstruation. Drotaverine helps relax the uterus, while providing an analgesic effect.
For menstrual pain, drugs that suppress Pg synthesis in the body (for example, Brufen , Butadione or Indomethacin ) can be added to No-Shpe.
For headaches
According to the instructions, No-Spa does not help with tension headaches, which are accompanied by fatigue and insomnia. A painful syndrome of this nature appears due to constant lack of sleep, stressful situations, physical or mental overload.
Patients often ask the question whether it is possible to take noshpa with paracetamol at the same time. The medication should not be supplemented with other antispasmodics, but can be taken with the following medications:
- Analgin;
- Paracetamol and other painkillers.
If you have constant headaches, you should not overuse medications and it is better to have the condition diagnosed by a doctor.
Contraindications
Contraindications for No-Shpu:
- hypersensitivity to drotaverine or any other substance in the solution/tablets;
- severe forms of renal and liver failure ;
- low cardiac output syndrome;
- lactase deficiency , galactose intolerance, glucose/galactose malabsorption syndrome (for tablets).
The medicine is prescribed with caution to pregnant women, children and persons suffering from arterial hypotension.
For painful menstruation
Algomenorrhea is pain during menstruation, the most common disorder of menstrual function. Pain syndrome causes physical and psychological discomfort. The pain is cramping and is felt in the area:
- sacrum;
- belly;
- lower back.
No-spa during menstruation neutralizes the effect of prostaglandin, which allows for more intensive removal of secretions. The cause of pain is contraction of the uterus, and the antispasmodic promotes relaxation of the uterine muscles, so the pain decreases.
Side effects
The drug usually does not have side effects, however, it must be taken into account that during treatment the following may sometimes be observed:
- decreased blood pressure ;
- increased heart rate;
- insomnia;
- headache;
- dizziness;
- constipation;
- nausea;
- hypersensitivity reactions.
If the drug is administered intramuscularly or intravenously, local reactions at the injection site are possible.
General information
Many people are interested in how quickly No-Shpa works. In what form is it best to use? This is a very famous medicine. It is used to relieve spasms of the smooth muscles of the urinary and biliary tract, as well as for a number of other painful conditions.
Answering the question of how long it takes for No-Shpa to start working, it must be said that the first result can be noticed within 10-15 minutes. It is worth remembering that the drug has certain contraindications and has side effects, so you need to be careful when using it.
Instructions for use of No-Shpa (Method and dosage)
No-Shpa tablets: instructions for use
To alleviate the condition, it is recommended for an adult to take from 120 to 240 mg of drotaverine during the day. Thus, the daily dose is from 3 to 6 tablets of No-Shpa. It is recommended to divide it into 2-3 doses.
The maximum permissible single dose is 2 tablets of 40 mg, the daily dose is 240 mg.
The standard dose for a child under 12 years of age is 80 mg/day. (the dose is divided into 2 doses), for a child over 12 years old - 160 mg/day. (the dose is divided into 2-4 doses).
The recommended duration of use without consulting a doctor is no more than 2 days. If the condition does not improve within 48 hours, you should consult a doctor to clarify the diagnosis and select the correct treatment regimen.
In situations where No-Shpa is used as an addition to the main therapy, the recommended duration of use without consulting a doctor is 2-3 days.
Instructions for No-Shpa Forte
Forte tablets are taken in the same way as 40 mg tablets. The daily dose of the drug is 3-6 tablets, divided into 2-3 doses.
No-Shpa ampoules: instructions for use
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-Shpa 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).
How long does it take for the medicine to work?
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.
When taken orally, the effect of No-Shpa appears within 10-15 minutes, and when administered intramuscularly, within 5 minutes.
Dosage for animals
Dosage for dogs: 40 mg (1 tablet) for every 10 kg of weight. If parenteral administration of the drug is indicated for the animal, the dose is 1 ml/kg.
Dosage for cats is 0.1 ml/kg, injections are given 2 times a day.
