Nefopam

1. Introduction

Nefopam is a centrally acting, non-opioid analgesic used for the treatment of moderate to severe pain. Unlike NSAIDs or opioids, it does not affect prostaglandin synthesis or interact with opioid receptors. Nefopam is often used in cases where NSAIDs are contraindicated or when an alternative to opioids is preferred.

2. Indications

• Acute and chronic pain management, including:
  • Postoperative pain
  • Musculoskeletal pain
  • Dental pain
  • Cancer pain (adjunctive therapy)

3. Dosage

Adults (≥18 years):

• Initial dose: 30–60 mg three times daily.
• Maintenance dose: 30–90 mg three times daily.
• Maximum dose: 180 mg/day.

Children (<18 years):

• Not recommended for use in children due to limited safety data.

Elderly:

• Start with a lower dose (30 mg twice daily) and adjust based on tolerance and response.

4. Administration

• Take orally with water.
• Can be taken with or without food.
• Avoid crushing or chewing tablets to maintain the controlled-release properties.

5. Forms Available

• Tablets: 30 mg
• Injectable solution (off-label use): 20 mg/mL

6. Side Effects

6.1 Common Side Effects:

• Nausea
• Drowsiness
• Dry mouth
• Sweating

6.2 Less Common Side Effects:

• Dizziness
• Headache
• Palpitations

6.3 Rare but Serious Side Effects:

• Tachycardia
• Urinary retention
• Severe allergic reactions (e.g., rash, swelling, difficulty breathing)

7. Warnings

• Central Nervous System Effects: May cause drowsiness or dizziness; caution is advised when driving or operating machinery.
• Cardiac Effects: May increase heart rate; avoid use in patients with severe cardiac disease or tachyarrhythmias.
• Seizure Risk: Use cautiously in patients with a history of seizures or epilepsy, as nefopam lowers the seizure threshold.

8. Precautions

• Avoid use in patients with closed-angle glaucoma due to the risk of increased intraocular pressure.
• Use cautiously in patients with prostatic hypertrophy or urinary retention.
• Do not combine with monoamine oxidase inhibitors (MAOIs) due to the risk of serotonin syndrome.

9. Interactions

• MAOIs (e.g., phenelzine, tranylcypromine): Risk of serotonin syndrome; avoid concurrent use.
• CNS Depressants (e.g., benzodiazepines, alcohol): Increased sedation and drowsiness.
• Anticholinergic Drugs: Increased risk of side effects such as dry mouth, urinary retention, and blurred vision.

10. Monitoring Parameters

• Monitor pain relief and overall symptom improvement.
• Watch for signs of tachycardia or palpitations, particularly in patients with cardiac conditions.
• Assess for side effects such as dizziness or drowsiness that may impair daily activities.

11. Use in Children

• Not recommended for children under 18 years due to a lack of sufficient safety and efficacy data.

12. Use in Pregnancy

• Not recommended during pregnancy due to insufficient safety data. Use only if the potential benefits outweigh the risks.

13. Use in Elderly

• Initiate treatment at the lowest effective dose due to increased sensitivity to side effects, particularly dizziness and tachycardia.

14. Use in Kidney Disease

• Use with caution in patients with moderate to severe renal impairment. Adjust the dose based on renal function.

15. Use in Liver Disease

• Use cautiously in patients with liver impairment, as hepatic metabolism plays a role in nefopam clearance.

16. Patient Counselling Points

• Take nefopam exactly as prescribed, and do not exceed the recommended dose.
• Avoid driving or operating heavy machinery if you feel drowsy or dizzy.
• Do not combine with alcohol or sedatives, as this may increase drowsiness.
• Inform your doctor if you have a history of glaucoma, urinary retention, or seizures.
• Report any unusual symptoms, such as rapid heartbeat, difficulty urinating, or severe allergic reactions.

17. Table of Brand Names, Manufacturer, and Prices in USD

18. 15 FAQs (Frequently Asked Questions)

1. What is Nefopam used for?
Nefopam is used to treat moderate to severe pain, including postoperative, musculoskeletal, and chronic pain.

2. How does Nefopam work?
It is a centrally acting analgesic that modulates pain perception without affecting prostaglandins or opioid receptors.

3. Can Nefopam be used in children?
No, it is not recommended for use in children under 18 years due to limited safety data.

4. What is the usual dose of Nefopam?
The typical dose for adults is 30–90 mg three times daily, not exceeding 180 mg/day.

5. Can Nefopam cause drowsiness?
Yes, drowsiness is a common side effect. Avoid activities requiring alertness until you know how it affects you.

6. Can Nefopam be taken with NSAIDs or opioids?
Yes, it can be combined with other analgesics, but consult your doctor to ensure safety and avoid excessive sedation.

7. Can Nefopam be used during pregnancy?
It is not recommended during pregnancy due to insufficient safety data.

8. Does Nefopam cause addiction?
Nefopam is not classified as addictive, unlike opioids, but should still be used only as prescribed.

9. How long does Nefopam take to work?
It typically begins to relieve pain within 30–60 minutes of oral administration.

10. Can Nefopam cause tachycardia?
Yes, it may increase heart rate; inform your doctor if you experience palpitations or discomfort.

11. Can I drink alcohol while taking Nefopam?
No, alcohol can enhance sedation and other central nervous system effects.

12. Is Nefopam safe for elderly patients?
Yes, but start with a lower dose due to increased sensitivity to side effects like dizziness or tachycardia.

13. How should Nefopam be stored?
Store at room temperature, away from moisture and heat.

14. What should I do if I miss a dose?
Take it as soon as you remember, but skip it if it’s close to your next dose. Do not double the dose.

15. Is Nefopam available over the counter?
No, Nefopam is a prescription-only medication.