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Papaverine Injection

[14 July 2014]

Products Affected - Description

Papaverine injection, American Regent3
30 mg/mL, 2 mL single dose vial (NDC 00517-4002-25)
30 mg/mL, 10 mL vial (NDC 00517-4010-01)

Reason for the Shortage

  • Bedford and Sandoz have discontinued their papaverine presentations.1,2
  • American Regent, the sole supplier of papaverine injection, had temporarily suspended distribution of all drug products in April, 2011.
  • American Regent resumed manufacturing in Shirley, New York in early-May, 2011.

Available Products

There are insufficient supplies for usual ordering.

Estimated Resupply Dates

American Regent has papaverine 30 mg/mL 10 mL vials on back order and the company cannot estimate a release date. The 2 mL vials are available on allocation in limited supply.3

Implications for Patient Care

  • Papaverine hydrochloride is an unapproved drug. It is a phosphodiesterase inhibitor that relaxes smooth muscle of the vascular system (eg, large blood vessels), bronchial musculature, and the gastrointestinal, biliary, and urinary tracts. Papaverine is labeled for the management of smooth muscle spasm including vascular spasm from acute myocardial infarction, angina pectoris, pulmonary or peripheral embolism, peripheral vascular disease with vasospasm, and some cerebral angiospastic states, and visceral spasm such as ureteral, biliary or gastrointestinal colic.4-7
  • Unlabeled uses for papaverine include intracavernous injection for the treatment of erectile dysfunction, and topical administration in the perioperative setting to prevent spasm during coronary artery bypass grafting or arterial reconstruction.5,7-12

Alternative Agents & Management

  • Papaverine is used by Cardiothoracic and Vascular Surgeons perioperatively to prevent vasospasm and relax vascular grafts. It is a component of irrigation solutions or “vein bath” solutions. Consult with the surgeons at your institution for their recommendations on alternatives to papaverine. Other vasodilators, such as nitroglycerin alone or in combination with verapamil, have been used and may be suitable alternatives.7-16
  • Reserve papaverine injection for intraoperative use. Use alternative agents for the treatment of erectile dysfunction.5

Related Shortages

References

  1. Bedford Laboratories (personal communications). April 21, 2011.
  2. Sandoz (personal communications). April 22, 2011.
  3. American Regent (personal communications and website). April 21, May 6, July 22, September 14, October 3, 11, and 20, November 8, December 5, 2011; January 10 February 3, March 29, May 24, August 1, October 16, November 8, December 4 and 19, 2012; January 24, March 8, May 31, June 24, July 18 and 31, September 19, October 31, December 10, 2013; January 2, February 26, March 13 and 20, April 1 and 24, May 9, June 6, and July 14, 2014.
  4. American Regent. Papaverine hydrochloride injection [product information]. Shirley, NY: American Regent; January 2009.
  5. McEvoy GK, Snow EK, Kester L, Litvak K, Miller J, Welsh OH, eds. AHFS DI (Lexi-Comp Online). Bethesda, MD: American Society of Health-System Pharmacists; 2011.
  6. Wickersham RM, Novak KK, managing eds., eds. Drug Facts and Comparisons (eFacts). St. Louis, MO: Wolters Kluwer Health, Inc.; 2011.
  7. Anon. Drug Evaluation: Papaverine. In: Hutchison TA, Shahan DR, Anderson ML, eds. Drugdex System [internet database]. Greenwood Village, CO: Thomson Healthcare; 2011. Updated periodically.
  8. Rosenfeldt FL, He GW, Buxton BF, Angus JA. Pharmacology of coronary artery bypass grafts. Ann Thorac Surg. Mar 1999;67(3):878-888.
  9. Attaran S, John L, El-Gamel A. Clinical and potential use of pharmacological agents to reduce radial artery spasm in coronary artery surgery. Ann Thorac Surg. Apr 2008;85(4):1483-1489.
  10. Owens CD. Adaptive changes in autogenous vein grafts for arterial reconstruction: clinical implications. J Vasc Surg. 2010; Mar;51(3):736-746.
  11. Roubos N, Rosenfeldt FL, Richards SM, Conyers RA, Davis BB. Improved preservation of saphenous vein grafts by the use of glyceryl trinitrate-verapamil solution during harvesting. Circulation. Nov 1 1995;92(9 Suppl):II31-36.
  12. Adcock OT, Jr., Adcock GL, Wheeler JR, Gregory RT, Snyder SO, Jr., Gayle RG. Optimal techniques for harvesting and preparation of reversed autogenous vein grafts for use as arterial substitutes: a review. Surgery. Nov 1984;96(5):886-894.
  13. Chanda J, Canver C. Reversal of preexisting vasospasm in coronary artery conduits. Ann Thorac Surg 2001; 72:476-80.
  14. Mussa S, Guzik T, Black E et al. Comparative efficacies and durations of action of phenoxybenzamine, verapamil/nitroglycerin solution, and papaverine as topical antispasmodics for radial artery coronary bypass grafting. J Thorac Cardiovasc Surg 2003; 126:1798-805.
  15. He GW. Arterial grafts: clinical classification and pharmacological management. Ann Cardiothorac Surg 2013; 2(4):507-18.
  16. Rehman SM, Yi G, Taggart DP. The radial artery: current concepts on its use in coronary artery revascularization. Ann Thorac Surg 2013; 96:1900-9.

Updated

Updated July 14, 2014, by Michelle Wheeler, PharmD, Drug Information Specialist. Created May 3, 2011, by Jane Chandramouli, PharmD, Drug Information Specialist and Michelle Wheeler, PharmD, Drug Information Specialist. Copyright 2014, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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