Buy No-spa solution intravenously and intramuscularly 40mg/2ml 2ml No. 5 in pharmacies

The drug "No-Shpa" refers to antispasmodic medications. It relieves pain from smooth muscle spasms. The drug is taken to relieve pain in diseases of the stomach, intestines, liver, kidneys and other internal organs. The product rarely causes side effects and is effective.

"No-Shpa": composition and other characteristics

The drug belongs to the category of antispasmodics. Available in the form of tablets (6, 10, 24 pieces in one package) or in the form of injections (25 ampoules of 2 ml each).

The active ingredient is drotavertin (represented as hydrochloride). Each tablet contains 40 mg, each ampoule solution contains 20 mg. In the No-Shpa Forte variety (dosage doubled - 80 mg).

The tablets may have a yellowish, greenish or orange color. The shape of the tablets is round, both surfaces are convex. On one side there is a fault line in the middle, on the other there is a monolithic surface with the inscription “NOSPA”. The solution in the ampoules is also colored in shades of yellow and green.

The shelf life depends on the form of release. Tablets can be stored for 5 years, and ampoules - 3 years from the date of release. The drug is protected from light and stored at room temperature in the range from 15 to 25 degrees.

Attention!

Tablets can be purchased without a doctor's prescription, but injections can only be purchased with a prescription.

Antispasmodics: from clinical pharmacology to pharmacotherapy

Drugs belonging to the group of antispasmodics are among the most popular and prescribed by doctors of various specialties. Dysfunction of smooth muscle cells of internal organs underlies both chronic and acute pain syndromes in various diseases of the digestive system and urinary system of the pelvic organs [1, 2]. The most common cause of pain in pathologies of internal organs that have a layer of smooth muscle cells is their excessive contraction. Symptoms of spastic dysfunction of the digestive organs occur in 30% of cases in the absence of organic damage to the stomach or intestines, which leads to the frequent independent (without medical prescription) use of antispasmodic drugs. The widespread use of drugs in this group dictates the need to constantly remind about their clinical pharmacology, especially properties and tolerability, in order to avoid both underestimation and overestimation of therapeutic capabilities.

It is important that, by eliminating or preventing spasms of smooth muscles, antispasmodics, although they have a pronounced analgesic effect, normalizing the functioning of the organ, do not interfere with the mechanisms of pain. Unlike non-narcotic and opioid analgesics, they do not pose a significant threat of “erasing” symptoms in severe organic damage (masking the picture and making it difficult to verify the diagnosis).

Antispasmodics are most often used for:

• symptomatic treatment if spasm is a characteristic accompanying symptom of the disease, but does not play a role in pathogenesis;
• etiotropic therapy if spasm underlies the pathological condition;
• premedication when preparing patients for various procedures.

The process of contraction of a muscle cell is determined by the concentration of calcium ions in its cytoplasm, entering from the extracellular space through calcium (slow) channels of cell membranes. Another source of calcium is intracellular depots, which are more present in the smooth muscles of the colon and much less in the small intestine, including the duodenum. The release of this fraction of calcium ions leads to a phase contraction of the muscle cell [3]. One of the most common mediators influencing the process of muscle contraction is acetylcholine. When it interacts with muscarinic cholinergic receptors (M-cholinergic receptors), sodium channels open, sodium ions enter the cell and, as a result, membrane depolarization occurs. Depolarization, in turn, leads to the opening of calcium channels and the entry of calcium into the cell, increasing its intracellular concentration and muscle contraction. Activation of M-cholinergic receptors by acetylcholine leads to an increase in tone and contraction of smooth muscle cells, and blockade leads to a decrease in tone and relaxation of smooth muscle cells, which underlies the prescription of M-cholinergic blockers as antispasmodics [4, 5].

Calcium interacts with calmodulin, activates myosin light chain kinase, which cleaves the phosphorus residue from the ATP molecule bound to myosin, which leads to the interaction of actin and myosin and cell contraction. The most important role in muscle functioning is known to be played by the system of cyclic nucleotides [6]. Cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) inhibit the release of intracellular calcium and the entry of calcium ions into the cell (cAMP), weaken the interaction of calcium ions with calmodulin. The levels of cAMP and cGMP are controlled by phosphodiesterase (PDE), which breaks down these nucleotides. Thus, the higher the PDE activity, the lower the concentration of cAMP and cGMP, the higher the concentration of calcium ions in the cytoplasm and the tone of the muscle cell and, conversely, the lower the PDE activity, the higher the concentration of cAMP and cGMP, the lower the concentration of calcium ions in the cytoplasm and muscle cell tone. The physiological role of PDE is diverse. 11 isoforms of this enzyme have been identified [4]. The main types of PDEs that affect the tone of smooth muscle cells are presented in

.

