General

Canada-Approved Medicine

This monograph describes a medication approved for use in Canada by the Therapeutic Products Directorate, a division of Health Canada’s Health Products and Food Branch. The medication is not approved by the United States Food and Drug Administration; however, a similar formulation carrying a different generic or brand name might be available in the US.

Pronunciation:
pin-ah-veer-ee-um

Trade Name(s)

• Dicetel 

Ther. Class.
anti irritable bowel syndrome agents

Pharm. Class.
calcium channel blockers

Indications

• Management of symptoms of irritable bowel syndrome (IBS) including abdominal pain, bowel disturbances and discomfort.
• Treatment of symptoms related to biliary tract disorders.

Action

• Acts as a calcium channel blocker with specific selectivity for intestinal smooth muscle.
• Relaxes gastrointestinal (mainly colon) and biliary tracts, inhibits colonic motor response to food/pharmacologic stimulation.

Therapeutic Effect(s):

Decreased symptoms of IBS.

Pharmacokinetics

Absorption: Poorly absorbed (1–10%).

Distribution: Distributes selectively to digestive tract.

Protein Binding: 97%.

Metabolism and Excretion: Minimal enterohepatic cycling, eliminated almost entirely in feces. Some metabolism.

Half-life: 1.5 hr.

TIME/ACTION PROFILE (blood levels)

Contraindication/Precautions

Contraindicated in:

• Known hypersensitivity;
• Galactose intolerance/Lapp lactase deficiency/glucose-galactose malabsorption (tablets contain lactose);
• Lactation: Avoid use if breast-feeding;
• Pedi:  Safety and effectiveness not established, use is not recommended.

Use Cautiously in:

• Pre-existing eosphageal lesions/hiatal hernia (glass of water and snack should be taken with each dose);
• OB:  Should be used only if essential to welfare of patient.

Adverse Reactions/Side Effects

All less than 1%

CNS: drowsiness, headache, vertigo

GI: constipation, diarrhea, distention, dry mouth, epigastric pain/fullness, esophageal irritation, nausea

Derm: rash

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Concurrent use of  anticholinergics  may ↑ spasmolytic effects.

Route/Dosage

PO (Adults): 50 mg 3 times daily; may be ↑ as needed/tolerated up to 100 mg 3 times daily.

Availability

Tablets (contain lactose): 50 mg, 100 mg

Assessment

• Assess for symptoms of IBS (abdominal pain or discomfort, bloating, constipation).
• Assess for lactose intolerance; product contains lactose.

Potential Diagnoses

• Acute pain
• Diarrhea

Implementation

• PO Administer tablet with a glass of water and food. Swallow tablet whole, do not crush, chew or suck. If >3 tablets/day prescribed, take additional tablets with glass of water and a snack. May be irritating to esophagus. Do not take the tablet while lying down or just before bedtime.

Patient/Family Teaching

• Instruct patient to take pinaverium as directed. Take missed doses as soon as remembered unless almost time for next dose; do not double doses.
• Caution patient to inform health care professional if the following side effects persist or worsen; stomach pain or fullness, nausea, constipation or diarrhea, heartburn, headache, dry mouth, dizziness, skin rash.
• Instruct patient to avoid alcohol intake while taking this medication.
• Advise female patient to inform health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

A decrease in symptoms of irritable bowel syndrome. The length of treatment depends on the condition being treated.