Overdose
A severe overdose of No-Shpa is accompanied by cardiac arrhythmia and disturbances in the conduction function of the heart, up to complete blockade of the branches of the PG (bundle of His) and cardiac arrest , which can lead to the death of the patient.
The literature indicates that the lethal dose of drotaverine is 1.6-2.4 grams (from 40 to 60 tablets of 40 mg). Death occurred 2-3 hours after the drug was taken. Wikipedia states that the LD50 of drotaverine is approximately 135 mg/kg.
After taking a large dose of drotaverine, the victim should be under medical supervision. Treatment is symptomatic, including gastric lavage, induction of vomiting and maintenance of vital body functions.
Interaction
Like other PDE inhibitors similar to papaverine, drotaverine weakens the antiparkinsonian effect of Levodopa . When taking these drugs in combination, tremor and rigidity may increase.
In combination with other antispasmodics (including m-anticholinergic blockers), a mutual enhancement of the antispasmodic effect is noted.
of drotaverine taken is in a state associated with plasma proteins (mainly with β-, γ-globulins and albumin ).
There are no data on the interaction of the substance with drugs that significantly bind to plasma proteins; however, their interaction is hypothetically possible at the level of protein binding (one of the drugs may be displaced from this bond, as a result of which the concentration of the free fraction of the drug in the patient’s blood whose binding to the protein is weaker).
Hypothetically, this is fraught with the occurrence of toxic and/or pharmacodynamic effects of such a drug.
special instructions
The tablets contain lactose, which should be kept in mind when prescribing the drug to people with glucose/galactose malabsorption syndrome, lactase deficiency and galactosemia.
When administering the solution intravenously, due to the risk of collapse, the patient should be in a supine position.
The drug should be used with caution in patients suffering from arterial hypotension .
The injection form of No-Shpa contains sodium metabisulfite, which can cause allergic reactions . In sensitive patients (especially those with a history of bronchial asthma or allergies ), bronchospasm and symptoms of anaphylactic shock .
Patients with known hypersensitivity to sodium metabisulfite should avoid the use of No-Shpa injections.
For colic
Colic is caused by muscle spasms in the abdominal or retroperitoneal space. Depending on the location, colic is divided into:
- renal;
- pancreas;
- hepatic;
- intestinal.
No-spa in this case is the surest remedy for eliminating pain and spasms. However, the antispasmodic will not eliminate the cause of the pain syndrome, and often, under the mask of colic, various serious pathologies of the abdominal cavity are hidden, in which surgical intervention is necessary.
Analogues of No-Shpa
Level 4 ATC code matches:
Spasmol
Drotaverine Hydrochloride
Papaverine
Drotaverine
The most famous Russian analogue of No-Shpa is Drotaverin . Other generics of the drug: Vero-Drotaverine , Bioshpa , Nosh-Bra , Ple-Spa , Spasmonet , Spasmol , Spazoverine , Spakovin .
Which is better: Drotaverine or No-Shpa?
drotaverine hydrochloride as an active substance . Based on this, we can conclude that Drotaverine is essentially No-Shpa.
The only significant difference between the drugs is the price: Drotaverine is several times cheaper than its imported counterpart.
At a temperature
There are two types of hyperthermia:
- pink;
- white.
If the whole body becomes hot as the temperature rises, only an antipyretic agent (pink hyperthermia) is sufficient. But if the hands and feet are cold (white hyperthermia), muscle spasms or convulsions occur, so antispasmodics must be added to the treatment. No-spa is ineffective as a stand-alone drug for fever, but it helps in combination with an antipyretic and antihistamine (suprastin).
No-Shpa for children
According to the annotation, there are no restrictions on the use of the solution for IM and IV administration in pediatrics. 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.
Indications for use in pediatric practice
It is advisable to give 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 .