The mechanisms described above for regulating the calcium concentration inside the muscle cell, which are disrupted under pathological conditions and lead to spasm of the smooth muscle cells of the internal organs, imply the presence of several targets for pharmacological action [7]:

1. blockade of neurotropic effects, that is, blocking the effect of acetylcholine on the M-cholinergic receptor (atropine, hyoscine butyl bromide);
2. inhibition of PDE IV activity (drotaverine (No-spa));
3. blockade of calcium ion entry (calcium channel blockers);
4. blockade of calcium release from intracellular stores (mebeverine).

M-anticholinergics

This is one of the oldest groups of drugs used in medicine to affect the upper gastrointestinal tract. They are 5–10 times more effective in affecting the motility of the stomach than the large intestine, which is associated with the unequal density of M-cholinergic receptors in different parts of the gastrointestinal tract [8]. The largest number of receptors is in the stomach, much less in the intestines. The classic anticholinergic atropine has lost its value due to a large number of side effects. An attempt to increase the safety of therapy with M-anticholinergics was the creation of hyoscine butyl bromide, which is a relatively selective M-anticholinergic blocker acting on the M1 and M3 receptor subtypes, localized primarily in the walls of the upper gastrointestinal tract, gall bladder and biliary ducts. Unlike atropine, the drug does not penetrate the blood-brain barrier and has low (8–10%) systemic bioavailability, which leaves its mark on the variability in the manifestations of the effect.

Hyoscine butyl bromide accumulates in the smooth muscles of the gastrointestinal tract and is excreted unchanged from the body by the kidneys. It acts mainly on the stomach, duodenum, and gall bladder. The antispasmodic effect on the small and large intestines is realized in doses 2–10 times higher than therapeutic ones, therefore, for spasms of these parts of the intestine, use is not advisable (it is better to use myotropic antispasmodics, for example, drotaverine (No-shpa)) [9].

Anticholinergics are successfully used for abdominal pain caused by spasm in the upper gastrointestinal tract: sphincter of Oddi dysfunction, biliary dyskinesia, pylorospasm. Despite the fact that hyoscine butylbromide does not penetrate the central nervous system, it can cause side effects typical of M-anticholinergics (4% more often than placebo). This makes it, like other drugs in the group, contraindicated for glaucoma, benign prostatic hyperplasia, organic stenosis of the gastrointestinal tract, and tachyarrhythmias [10]. Since the drug is sold without a prescription and may cause unwanted effects in patients suffering from these diseases, it is important to inform them in advance. Unfortunately, the importance of selectivity of drug action is often unreasonably exaggerated. Thus, the statement that hyoscine butylbromide acts only at the site of spasm seems controversial, since M-cholinergic receptors are not located locally.

From the point of view of the breadth of effects on organs and systems of hyoscine, butyl bromide is no less effective than myotropic drugs (drotaverine (No-shpa)), but its action, unlike myotropic drugs, can increase the risks of its use: it should not be taken by children under 6 -years of age, simultaneously with antidepressants (especially tricyclics), antihistamines and antiarrhythmic drugs, as well as beta-agonists (high risk of negative interaction between these drugs). Hyoscine butylbromide, like other M-anticholinergics, worsens the condition of patients with reflux esophagitis, hiatal hernia due to relaxation of the lower esophageal sphincter and increased reflux of acidic contents into the esophagus. In elderly patients with chronic atonic constipation, in weakened patients, there is a risk of developing intestinal obstruction. In case of chronic lung diseases, when using M-anticholinergics, thickening of secretions may occur and the degree of bronchial obstruction may increase. In men, a decrease in potency is possible.

With prolonged use, the drug should be discontinued gradually; during treatment, it is strictly forbidden to drink alcoholic beverages, be in the hot sun, perform intense physical work or play sports (impairment of the functions of the sweat glands by the drug with simultaneous insolation can lead to heat stroke).

