No-spa is a very effective antispasmodic drug that helps eliminate fairly strong or moderate pain in the abdomen, which is mainly caused by cramps smooth muscle gastrointestinal tract.
The drug can significantly expand blood vessels in the cavity internal organs, as well as reduce increased peristalsis(functioning) of the intestines.
Main operating medicinal substance No-shpy is drotaverine hydrochloride, which has a pronounced and fairly rapid antispasmodic effect (reduces muscle tone).
No-shpa is used for various acute or chronic diseases gastrointestinal tract, accompanied by abdominal pain (gastritis, pancreatitis, cholecystitis, etc.).
As a rule, the beginning therapeutic effect noted within 20-30 minutes. after internal administration of No-shpa and continues for 4-6 hours, depending on the severity and nature of pain.
Main indications for use of No-shpa:
Attention: Before long-term use of No-shpa, it is advisable to consult a gastroenterologist or therapist!
Available medicinal product in the form of tablets for oral (internal) administration, as well as a solution for intramuscular or intravenous administration.
For adults, the daily dose of No-shpa is from 3 to 6 tablets (120-240 mg), which is recommended to be taken 1-2 t. 2-3 r. daily with plenty of liquid.
Children over 6 years old medicinal dose No-shpa is 1 t. 2-3 r. per day depending on the specific age of the child. The total daily dose for children under 12 years of age should not exceed more than 120-160 mg.
At intramuscular injection The daily dose for adults is 2.0-4.0 ml. no more than 2-3 rubles. per day depending on the severity of pain.
The maximum duration of continuous treatment with this antispasmodic drug without prior consultation with a doctor should not exceed more than 2-3 days.
Most common adverse reactions after long-term use But there are problems.
Trade name: NO-SHPA ®
International (nonproprietary) name: Drotaverine
Dosage form : pills
Compound:
active ingredient: drotaverine hydrochloride - 40 mg;
excipients: magnesium stearate - 3 mg, talc - 4 mg, povidone - 6 mg,
corn starch - 35 mg, lactose monohydrate - 52 mg.
Description
Round biconvex tablets, yellow with a greenish or orangish tint, with spa engraving on one side.
Pharmacotherapeutic group:
Antispasmodic.
ATX code: A03A D02
Pharmacodynamics
Drotaverine is an isoquinoline derivative that exhibits a powerful antispasmodic effect on smooth muscle due to inhibition of the enzyme phosphodiesterase (PDE). The enzyme phosphodiesterase is necessary for the hydrolysis of cyclic adenosine monophosphate (cAMP) to adenosine monophosphate (AMP). Inhibition of the phosphodiesterase enzyme leads to increased concentrations of cAMP; which triggers the following cascade reaction: high concentrations of cAMP activate cAMP-dependent phosphorylation of myosin light chain kinase (MLCK). Phosphorylation of MLCK leads to a decrease in its affinity for the Ca 2+ -calmodulin complex, resulting in an inactivated form of MLCK supporting muscle relaxation. cAMP also affects the cytosolic concentration of Ca 2+ ion by stimulating the transport of Ca 2+ into the extracellular space and the sarcoplasmic reticulum. This lowering Ca 2+ ion concentration effect of drotaverine through cAMP explains the antagonistic effect of drotaverine towards Ca 2+.
In vitro, drotaverine inhibits the PDE IV isoenzyme without inhibiting the PDE III and PDEV isoenzymes. Therefore, the effectiveness of drotaverine depends on the concentration of PDE IV in tissues, the content of which varies in different tissues. PDE IV is most important for the suppression of smooth muscle contractility, and therefore selective inhibition of PDE IV may be useful for the treatment of hyperkinetic dyskinesias and various diseases accompanied by a spastic state of the gastrointestinal tract.
Hydrolysis of cAMP in the myocardium and vascular smooth muscles occurs mainly with the help of the PDE III isoenzyme, which explains the fact that with high antispasmodic activity, drotaverine has no serious side effects on the part of the heart and blood vessels and pronounced effects on the cardiovascular system.
Drotaverine is effective against smooth muscle spasms of both neurogenic and muscular origin. Regardless of type autonomic innervation drotaverine relaxes the smooth muscles of the gastrointestinal tract, biliary tract, and genitourinary system.
