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Trade namesPavabid, others
  • 1-(3,4-Dimethoxybenzyl)-7,8-dimethoxyisoquinoline
Clinical data
Drug classVasodilator[1]
Main usesArterial spasm, erectile dysfunction (ED)[1]
Side effectsNausea, constipation, headache, abdominal pain, flushing, low blood pressure, priapism[1]
  • AU: A
  • US: C (Risk not ruled out)
Routes of
By mouth, intravenous, intramuscular, rectal, intracavernosal
External links
Legal status
Protein binding~90%
Elimination half-life1.5–2 hours
Chemical and physical data
Molar mass339.391 g·mol−1
3D model (JSmol)
  • COc1ccc(cc1OC)Cc2c3cc(c(cc3ccn2)OC)OC
  • InChI=1S/C20H21NO4/c1-22-17-6-5-13(10-18(17)23-2)9-16-15-12-20(25-4)19(24-3)11-14(15)7-8-21-16/h5-8,10-12H,9H2,1-4H3 checkY

Papaverine is a medication primarily used to treat arterial spasm and erectile dysfunction (ED).[1] It is not a first line agent for ED.[1] Other uses have include painful periods and gastrointestinal spasms.[1] It is given by mouth or by injection.[1] Onset is relatively rapid and lasts for hours.[1]

Common side effects include nausea, constipation, headache, abdominal pain, flushing, low blood pressure, and priapism.[1] Other side effects may include respiratory arrest, liver problems, abuse, and arrhythmia.[1] Safety in pregnancy is unclear.[2]

Papaverine was first isolated in 1848 from opium.[3] Despite being from opium it contains no opioid activity.[4] In the United States a 60 mg dose costs about 40 USD as of 2021.[5]

Medical uses

Papaverine is approved to treat spasms of the gastrointestinal tract, bile ducts and ureter and for use as a cerebral and coronary vasodilator in subarachnoid hemorrhage (combined with balloon angioplasty)[6] and coronary artery bypass surgery.[7] Papaverine may also be used as a smooth muscle relaxant in microsurgery where it is applied directly to blood vessels.

Papaverine is used as an erectile dysfunction drug, alone or sometimes in combination.[8][9] Papaverine, when injected in penile tissue, causes direct smooth muscle relaxation and consequent filling of the corpus cavernosum with blood resulting in erection. A topical gel is also available for ED treatment.[10]

It is also commonly used in cryopreservation of blood vessels along with the other glycosaminoglycans and protein suspensions.[11][12] Functions as a vasodilator during cryopreservation when used in conjunction with verapamil, phentolamine, nifedipine, tolazoline or nitroprusside.[13][14]

Papaverine is also being investigated as a topical growth factor in tissue expansion with some success.[15]

Papaverine is used as an off-label prophylaxis (preventative) of migraine headaches.[16][17][18] It is not a first line drug such as a few beta blockers, calcium channel blockers, tricyclic antidepressants, and some anticonvulsants such as divalproex, but rather when these first line drugs and secondary drugs such as SSRIs, angiotensin II receptor antagonists, etc. fail in the prophylaxis of migraines, have intolerable side effects or are contraindicated.

Papaverine is also present in combinations of opium alkaloid salts such as papaveretum (Omnopon, Pantopon) and others, along with morphine, codeine, and in some cases noscapine and others in a percentage similar to that in opium, or modified for a given application.

Papaverine is found as a contaminant in some heroin[19] and can be used by forensic laboratories in heroin profiling to identify its source.[20] The metabolites can also be found in the urine of heroin users, allowing street heroin to be distinguished from pharmaceutical diacetylmorphine.[21]


For arterial spasm it is taken by mouth mouth at a dose of 150 to 300 mg twice per day.[1] Or by injection at 30 mg to 120 mg.[1] For ED a dose of 2.5 to 37.5 mg is used.[1]

Side effects

Frequent side effects of papaverine treatment include polymorphic ventricular tachycardia, constipation, interference with sulphobromophthalein[22] retention test (used to determine hepatic function), increased transaminase levels, increased alkaline phosphatase levels, somnolence, and vertigo.

Rare side effects include flushing of the face, hyperhidrosis (excessive sweating), cutaneous eruption, arterial hypotension, tachycardia, loss of appetite, jaundice, eosinophilia, thrombopenia, mixed hepatitis, headache, allergic reaction, chronic active hepatitis, and paradoxical aggravation of cerebral vasospasm.[23]

Papaverine in the plant Sauropus androgynus is linked to bronchiolitis obliterans.[24]


The in vivo mechanism of action is not entirely clear, but an inhibition of the enzyme phosphodiesterase causing elevation of cyclic AMP and cyclic GMP[clarification needed] levels is significant. It may also alter mitochondrial respiration.

Papaverine has also been demonstrated to be a selective phosphodiesterase inhibitor for the PDE10A subtype found mainly in the striatum of the brain. When administered chronically to mice, it produced motor and cognitive deficits and increased anxiety, but conversely may produce an antipsychotic effect,[25][26] although not all studies support this view.[27]


Capsule of Papaver somniferum showing latex (opium) exuding from incision. Papaverine occurs naturally in opium.

Papaverine was discovered in 1848 by Georg Merck (1825–1873).[28] Merck was a student of the German chemists Justus von Liebig and August Hofmann, and he was the son of Emanuel Merck (1794–1855), founder of the Merck corporation, a major German chemical and pharmaceutical company.[29]

Society and culture

The name "papaverine" is from Latin papaver meaning "poppy".


Papaverine is available as a conjugate of hydrochloride, codecarboxylate, adenylate, and teprosylate. It was also once available as a salt of hydrobromide, camsylate, cromesilate, nicotinate, and amygdalic acid|phenylglycolate. The hydrochloride salt is available for intramuscular, intravenous, rectal and oral administration. The teprosylate is available in intravenous, intramuscular, and orally administered formulations. The codecarboxylate is available in oral form, only, as is the adenylate.

The codecarboxylate is sold under the name Albatran,[30] the adenylate as Dicertan,[31] and the hydrochloride salt is sold variously as Artegodan (Germany), Cardioverina (countries outside Europe and the United States), Dispamil (countries outside Europe and the United States), Opdensit (Germany), Panergon (Germany), Paverina Houde (Italy, Belgium), Pavacap (United States), Pavadyl (United States), Papaverine (Israel), Papaverin-Hamelin (Germany), Paveron (Germany), Spasmo-Nit (Germany), Cardiospan, Papaversan, Cepaverin, Cerespan, Drapavel, Forpaven, Papalease, Pavatest, Paverolan, Therapav (Canada[32]), Vasospan, Cerebid, Delapav, Dilaves, Durapav, Dynovas, Optenyl, Pameion, Papacon, Pavabid, Pavacen, Pavakey, Pavased, Pavnell, Alapav, Myobid, Vasal, Pamelon, Pavadel, Pavagen, Ro-Papav, Vaso-Pav, Papanerin-hcl, Qua bid, Papital T.R., Paptial T.R., Pap-Kaps-150.[33] In Hungary, papaverine and homatropine methylbromide are used in mild drugs that help "flush" the bile.[34]


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 "Papaverine Monograph for Professionals". Archived from the original on 8 June 2021. Retrieved 26 October 2021.
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  3. Hanessian, Stephen (18 December 2013). Natural Products in Medicinal Chemistry. John Wiley & Sons. p. 227. ISBN 978-3-527-67655-2. Archived from the original on 26 October 2021. Retrieved 26 October 2021.
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External links