Thus, the status of hyoscine butyl bromide as an over-the-counter drug does not relieve the patient from the need for periodic medical monitoring. It is precisely these problems that are responsible for the fact that currently the M-anticholinergics known to us abroad are used less and less often. In addition, the severity of their effect depends on the initial tone of the parasympathetic nervous system, which determines significant individual differences in the effectiveness of drugs in patients with varying severity of vagotonia.

Phosphodiesterase inhibitors (PDEs)

The effect of traditional widely used antispasmodics, such as drotaverine (No-shpa), is based on the suppression of PDE IV activity. Since PDE IV is present in smooth muscle cells along the entire length of the intestine, biliary and urinary tracts, its blockade with drotaverine (No-shpa) has a universal antispasmodic effect, regardless of the degree of contraction or the cause that caused it. Drotaverine, unlike hyoscine butylbromide and other myotropic antispasmodics, has anti-edematous and anti-inflammatory effects (type IV PDE is actively involved in the development of inflammation).

Pharmacodynamic properties underlie the pathogenetic therapeutic effect of drotaverine and are widely used not only to relieve acute spastic syndrome, but also to provide long-term pharmacotherapy, for example, with biliary dyskinesias, cholelithiasis, chronic intestinal diseases with spastic syndrome accompanied by colicky or bursting pain. The absence of anticholinergic activity has a positive effect on the safety of drotaverine, expanding the range of people to whom it can be prescribed, in particular, restrictions on use in children are lifted (possible from the age of one year), in elderly men with prostate pathology, as well as with concomitant pathology and when taken together with other drugs.

The therapeutic concentration of drotaverine in plasma when taken orally is observed within 45 minutes. After a single oral dose of 80 mg, maximum plasma concentration is achieved after 2 hours, and oral bioavailability is 60%. The drug penetrates well into various tissues, is metabolized (oxidized) almost completely to monophenolic compounds, the metabolites are quickly conjugated with glucuronic acid. The half-life is 16 hours. About 60% of drotaverine when taken orally is excreted through the gastrointestinal tract and up to 25% in the urine. The presence of a dosage form for both enteral and parenteral administration makes it possible to widely use the drug in an emergency situation, followed by a transition to oral administration for long-term use. Thus, parenteral administration of drotaverine (No-shpa) provides a quick and strong antispasmodic effect, which is especially important in the development of acute, intense colicky spastic pain.

Drotaverine (No-shpa, No-shpa forte) is effective in the treatment of various gastrointestinal diseases characterized by spasm of smooth muscles (biliary dyskinesia, spasm of the sphincter of Oddi, pylorospasm, irritable bowel syndrome), is actively used for urolithiasis, increased blood pressure, disorders of regional blood flow, including for self-medication.

In a double-blind, placebo-controlled clinical trial, the use of No-shpa significantly reduced pain in sphincter of Oddi dyskinesia in 60% of patients, while placebo did not affect the intensity of pain in 55% of cases. In this study, No-shpa turned out to be 2 times more effective than analgesics. The research results showed that No-Spa is the drug of choice for spasms of the smooth muscles of the biliary system, both for monotherapy and in combination with other drugs and surgical methods of treatment. In a double-blind, randomized, placebo-controlled study in 62 patients with irritable bowel syndrome and constipation, abdominal pain (by 47%) and flatulence significantly decreased during 8 weeks of treatment with No-shpa. In another randomized, double-blind study, the effectiveness of No-shpa was studied in 70 aged patients with irritable bowel syndrome for 4 weeks. The results showed that No-shpa significantly reduces the frequency of pain compared to placebo - by 47% (p < 0.001), flatulence by 21% and dyspepsia - by 20% (p < 0.001), improves passage time in the colon [11] .

Long-term use of the drug is safe, which is associated with the absence of an effect on cholinergic structures and significantly improves its tolerability. No-spa is included in the standards for the diagnosis and treatment of diseases of the digestive system approved in the Russian Federation.

Sodium channel blockers

The action is based on disrupting the depolarization of the membrane of smooth muscle cells of the gastrointestinal tract, reducing the permeability of the membrane to extracellular sodium and, in addition, indirectly suppressing the release of potassium from the cell. The result of this is a disruption of the depolarization process and blocking of intracellular calcium stores. The most well-known drug is the veratric acid derivative mebeverine. It binds to the molecular structures of sodium channels without affecting the cholinergic receptor, reduces the outflow of ionized potassium from the cell, and therefore eliminates spasm without causing hypotension of the colon [12]. Metabolized when passing through the intestinal wall and liver, drug metabolites are excreted in the urine.