Pharmacokinetics
Absorption:
After oral administration, drotaverine is quickly and completely absorbed. After first-pass metabolism, 65% of the administered dose of drotaverine enters the systemic circulation. The maximum plasma concentration (Cmax) is reached after 45-60 minutes.
Distribution
In vitro, drotaverine has a high plasma binding (95-98%), especially with albumin γ and β-globumin.
Drotaverine is evenly distributed throughout the 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
In humans, drotaverine is almost completely metabolized in the liver by O-desethylation. Its metabolites quickly conjugate with glucuronic acid. The main metabolite is 4"-desethyldrotaverine, in addition to which 6-desethyldrotaverine and 4"-desethyldrotaveraldine have been identified.
Removal
In humans, a two-chamber test was used to evaluate the pharmacokinetics of drotaverine. mathematical model. The terminal half-life of plasma radioactivity was 16 hours.
Within 72 hours, drotaverine is almost completely eliminated from the body. More than 50% of drotaverine is excreted by the kidneys and about 30% through the gastrointestinal tract (excretion into bile). Drotaverine is mainly excreted in the form of metabolites; unchanged drotaverine is not detected in the urine.
Indications for use
As adjuvant therapy :
Contraindications
With caution:
For arterial hypotension.
In children (lack of clinical experience with use).
In pregnant women (see section “Pregnancy and lactation”).
Directions for use and doses
Adults
Typically, the average daily dose in adults is 120-240 mg (the daily dose is divided into 2-3 doses). Maximum single dose is 80 mg. The maximum daily dose is 240 mg.
Children
There have been no clinical studies using drotaverine in children.
In case of prescribing drotaverine to children:
For children from 6 to 12 years of age, the maximum daily dose is 80 mg, divided into 2 doses.
For children over 12 years of age, the maximum daily dose is 160 mg, divided into 2-4 doses. Duration of treatment without consulting a doctor
When taking the drug without consulting a doctor, the recommended duration of taking the drug is usually 1-2 days. If during this period pain syndrome does not decrease, the patient should consult a doctor to clarify the diagnosis and, if necessary, change therapy. In cases where drotaverine is used as an adjuvant therapy, the duration of treatment without consulting a doctor may be longer (2-3 days).
Performance Evaluation Method
If the patient can easily independently diagnose the symptoms of his disease, since they are well known to him, then the effectiveness of treatment, namely the disappearance of pain, can also be easily assessed by the patient. If within a few hours after taking the maximum single dose there is a moderate decrease in pain or no decrease in pain, or if the pain does not decrease significantly after taking the maximum daily dose, it is recommended to consult a doctor.
Below are adverse reactions, observed in clinical studies, divided by systems, organs, indicating the frequency of their occurrence in accordance with the following gradations: very frequent (≥ 10%), frequent (≥1%,<10); нечастые (≥0,1%, < 1%); редкие (≥0,01%, < 0,1%) и очень редкие, включая отдельные сообщения (< 0,01%), неизвестная частота (по имеющимся данным частоту определить нельзя).
From the cardiovascular system
Rare - increased heart rate, decreased blood pressure.
From the outside nervous system
Rare - headache, dizziness, insomnia.
From the gastrointestinal tract
Rare: nausea, constipation.
From the immune system
Rare - allergic reactions (angioedema, urticaria; rash, itching) (see section “Contraindications”).
Overdose
There are no data on drug overdose.
In case of overdose, patients should be under medical supervision and, if necessary, they should receive symptomatic treatment aimed at maintaining basic body functions, including artificial induction of vomiting or gastric lavage.
Interaction with other drugs
With levodopa
Phosphodiesterase inhibitors like papaverine reduce the antiparkinsonian effect of levodopa. When prescribing drotaverine simultaneously with levodopa, increased rigidity and tremor may occur. With other antispasmodics, including m-anticholinergics Mutual enhancement of antispasmodic action.
Drugs that are significantly bound to plasma proteins (more than 80%)
Drotaverine binds significantly to plasma proteins, mainly albumin,
γ and β-globulins (see section “Pharmacokinetics”). There are no data on the interaction of drotaverine. with drugs that are significantly bound to plasma proteins, however, there is a hypothetical possibility of their interaction with drotaverine at the level of protein binding (displacement of one of the drugs by another from protein binding and an increase in the concentration of the free fraction in the blood of the drug with a less strong protein binding), which is hypothetically may increase the risk of pharmacodynamic and/or toxic side effects of this drug.