Contraindications for children
In children, the use of No-Shpa is contraindicated in case of cardiac, renal or liver failure , individual intolerance to the components of the drug, low blood pressure, impaired absorption of galactose/lactose, angle-closure glaucoma , bronchial asthma , atherosclerosis of the coronary arteries .
The use of tablets is strictly contraindicated in children under 12 months, but it is considered safest to give the drug from the age of six. Very young children are given such a powerful antispasmodic only in cases where there is no alternative.
To improve the taste of the tablet, it can be crushed into powder and mixed with sweet syrup.
Dosage of No-Shpa for children
For children from one to six years of age, a single oral dose is 0.5-1 tablet. You should take the medicine 2 or 3 times a day. A school-age child is given No-Shpu from 2 to 5 r/day. a whole tablet.
Dosage for children with fever
For fever in children, No-Shpa is used as one of the components of the so-called “triad”.
In addition to the antispasmodic, such a mixture may include:
- Analgin and Diphenhydramine ;
- Analgin and Paracetamol ;
- Suprastin and Analgin ;
- Paracetamol and Suprastin .
To bring down the temperature, you can also use a simple combination “No-Spa + Analgin ”.
The dosage of each drug is calculated depending on the age of the child. So, for example, for a 2-year-old child, ⅓ Analgin tablet and ⅓ No-Shpa tablet are enough.
For cystitis
Inflammatory process in the bladder is a common pathology that affects women, men and children. To prevent the disease from becoming chronic, it is important to take timely measures. Doctors often prescribe No-shpu as an additional therapy for cystitis. The medicine works as follows:
- relieves pain;
- removes heaviness in the lower abdomen and lumbar region.
After taking an antispasmodic, the urinary muscles relax, which allows the organ to function normally.
No-Shpa during pregnancy and breastfeeding
Drotaverine has a relaxing effect on all smooth muscle structures of the body, while provoking dilation of blood vessels and helping to increase blood flow to various organs.
During pregnancy , the remedy is used mainly for uterine tone in the early stages. It is not prescribed before childbirth, this is due to the fact that taking No-Shpa before childbirth will help relax and dilate the cervix.
Taking the drug during childbirth helps to normalize the contractile activity of the uterine muscles and reduce pain, reduces the risk of injury, and also reduces the period of labor. Despite this, in many European countries, the administration of No-Shpa during childbirth is considered a relic of the old school.
No-Shpa is considered a safe drug for pregnant women. Clinical experience with the use of the drug in pregnant women, as well as the results of reproductive studies conducted on animals, show that drotaverine has neither embryotoxic nor teratogenic effects.
However, during pregnancy it is necessary to balance the potential benefits for a woman with the possible risks for her unborn child.
Dosage of No-Shpa during pregnancy
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.
Women who took the drug during pregnancy - the reviews are confirmation of this - claim that No-Shpa not only copes well with severe cramps in the first months of pregnancy, but also greatly facilitates the course of childbirth.
No-Shpa during breastfeeding
Due to the fact that there are few necessary clinical data on the use of No-Shpa during lactation , it is not recommended to prescribe the drug during breastfeeding.
Against cough
A cough develops due to infection or inflammation of the respiratory tract. No-spa is not effective for cough attacks, but together with antitussive and expectorant drugs it eliminates such unpleasant symptoms as:
- suffocation;
- spasms;
- inflammation in the lungs and bronchi.
A medicine based on drotaverine acts on the smooth muscles of all organs, including the respiratory system. No-spa dilates blood vessels, relieves cough and improves sputum discharge.
Reviews about No-Shpe
Reviews about No-Spe vary: for some, the drug literally saves them (especially during pregnancy), while others consider it completely ineffective.
The main advantages of the drug are:
- high safety profile, which is confirmed by the results of a large number of clinical and post-marketing studies;
- the ability to reliably prevent smooth muscle spasm and reduce its severity;
- availability of 2 dosage forms;
- absence of side effects that are typical for certain antispasmodics with anticholinergic effects ;
- the ability to eliminate spasms of various origins (No-Spa is effective for spasms caused by urological and gynecological diseases , gastrointestinal and obstetric diseases; the drug is a first-line drug when it comes to providing emergency care).