Mebeverine is prescribed mainly for functional diseases of the gastrointestinal tract (non-ulcer dyspepsia, irritable bowel syndrome), as well as for secondary spasms caused by organic diseases of the intestines and biliary tract. It is used exclusively as planned, i.e., only a course of treatment is provided, unlike drotaverine, which can be used both for the relief and prevention of spastic pain.

The effectiveness of mebeverine is not always observed with monotherapy. Thus, in an extensive pharmacoepidemiological study [13], it was shown that in irritable bowel syndrome in comparison with control (standard therapy), it requires more joint drug support than in control, which leads to increased costs (Table 2).

From the table 2 it is clear that the odds ratio is always higher in the mebeverine group, which indicates a greater likelihood of prescribing concomitant pathogenetic therapy in comparison with traditional treatment. In addition, using a representative group (n = 3431), it was found that when using mebeverine, the likelihood of hospitalization for various diseases increases, which indicates the variability of the therapeutic effect of the drug and is accompanied by an increase in treatment costs (Table 3).

IN

The main indications for prescribing antispasmodics for diseases and conditions of internal organs have been formulated.

Conclusion

Pain is a universal symptom for a wide variety of lesions of internal organs; its occurrence is often based on spasm of smooth muscles. Knowledge of the clinical pharmacology of drugs in this group allows for the most targeted choice of drug. Using the pharmacodynamics of drugs, it becomes possible to combine them rationally, effectively and safely. Of the entire group of antispasmodic drugs, the most popular is drotaverine (No-spa), which meets the criteria of effectiveness, safety and cost-effectiveness to a greater extent than the others. A review of research results shows that No-Spa is effective both for the rapid relief of acute pain caused by spasms, and for a fairly long-term treatment of patients with chronic pathology. Unlike other antispasmodics, the effect of No-shpa is not limited to the gastrointestinal tract, which makes the drug universal for relieving spasmodic conditions of any origin and location and the associated pain syndrome. An important feature of the pharmacodynamics of No-shpa is the lack of effect on cholinergic structures, which makes the drug safer compared to M-anticholinergics. The mechanism of action, which is different from other drugs in the group, provides opportunities for a wide effective combination both within the group of antispasmodics and with drugs from other pharmacological groups (antisecretory, non-narcotic analgesics, opioids).

For questions regarding literature, please contact the editor.

M. V. Pchelintsev , Candidate of Medical Sciences, Associate Professor Institute of Pharmacology of St. Petersburg State Medical University named after. acad. I. P. Pavlova , St. Petersburg

What do No-Spa tablets help with?

The drug is taken in tablets, as well as in the form of injections (both intramuscularly and intravenously) to quickly relieve spasms of smooth muscles. This is necessary to relieve pain that manifests itself against the background of such diseases:

• pyelitis;
• cystitis;
• cholecystitis;
• papillitis;
• pnephrolithiasis;
• cholecystolithiasis;
• Urolithiasis

“No-Shpu” is also used to relieve spasms associated with pathologies of the stomach and intestines. Such symptoms may occur due to constipation, ulcers, colitis, IBS and other disorders. Another indication for use is headache and dysmenorrhea. However, in this case, the drug will only work if the pain is associated with vasospasm (felt like tension in the head).

In ordinary cases, the “No-Shpa” form is used. An increased concentration in the composition of the drug “No-Shpa Forte” is used if necessary to ensure a lasting long-term effect (for days, weeks in advance). Forte is also taken if it is necessary to reduce the frequency, for example, to 1 time per day.

Poisons are not a toy for adults

Admit it, each of us sometimes wanted to “die so that everyone would cry.” One of the most common ways to prove something to someone, take revenge and make them nervous is an attempt at poisoning. Alas, sad statistics show that dying from poison is not so easy. A much more likely prospect is to continue living on disability and regretting “what a fool I was.” So I warned you. And now I’ll tell you what to do with those who didn’t listen.

Juliet with no-shpa

One morning I was replacing a colleague. We stood in the smoking room, sharing the latest news.