Special instructions
No-shpa® 40 mg tablets contain 52 mg of lactose. This may cause gastrointestinal complaints in individuals who are lactose intolerant. This form is unacceptable for patients suffering from lactose deficiency, galactosemia or impaired glucose/galactose absorption syndrome (see section “Contraindications”).
Pregnancy and lactation
As animal reproduction experiments and retrospective studies of clinical data have shown, the use of drotaverine during pregnancy does not lead to either teratogenic or embryotoxic effects. However, the use of the drug is recommended only after carefully weighing the balance of benefits and risks.
Due to the lack of necessary clinical data, it is not recommended to prescribe during lactation.
Impact on the ability to drive a car and other mechanisms
When taken orally in therapeutic doses, drotaverine does not affect the ability to drive a car or perform work that requires increased attention. If any side effects occur, the issue of driving and operating machinery requires individual consideration. If dizziness occurs after taking the drug, you should avoid engaging in potentially hazardous activities, such as driving a car or operating machinery.
Release form
Tablets 40 mg.
6, 10 or 20 tablets in a PVC/Aluminium blister.
1, 2,4 or 5 blisters of 6 tablets each with instructions for use in a cardboard box.
3 blisters of 10 tablets each with instructions for use in a cardboard box.
1 blister of 20 tablets with instructions for use in a cardboard box.
10 tablets per blister Aluminum/Aluminium (laminated with polymer).
2 blisters with instructions for use in a cardboard box.
60 or 64 tablets in a polypropylene bottle with a polyethylene stopper,
equipped with a piece dispenser.
100 tablets in a polypropylene bottle with a polyethylene stopper.
1 bottle with instructions for use in a cardboard box.
Best before date
For tablets in Aluminum/Aluminium blisters: 5 years. For tablets in PVC/Aluminium blisters: 3 years.
For tablets in bottles: 5 years.
Do not use the drug after the expiration date indicated on the package.
Storage conditions
For tablets in Aluminum/Aluminium blisters: store at a temperature not exceeding 30 °C.
For tablets in PVC/Aluminium blisters: store at a temperature not exceeding 25 °C. For tablets in vials: store in a place protected from light at a temperature of 15°C to 25°C. Keep out of the reach of children.
Conditions for dispensing from pharmacies
Over the counter
Manufacturer
Hinoin Pharmaceutical and Chemical Products Plant JSC, Hungary st. Levay 5,2112 Veresedház, Hungary.
Consumer complaints should be sent to the following address in Russia:
115035, Moscow, st. Sadovnicheskaya, 82, building 2.
The medicine “No-shpa” is known to everyone. This is not surprising, since the product helps relieve pain caused by spasms in a matter of minutes. The medication is inexpensive, but it helps in a variety of cases, so doctors recommend always keeping it in your home medicine cabinet.
The composition of the drug is simple. It has only one active substance - drotaverine. This is what is responsible for the analgesic effect. All other ingredients of the composition may vary depending on the form of production of the drug. There are only two of them and both of them involve a systemic effect on the body.
Both pills and injections work the same way. The injection solution works quickly, but a person does not always have the opportunity to give an injection. In this case, you can take a pill to relieve pain.
The drug is famous for its antispasmodic effect. The main task of the active substance is to relax the muscles, which have reached a state of excessive tone. As a result, the motor activity of smooth muscle tissue is normalized, and dilation of blood vessels is also observed, since their walls are formed by muscle fibers.
The active substance is absorbed quickly into the bloodstream. Its maximum concentration in the blood can be recorded after 45–60 minutes. It acts for a long time, up to 6–8 hours, after which, if necessary, a repeat dose can be taken.
The medicine will be completely eliminated from the body within 72 hours. The entire incoming volume is metabolized. Most of it is utilized by the kidneys and urinary system. A certain amount of the spent drug leaves the body through the gastrointestinal tract by excretion into bile produced by the liver.
The popularity of the drug "No-Shpa" is explained by its high analgesic, tonic and diuretic effects. The root of the clinical effect is the relief of smooth muscle spasms. There are several forms of release of “No-Shpy” - in tablet form or in capsules, which are coated with a special enteric coating. There is also a solution for intravenous and intramuscular injection. Regardless of the form, the active ingredient is drotaverine.
