Myotropic antispasmodics
ATC code: A03AD02 (Drotaverine)
Inhibits phosphodiesterase 4 (PDE-4) in smooth muscle. Reduces intracellular calcium concentration and causes relaxation of smooth muscles in the GI tract, biliary system, urinary tract, and uterus. Does not affect skeletal muscles and has no anticholinergic activity.
Adjunct
Symptomatic relief of abdominal smooth muscle spasm – intestinal colic, biliary colic, renal colic. Does not address the underlying cause. Drotaverine is not mentioned in international guidelines by , , or . The evidence base is limited to older, low-quality studies. Widely used in Russia and CIS countries.
Adjunct
Adjunctive agent for dysmenorrhea. First-line is NSAIDs (ibuprofen, naproxen), which suppress prostaglandin synthesis. Drotaverine relieves uterine spasm but does not affect inflammation. Several small RCTs showed pain relief, but study quality was low.
Safety data in pregnancy are limited. In Russian practice, it is used for threatened abortion to reduce uterine tone. This use is not described in international guidelines.
drotaverine is evaluated for the following indications with varying evidence strength: Dysmenorrhea (evidence tier B), Abdominal smooth muscle spasm (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of drotaverine (≥ 1 in 100): Headache, Dizziness, Nausea, Hypotension. See the Safety section for uncommon and serious reactions.
Safety data in pregnancy are limited. In Russian practice, it is used for threatened abortion to reduce uterine tone. This use is not described in international guidelines.
drotaverine is contraindicated in: Severe hepatic or renal insufficiency; Severe heart failure (low cardiac output syndrome); Hypersensitivity to drotaverine; Breastfeeding (insufficient data). Full list in the Safety section.