“What, how did it go?” I asked, passively inhaling the aroma of nicotine tar. “It was a lousy shift,” a fellow resuscitator exhaled a portion of smoke sadly. - What's wrong? “I didn’t sleep half the night, they brought a knife to my stomach.” After the operation, while blood and plasma were infused, treatment was prescribed, it was already three nights. Lie down. Half an hour of rest and the call again - the receiver calls,” here he grinned slyly, “they brought a girl and a guy, she’s in snot and tears, the second one is pale, shaking. - What, love wasn’t shared? “Yeah, stupid,” she swallowed the pills. Blood pressure is normal, conscious... - Why come to us? “So I ask the short-lived people: “Why come to us?” Those: “well, like some kind of order, the young girl will suddenly die”...

They took me to the intensive care unit, I asked: “What did you swallow?”, she rubbed away her tears, sat pale: “I-I took five tablets of no-shpa and five charcoal.” "Yo Mama!" - I burst out. They were scared. Guy: “What, doctor, is everything so serious?” I told him: “It’s a complete mess! I don’t know how this could end!” The lady turned paler than ever and began to tremble. Guy: “Doctor, please save my girlfriend! It's my fault! Help!”...

It’s funny now, but then I was as angry as a dog: I pulled my gloves up to my elbows, found the thickest gastric tube, put on an apron, and screwed the tube into her as hard as possible. They managed to substitute a basin in time, the thin girl folded in half and vomited. The probe fell into the basin... I took out this dirty hose, all the liquid was draining from it. She told me with tears in her eyes: “A-are you going to shove this at me again?” “But of course!” – I grinned, wiped it with a rag and again forced the rubber snake to swallow.

- Well, you give it! – I laughed. - Well, what? There’s no point in playing suicide at night,” he grinned, putting out his cigarette.

"Weapons of Cowards and Women"

Since time immemorial, people have used plant extracts, the mucus of poisonous frogs, and chemical compounds to kill their enemies. Women dropped belladonna into their eyes “for the beauty of the eyes.” Men of the New World used curare poison to kill animals. Kings and courtiers poisoned each other with plant poisons. Opium was the drug of choice in the Middle East.

There have always been poisons. Some were transformed into medicines, others remained poisons. Time passes, but life turns out to be not so changeable, and we encounter poisons everywhere (acids, alkalis, cleaning products, varnishes, paints and much more).

As a resuscitator, this topic, on the one hand, is close to me, but on the other hand, it remains the dark side of the profession. Close - because the drugs we use are overwhelmingly potent and poisonous, and any mistake can cost the life of our patient.

The problem is that knowledge is sometimes powerless, especially when a patient admitted in a comatose state is not able to explain the cause of his condition. And it is not always possible to find out the type of poison “by eye”.

Although some symptoms scream about themselves. Let’s say there is an overdose of opiates: the patient breathes every once in a while, the mucous membranes are cyanotic, and most importantly, the pupils are narrow and pinpointed. Those poisoned by carbon monoxide are always pink, from altered hemoglobin, unable to carry oxygen. Fortunately, if relatives bring packages of medications, they will report inhalation of toxic fumes. But all this is rare.

In the vast majority of cases, we work by touch. Of course, we take tests of gastric contents, blood, urine, but when will these tests be ready? A week later! And even later. And the patient must be saved now!

Often the poison, like the Moor, has done its job and left, triggering a set of reactions leading to multiple organ failure. And we are not “Doctor Houses”; we do not have the opportunity or time to crawl through apartments and examine the contents of cellars. Therefore, I’m not going to fill your heads with secret antidotes, I’ll just tell you about the basics of detoxification.

In general, now I’ll tell you in detail what to do when someone accidentally or not very well, in everyday life, swallowed or sniffed, or spilled some nasty stuff on themselves. About what you can do at home without harming the health of the victim.

While the ambulance is on the way

Poisoning with acids and alkalis.

I combined them as cauterizing poisons. Yes, alkalis cause liquefaction necrosis, and acids cause coagulation necrosis, causing more superficial tissue damage. But let the professionals understand these subtleties.

It is important for you: if this is a skin lesion, you need to rinse the affected surfaces with a stream of plain clean water and consult a doctor. If you take poison internally, drink water. Not soda, not acid, but ordinary water!

Under no circumstances should soda be used for acetic acid poisoning, although in chemistry lessons we conducted experiments on neutralizing acids with alkalis. And all because all reactions proceed with the release of a large amount of heat.

Do not induce vomiting, as burns can spread to the respiratory tract and vomiting can injure the mucous membranes and cause bleeding. You can drink Almagel, or Novocaine. But be sure to call an ambulance as soon as possible!