"No-Shpa" acts quickly, and the effect lasts a long time, in comparison with similar drugs. The principle of action is as follows: the medicine prevents Ca+ from entering the smooth muscle cells, thereby dilating the blood vessels. All this causes a strong antispasmodic effect. Due to the acceleration of blood flow, increased work of the kidneys occurs, which has a diuretic effect. The speed of action is achieved by reducing the production of the PDE4 enzyme by drotaverine in the No-Shpy composition. This allows you to level out side effects regarding cardiovascular. It is important that the medicine does not penetrate the central nervous system. In some cases, the diuretic effect is considered a side effect.
The drug is used to cure any pain. Main conditions requiring application:
Before taking the medicine, you need to first consult a doctor. Injection use (in the form of a solution) accelerates the effect. The drug almost instantly relieves discomfort. But uncontrolled use is not recommended - a preliminary consultation with a doctor is required, who will prescribe the regimen and dose of No-Shpa. The dosage regimen varies depending on the disease. The average single dose is 40-80 mg, per day - no more than 240 mg (8 tablets). Depending on the situation, you need to take the medicine 3-6 times a day. The No-Shpy tablet will take effect half an hour after taking it, and after three hours the effect will reach its peak. Due to the diuretic effect, it is recommended to drink more water.
Women often buy No-Shpu during their menstrual periods to relieve pain and discomfort. However, it should be taken into account that if the pain is very severe and does not go away, in this case, choose another, more radical remedy. In other words, if the pain still does not go away after taking No-Shpa, it is better not to increase the dosage, but to take another drug.
Such medications are quite often used for headaches. But you should not take medicine for all pains. With migraine, the nature of the pain is completely different: the blood vessels dilate rather than narrow. If you take an antispasmodic, the symptoms may worsen. The medicine can reduce blood pressure. This can manifest itself as nausea, weakness, dizziness and, in extreme cases, loss of consciousness.
Pain in the abdominal area is suspicious, so it is better to go to the doctor immediately. Often, taking painkillers prevents specialists from making a correct diagnosis. In particular, a patient is admitted to the hospital with suspected appendicitis, but due to diarrhea (as a result of taking medication), doctors diagnose it as an intestinal infection. During pregnancy, No-Shpu should be taken only as prescribed by a doctor. The drug should not be taken during breastfeeding.
What scientific research says about the popular anti-spasm drug, No-shpe, what it has in common with Viagra, where autocracy reigns in our body and where is parliamentary democracy, how the medicine helps during childbirth and what does the lost chess talent have to do with it, read in the section “What are they treating us with?”
No-shpa is one of the most popular antispasmodics in Russia. However, it is practically not sold abroad anywhere except in the countries of Eastern Europe and Asia, and many English speakers write about its active ingredient only as an intravenous medicine to reduce pain during prolonged labor pains.
In Russia, No-shpa is included in the “List of Vital and Essential Medicines”. This list was created to regulate prices in pharmacies, so when choosing a medicine, you should not rely only on it. As we already found out in the case of , this also includes medications that cannot be unambiguously recommended as having definitively proven their effectiveness, and in some years - simply quack remedies.
But in the list of the World Health Organization and on the website of the American Food and Drug Administration, the drug is more likely to be found in quotations from the guidelines of individual countries, for example, Ethiopia or Afghanistan, which are unlikely to have the most exemplary level of medicine in the world.
Can No-shpa be used and for what purpose? What are the contraindications? What kind of pain is best left to non-steroidal anti-inflammatory drugs or analgin? Let's try to figure it out.
From what, from what?
The main active ingredient of No-shpa is drotaverine (in the form of hydrochloride), contained in tablets in an amount of 40 mg. This substance is a modification of papaverine - an antispasmodic and analgesic, which is produced from the opium poppy. Despite this, papaverine is very different in structure and properties from substances obtained from morphine. Papaverine was invented by Georg Merck, a student of the famous chemists Justus Liebig and Albert Hoffmann and the son of the same Emmanuel Merck who founded the famous German pharmaceutical corporation.
Structure of papaverine
Public domain
Both substances are similar in their formula: in the center there are the same three aromatic “rings”. Drotaverine was registered in Hungary at the dawn of the sixties of the last century by researchers from the Hinoin company. The medicine was called No-shpa (short for the Latin no spa - “no spasm”).
