Icatibant Acetate and Papaverine Hydrochloride

• Generic Name: icatibant
• Dosage Forms: n.a.
• Other Brand Names: Firazyr

Treatment of acute attacks of hereditary angioedema (HAE); designated an orphan drug by FDA for this use.

Currently not FDA-labeled or recommended for prophylaxis of HAE attacks.

• Generic Name: papaverine
• Dosage Forms: n.a.
• Other Brand Names:

  Para-Time SR

Relief of cerebral and peripheral ischemia associated with arterial spasm and myocardial ischemia complicated by arrhythmias.

Has been used IV and intra-arterially in treatment of acute vascular occlusion in conjunction with anticoagulants.

Treatment of angina pectoris; results not impressive at usual dosages. Not recommended as a substitute for nitroglycerin in anginal attacks.

Has been used in the treatment of other cardiovascular or vascular conditions including vascular encephalopathy associated with hypertensive disease, certain cerebral angiospastic states, and chronic peripheral vascular diseases (i.e., Raynaud’s syndrome, Buerger’s disease); however, use in these conditions has been superseded by more effective agents.

Self-treatment of erectile dysfunction (ED, impotence).

Has been used alone or in combination with phentolamine and/or alprostadil in patients with neurogenic and/or limited vasculogenic impotence or those with psychogenic impotence, but efficacy in patients with a vasculogenic component of their impotence may be variable depending on the extent and type of vascular dysfunction.

The goal of therapy is to provide an erection of adequate rigidity and duration to be sexually functional while avoiding prolonged erection or priapism.

Some experts (American Urological Association [AUA]) recommend that selective phosphodiesterase (PDE) type 5 inhibitor therapy (sildenafil, tadalafil, vardenafil) be offered as first-line erectile dysfunction treatment unless contraindicated.

Intracavernosal therapy with papaverine and/or other drugs generally reserved for patients who do not respond to psychotherapy/behavioral therapy, vacuum constriction devices, and/or selective PDE type 5 inhibitors and in whom attempts at identifying and modifying any drug-related (e.g., certain antihypertensive agents) or other potential reversible medical cause of erectile dysfunction have proved inadequate.

Some clinicians currently prefer alprostadil, alone or combined with other agents, when intracavernosal treatment of impotence is indicated because of possible improved efficacy and decreased adverse effects (e.g., priapism, fibrotic changes) compared with papaverine therapy.

Choice of therapy for erectile dysfunction should be individualized taking into account differences in response, tolerability and safety, administration considerations, cost and patient reimbursement factors, experience and judgment of the clinician, and individual patient and partner preference, expectations, and satisfaction.

Do not use for enhancing erections in men who are not impotent.

Has been used in the treatment of GI spasms, dysmenorrhea, biliary or ureteral colic, bronchial asthma, cardiac arrhythmias, and other pathologic conditions; however, insufficient evidence to establish therapeutic value.