I don’t know what motivates suicidal people when they drink vinegar essence, but the fact that they are dooming themselves to torment is one hundred percent. And it is far from certain that death will occur. But the fact is that there will be wild pains that cannot be controlled by drugs, there will be a narrowing of the esophagus, there will be bougienage, there will be feeding through a hole in the stomach if the expansion of the esophagus does not help. Very often, cancer grows at the site of the altered esophagus...

In general, I repeat, to save the sufferer, use just water and no chemicals.

A small lyrical digression.

The further science goes, the easier it is to treat. Back at the beginning of this century, when liquid starches appeared, we literally prayed for them. The head of the department took this miracle drug out of the safe, and we fell on our faces. They pulled a match to see who would get this life-giving moisture today, who would come out of the coma today. And then the whole crowd walked and contemplated how the moisture sparkling in the morning dawn poured in drop by drop. Drip-drip-drip... We stood and watched and... nothing happened.

Moreover, as it turned out, this starch preparation is not without side effects and we are now using it strictly according to indications. Resistance to antibacterial drugs of the latest generations is still developing. All cerebroprotectors turned out to be ineffective. But the water... the water remained. Salty, sweet, it became the basis of our resuscitation care.

So don't make things up! Treat with water! And we, with our clinical and pharmacological knowledge, will... also treat with water, and something else.

Poisoning with pills.

Here, as much as possible, you need to find out what you took, when you took it, the total dose, in order to inform the doctor as accurately as possible. If you see a victim, he feels bad, there are tubes of pills nearby - call an ambulance!

If the patient is conscious

, simply trigger the gag reflex by irritating the back wall of the throat. Let him drink water - and he will vomit again. Gastric lavage is one of the main methods of detoxification. Even if a lot of time has passed and the poison has been absorbed, by washing the stomach, removing gastric contents along with the released toxin, even in such a household way, you will reduce the total concentration of the drug in the body. After gastric lavage, you can force him to take banal charcoal tablets.

If a person loses consciousness

, then, on the contrary, do not induce vomiting under any circumstances! In this state, protective reflexes are impaired, and all this nasty stuff can fly into the lung, aggravating the situation. In this case, we, resuscitators, first insert a tube into the trachea, protect the airways, and only then rinse the stomach with water.

Methyl alcohol, ethylene glycol or brake fluid

. It's more difficult with them. The fact is that they, in fact, are not poisonous, but as a result of the so-called “lethal synthesis”, thanks to the enzyme - alcohol dehydrogenase, toxic substances are formed. Formaldehyde and formic acid are formed from methanol. They are extremely toxic, 100 ml is considered lethal! The central nervous system and retina of the eye are affected, causing blindness.

Ethylene glycol breaks down to glycolaldehyde, glyoxal and oxaloacetic acid. These substances primarily affect the brain and kidneys.

Why did I dwell on metabolism in such detail? Yes, because for these poisonings you can prescribe an antidote. This antidote is ethyl alcohol, drinking alcohol or just good vodka. It is high-quality alcohol that will competitively bind to alcohol dehydrogenase and prevent lethal metabolism. Make him drink a glass of vodka before the ambulance arrives. Of course, if the patient is conscious.

If the victim is in a coma, that is, you cannot wake him up, he does not open his eyes, and is not available for contact - under no circumstances induce vomiting! Don't force him to drink anything. Just turn on your side, thereby making breathing easier and preventing vomit from entering the trachea.

Carbon monoxide poisoning

. And in general any gases. Be sure to pull the victim away from the source of poisoning and give him the opportunity to breathe fresh air. And be sure to call an ambulance!

Opiate poisoning

. I have already mentioned these substances. Symptoms: the patient does not breathe or breathes shallowly, the mucous membranes are bluish. Take a breath for him. It's simple: tilt your head back, open your mouth slightly, put on a scarf, pinch your nose, take a deep breath and exhale into the victim. You should see how the chest rises and he passively exhales and inhales again.

Call an ambulance! Emergency doctors have an antidote - naloxone, and there are means for artificial ventilation of the lungs. Until the ambulance arrives, you will have to breathe for him on your own. You can try to stir him up, rub his ears - he’s not waking up, he’s not breathing? Keep breathing yourself.