Structure of drotaverine
Public domain
According to the instructions, 65% of the dose taken enters the blood. A blood test can easily show whether drotaverine is in the blood. It reaches its maximum concentration after about 45-60 minutes, and is completely eliminated from the body after three days. This allows you to find out whether a person has taken the medicine and study how it is transported throughout the body and where it is broken down. Some manufacturers write (for example, in the “Pharmacokinetics” section) that their substances are not determined in the blood by available methods, which makes us wonder whether there is any active substance there at all, or whether we are faced with yet another homeopathy.
But what should he influence there? According to drug website DrugBank, drotaverine blocks the activity of phosphodiesterase type 4 (PDE 4). This same information is listed in the instructions and in the introduction to several scientific articles as known, but there are no articles that clearly describe the mechanism by which the drug binds to this enzyme.
The group of enzymes itself got its name in honor of phosphodiester bonds. The job of the FDE is to destroy these connections. Depending on the type, each of which has its own number, PDEs specialize in different molecules. Too active PDE activity can be associated with various diseases. Phosphodiesterase 3, for example, affects the contraction of the heart muscle. Its deficiency blocks the His bundle, which carries signals to the heart, which can cause it to stop. PDE 5 is affected by drugs to increase potency (for example, Sildenafil, which is sold under the brand name Viagra). The drug to block PDE 4 must be very specific so as not to cause serious side effects.
PDE 4 itself is involved in many reactions, including inflammatory processes (which is why drugs that suppress it are prescribed for pulmonary obstruction), Parkinson's disease and even schizophrenia. The target in which PDE 4 cleaves phosphodiester bonds is called cAMP - a derivative of ATP (the main molecule for storing energy in cells). Working at the beck and call of other hormones and molecules (in this case, the substance is called a second messenger), cAMP can activate calcium channels that allow positively charged calcium ions into the cell. Normally, there are more calcium ions outside the cell than inside. When Ca 2+ rushes into the cell, sodium channels in it are also activated. As a result, the charge of the cell changes, and since muscle contractions depend on this charge, the suppression of PDE 4 ultimately affects them. There are also several scientific works in favor of the hypothesis that drotaverine can act on calcium channels directly.
All human muscles are divided into three types. Cross-striped, also known as skeletal, are often attached to bones and are responsible for our movements. In the world of striated muscles there is complete authoritarianism: we can subordinate them to our direct will: raise a leg, wave a hand.
Striated muscles
In our hearts, on the contrary, parliamentary democracy reigns. The heart muscle consists of a special type of cells that are connected in a kind of network. Their electrical signals constantly excite neighboring cells to keep them contracting. The contractions themselves occur automatically and are initiated not only “from above”, but also by the heart’s own nerve fibers, therefore power in it is given to the “people” and elected representatives.
Smooth muscles are close in “degree of freedom” to the myocardium: they contract against our will, although they are controlled by many electrical and chemical signals, hormones, and the autonomic nervous system. But they do not have such developed “local self-government” as the heart has: the cells of these muscles are not connected by “bridges”. It is the layer of smooth muscles in the walls of blood vessels and hollow internal organs that causes them to contract, regulating blood flow, the expansion and contraction of the bronchi, the movement of food through the intestines and many other processes.
It is spasm (involuntary contraction) of smooth muscles, or more precisely, spasm of smooth muscles of the urinary tract and biliary tract that is considered the main indication for taking No-shpa according to the instructions. The drug is also recommended as an adjuvant for tension headaches caused by the fact that the head is in one position for a long time, and its muscles (here are no longer smooth, but striated) become numb, dysmenorrhea (menstrual pain), and spasms of the gastrointestinal tract.
Not on the lists
We've sorted out the theory, but what about clinical trials? Over more than half a century, a lot of them have been carried out. But most of them belong to the middle of the last century, when the requirements for testing new drugs before entering the market were completely different. Therefore, only a small number of articles about No-shpe and drotaverine meet the criteria that apply to modern drugs, that is, they relate to randomized, double-blind, placebo-controlled studies.
A double-blind, randomized, placebo-controlled method is a method of clinical drug research in which the subjects are not privy to important details of the study. “Double blind” means that neither the subjects nor the experimenters know who is being treated with what, “randomized” means that the assignment to groups is random, and placebo is used to show that the effect of the drug is not based on self-hypnosis and that This medicine helps better than a tablet without active ingredients. This method prevents subjective distortion of the results. Sometimes the control group is given another drug with proven effectiveness, rather than a placebo, to show that the drug not only treats better than nothing, but is superior to its analogues.
