Propiverine belongs to the group of active substances called spasmolytics and muscle relaxants. Preferably, this drug is prescribed for children with urinary incontinence.
What is propiverine?
Preferably, this medication is prescribed in children with urinary incontinence. Propiverine is also known by the alternative name propiverinum. This drug is classified under the drug groups of spasmolytics and muscle relaxants. Propiverine is the drug of first choice in children with urinary incontinence when it is caused by increased tension of the urinary muscle. In patients with overactive urinary bladder due to paraplegia, multiple sclerosis and spinal cord damage, this drug is also used. Propiverine has active metabolites that dock to muscarinic receptors (anticholinergic system) and in this way cause relaxation of the bladder. In vitro, a calcium antagonistic effect also occurs on the involved cells of the smooth muscle of the urinary bladder.
Pharmacological effects
Propiverine is preferably used in children with urinary incontinence. This incontinence is due to hyperexcitability of the urinary muscle, which causes abnormal urinary behavior, such as nocturnal enuresis, nocturnal urination (nocturia), sudden loss of urine, and leakage of small amounts of urine (pollakiuria). Often, patients with paraplegia, multiple sclerosis and spinal cord damage experience uncontrolled urinary behavior due to an overactive bladder. Propiverine is also the drug of first choice in these cases. A third area of application is in the treatment of bladder damage following surgical procedures and radiation. As a spasmolytic, propiverine acts directly on the activity of muscles and nerves. In the area of muscles, the drug becomes active on the muscle fibers of the hollow organs, which include the bladder. In the area of parasympathetic nerve fibers, which belong to the autonomic nervous system, propiverine with its anticholinergic effect displaces the endogenous messenger acetylcholine docked on the nerve fibers and prevents excessive excitation of these receptors, which leads to the undesirable reflex of excessive urination. The urge to urinate noticeably decreases and the urinary bladder records a greater filling capacity.
Medical application and use
Propiverine has a long half-life of 14 to 20 hours. One film-coated tablet contains 15 mg of propiverine hydrochloride. Taking one film-coated tablet twice daily is usually sufficient. Due to the favorable action profile, patients with minor symptoms can manage with one tablet daily. In the case of nerve-related disorders of bladder emptying, the daily dose may be increased to three tablets, corresponding to a maximum daily dose of 45 mg propiverine hydrochloride. Patients with renal dysfunction should not exceed a maximum daily dose of 30 mg. In children, treatment of overactive bladder should not begin before the age of five, as organ development is not complete at this age. Even though propiverine is the drug of first choice in children and is also considered to be well tolerated, treatment should only take place as part of an overall therapeutic concept (urotherapy). Overall, a low body weight of less than 35 kg is not suitable for the administration of film-coated tablets containing 15 mg of this active substance. In this case, film-coated tablets with a low propiverine content of 5 mg are prescribed. Dry mouth is described as the most common accompanying symptom when taking anticholinergic drugs. However, unlike oxybutynin, another active ingredient used in drug therapy for incontinence, propiverine is better tolerated. Physicians hypothesize that the rate of anticholinergic side effects will decrease because of the drug’s dual action.
Risks and side effects
Propiverine also lists risks and side effects that may constitute a contraindication. The drug should not be used in case of known hypersensitivity to the active substance. Patients with intestinal obstruction, lack of bowel movement (intestinal atony), inflammatory bowel disease, dilated colon due to bacterial colonization (toxic megacolon), and myasthenia gravis should not take propiverine. Other contraindications are liver dysfunction and glaucoma (narrow-angle glaucoma).A careful risk-benefit analysis must be performed in patients with renal and nerve dysfunction. In patients with narrow chamber angle of the anterior chamber, the drug may cause glaucoma attack due to its pupil dilating effect. Side effects may include various heart problems, heartburn, esophagitis, and benign enlargement of the prostate. Many patients suffer from visual disturbances, abdominal pain, digestive problems, decrease in visual acuity, fatigue and tiredness. Occasionally, lowering of blood pressure, tremors, dizziness, nausea, lightheadedness, urinary retention, and taste disturbances are possible. Nocturnal and frequent urination due to kidney disease, organic bladder disease, bladder cancer, and cardiac insufficiency are medical conditions not suitable for treatment with propiverine. During pregnancy and lactation, this agent is prescribed only after a strict risk-benefit analysis. Since the active ingredient is suitable for children, there are no fundamental contraindications. However, it is important to adjust the dose to the body weight of the young patient. With simultaneous intake of various psychotropic drugs such as tretracyclic antidepressants, benzodiazepines and neuroleptics, an effect amplification occurs. This also applies to concomitant use of muscle relaxant drugs such as muscarinic receptor antagonists. Patients undergoing treatment for cardiac arrhythmias, Parkinson’s disease, and asthma may take propiverine only after prior clarification by the treating physician. Combining propiverine and metoclopramide for gastrointestinal disorders decreases the effect of both drugs. Isoniazid used to treat tuberculosis may cause a drop in blood pressure. Taking propiverine may also impair reactions, especially when taken at the same time as central depressant medicines such as psychotropic drugs, to the extent that operating machinery and driving a car is not safe. Sometimes medicines can cause allergic reactions.