And once again I ask - do not invent a bicycle, do not remember the school chemistry course! Let the professionals handle the antidotes. "DO NO HARM!" – should be your and our motto.

Appreciate life, it is beautiful! Time smooths out a lot and changes a lot. Don't do things that you or your family will regret... Be healthy!

Vladimir Shpinev

Photo thinkstockphotos.com

Contraindications for use

Contraindications to the use of the drug are the following diseases and features:

• low cardiac output;
• severe kidney and liver diseases (failure);
• hypersensitivity to the active substance (drotaverine) or to other components in the tablet;
• lactase deficiency (metabolism disorders of galactose and glucose).

During pregnancy (any period), the drug is taken with caution; similar recommendations are for children and people with low blood pressure. It is recommended to consult your doctor first.

Side effects from taking No-Shpa tablets

In most cases, no side effects are observed. But with long-term use, as well as due to the individual characteristics of the body and human condition, the following consequences may appear:

• increased heart rate;
• sleep disorders;
• headaches;
• dizziness;
• decreased blood pressure;
• nausea;
• bowel dysfunction (constipation);
• allergic reactions.

If an injection is administered, a local reaction (redness, foreign sensations) may additionally be observed.

What do you need to know before you start taking No-shpa?

Despite the fact that No-shpa is a fairly safe drug, its use is still contraindicated for people with the following conditions:

• severe kidney, liver and heart failure;
• low blood pressure;
• patients who are allergic to drotaverine;
• women who are breastfeeding;
• children whose age is less than 1 year.

Before using No-shpa, consult your family doctor.

No-Spa does not affect the reaction speed, but if you feel dizziness or other side effects, then do not drive or use complex mechanisms and devices.

Note!

If you suffer from lactose intolerance, then consult your doctor before using No-Spa, because each tablet contains 52 mg of lactose.

Instructions for use "No-Shpa"

Dosage and rules of administration depend on the form of the drug and the age of the person:

1. The daily dosage of the active substance for an adult is in the range of 120-240 mg, which corresponds to 3-6 tablets of the regular drug and 2-3 tablets of the “Forte” variety. In this case, it is allowed to consume no more than 40 mg at a time, i.e. maximum 2 tablets.
2. For children under 11 years of age inclusive, the optimal dose is 80 mg - this amount is taken 2 times a day.
3. For older children, a dose of 160 mg is indicated, divided into 2-4 times.

The general course of therapy (with self-treatment) is no more than 2 days. If during this time your health does not improve, you need to contact a specialist for a possible replacement of the drug and diagnostics. If No-Shpa is used as an additional medication as part of complex therapy, then the course without consulting a specialist can last up to 3 days.

Interaction of No-shpa with other drugs and substances

Tell your doctor if you are taking, have recently taken, or are about to take any other medications, as the medications may be incompatible with each other.

In case of simultaneous use with other medications taken for a long time, seek advice from your doctor before taking No-shpa.

No-spa interacts with the following medications:

• Levodopa - No-spa can increase muscle tone and tremors);
• antispasmodics (Papaverine, Bendazole) and Phenobarbital - the antispasmodic effect may increase;
• Morphine - its spasmogenic activity may decrease when interacting with No-shpa.

special instructions

No-Shpa contains lactose, so patients with impaired absorption of glucose and galactose should take the tablets with caution and only after the doctor’s approval.

If the solution is administered intravenously, the patient should lie down for several minutes at rest. If you have high blood pressure, use is allowed only in consultation with your doctor.

The injection solution contains sodium metabisulfite, which can cause an allergic reaction. In rare cases (especially in the presence of bronchial asthma, chronic allergies), bronchospasm and the onset of individual signs of anaphylactic shock are possible.

Pharmacokinetics

Absorption

Compared with papaverine, drotaverine, when taken orally, is absorbed faster and more completely from the gastrointestinal tract. After first-pass metabolism, 65% of the administered dose of drotaverine enters the systemic circulation. The maximum concentration (Cmax) of drotaverine in blood plasma is reached after 45-60 minutes.

Distribution

In vitro, drotaverine has a high binding to plasma proteins (95-98%), especially with albumin, γ- and β-globulins.

Drotaverine is evenly distributed in tissues and penetrates smooth muscle cells. Does not penetrate the blood-brain barrier. Drotaverine and/or its metabolites may slightly penetrate the placental barrier.

Metabolism

Drotaverine is almost completely metabolized in the liver.