Let's consider those tests that meet these criteria. These include two studies evaluating the effectiveness of drotaverine in renal colic: the first - compared with placebo, the second - with diclofenac. Both studies showed an approximately 50% superiority of therapy with drotaverine when tapering, but in rather modest samples: in both cases, participants included about a hundred patients.
Indian scientists investigated whether drotaverine helps with recurring lower abdominal pain in children. Scientists analyzed the condition of 132 children aged 4 to 12 years, half of whom received syrup with dissolved drotaverine, and the other - just syrup. The children who received the medicine complained of pain less often and began to miss school less, although the number of days when they were pain-free was comparable in both groups. At the same time, the children in the drotaverine group were more active, their mood improved, and they began to eat better. Doctors concluded that the medicine is safe and effective.
Drotaverine was compared with placebo and in irritable bowel syndrome. The authors noted that thanks to it, pain attacks became less frequent and weaker, as observed by both patients and doctors (and, unlike a study with a similar design, the reviews of doctors and patients coincided).
A study of the effectiveness of combining drotaverine with aceclofenac compared with aceclofenac alone for menstrual pain showed that the combination helps patients cope with pain faster and better. But how is an honest double-blind study possible when patients in the first group receive one tablet, and the second - two? Scientists have found a way to deal with this by blinding both groups.
To do this, those who received only aceclofenac were given a second placebo tablet, which in appearance was indistinguishable from the tablet with drotaverine. Although the group size was small (100 people each), and the study was sponsored by the Indian manufacturers of the drug based on drotaverine, there are no particular complaints about the study design itself.
No-shpa: from birth to death
Despite the large number of different studies, there was only one review of them by the Cochrane Collaboration, and it was devoted to the effect of antispasmodics on labor pains.
The Cochrane Library is a database of the international non-profit organization Cochrane Collaboration, which participates in the development of guidelines for the World Health Organization. The organization's name comes from its founder, the 20th-century Scottish medical scientist Archibald Cochrane, who championed the need for evidence-based medicine and good clinical trials and wrote the book Efficiency and Effectiveness: Random Reflections on Health Care. Medical scientists and pharmacists consider the Cochrane Database to be one of the most authoritative sources of such information: the publications included in it have been selected according to the standards of evidence-based medicine and report the results of randomized, double-blind, placebo-controlled clinical trials.
cases of which are described in the scientific literature. According to relatives and according to the test results that were distributed in the media, it was because of an overdose of No-shpa that a very young chess player, Ivan Bukavshin, a member of the Russian youth team, who had repeatedly won prizes at world championships, died. The parents even stated that ill-wishers added No-shpa to their son’s food and drinks: a dose four times higher than the lethal dose, according to them, the athlete could not drink himself. We don’t know whether it was accidental poisoning, murder or suicide, but we do know for sure that an overdose of antispasmodics does not promise anything pleasant.
The main studies available today were on small samples, but overall they show the effectiveness of the drug. But do not forget that No-Spa is intended for pain associated with spasms of smooth muscles (for example, muscles of the bladder, bile ducts, intestines). It can help with cholecystitis, renal colic and menstrual pain, but, say, with a fracture, it is very unlikely. Therefore, if you have acute pain after surgery or any other pain that is not associated with spasms, you should turn to a different type of pain reliever, such as non-steroidal anti-inflammatory drugs.
Despite the selectivity of the drug’s action, its overdose has more than once led to cardiac arrest and other serious consequences, so you should not take risks by taking large doses of No-shpa (especially if you already have heart problems). If the prescribed dose does not help within two days, you should not increase it, but consult a doctor to determine the cause of the pain and treat it, rather than suppress the symptoms. Even with renal colic, in which No-shpa can play the role of an anesthetic, the patient still needs to be hospitalized, since this syndrome is a sign of a serious dysfunction of the organ, possibly the appearance of stones in the kidneys that require removal.
Hypersensitivity to any of the components of the drug, including auxiliary ones: glucose, galactose, corn starch and others, as well as acute renal and liver failure (drotaverine is broken down in these organs) should also force you to abandon the drug. The effect of No-shpa on small children (up to six years old), pregnant and lactating women has not been fully studied, so in these cases you need to consult a doctor who will decide whether this is a necessary measure or whether it is not worth exposing yourself or your child to danger.
No-spa also reduces the effect of levdopa (this drug is prescribed for Parkinson's disease), which should be taken into account by those who use this drug.