Another important feature of No-Shpa is that it does not mask the symptoms of an “acute abdomen”.
How much does No-Shpa cost?
The price of No-Shpa in 40 mg tablets in Russian pharmacies is from 55 rubles (cost 6 pieces). You can buy 24 tablets of 40 mg for an average of 110 rubles, and 24 tablets of 80 mg for 160-200 rubles. The price of No-Shpa in ampoules is from 98 to 447 rubles. (depending on the number of ampoules in the package).
The price of No-Shpa in tablets in Ukraine is from 50 UAH (24 tablets of 40 mg). Injections in Kharkov or Kyiv can be bought for 245-260 UAH (25 ampoules of 2 ml). Price No-Shpa Forte - from 100 UAH.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- No-shpa - p.p.o. tablets
24 pcs., drotaverine 40 mg, for abdominal pain Quinoin Pharmaceutical and Chemical Products Plant CJSC RUB 129 order - No-spa forte - tablets 10 pcs., drotaverine 80 mg, for abdominal painChinoin
68 RUR order
- No-spa solution for intravenous and intramuscular injection. 2% 2ml 5 pcs. Chinoin
94 RUR order
- No-spa forte - tablets 24 pcs., drotaverine 80 mg, for abdominal pain, Chinoin
RUB 143 order
- No-spa tablets 64 pcs., drotaverine 40 mg, for abdominal pain Quinoin Pharmaceutical and Chemical Products Plant CJSC
180 rub. order
Pharmacy Dialogue
- No-spa Forte tablets 80 mg No. 24Chinoin
148 RUR order
- No-spa tablets 40 mg No. 6Chinoin
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- No-spa (amp. 20 mg/ml 2 ml No. 5) Chinoin
103 rub. order
- No-spa tablets 40 mg No. 24Chinoin
116 RUR order
- No-spa tablets 40 mg No. 100Chinoin
RUB 217 order
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Pharmacy24
- No-spa forte 80 mg N24 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
96 UAH.order - No-spa 40 mg N60 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
110 UAH order
- No-spa 40 mg No. 100 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
175 UAH order
- No-spa 40 mg N24 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
51 UAH order
- No-spa Comfort 40 mg No. 24 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
55 UAH order
PaniPharmacy
- No-shpa tablets No-shpa tablets. 40 mg No. 60 (dosing container) Hungary, Chinoin
118 UAH order
- No-shpa tablets No-shpa tablets. 40 mg No. 100 Hungary, Chinoin
191 UAH order
- No-Spa comfort tablets No-Spa Comfort tablets 40 mg No. 24 Hungary, Chinoin
68 UAH order
- No-shpa tablets No-shpa tablets. 40 mg No. 24 Hungary, Chinoin
54 UAH order
- No-spa ampoule No-spa solution for injection 40 mg ampoules 2 ml No. 25 Hungary, Chinoin
296 UAH. order
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A little history of the drug
Back in the middle of the twentieth century, attempts were made in Hungary to improve such an antispasmodic drug as Papaverine. This is how a new medicine appeared - Drotaverine, which in 1962 received the official name No-Shpa. "No Spasm!" - it sounds in Latin and means “No spasm.” This name characterizes with absolute clarity the main effect of the drug on the human body. In addition to its ability to relieve spasms, No-Spa is able to relax the smooth muscles of blood channels, dilate blood vessels, and lower blood pressure.
In the territory of the former Soviet Union, this remedy appeared in the 70s. Now it can be purchased in more than 50 countries around the world. No-Shpa gained such popularity due to its advantages:
- relative safety,
- effectiveness of action,
- affordable price.
Although most of us are familiar with No-Shpa as small yellow tablets, it is currently available in different forms:
- in tablets,
- in coated tablets,
- in capsules,
- in liquid for injection.
