nefopam hydrochloride: clinical use

Prescribing considerations

• Evidence supporting chronic-pain use is limited; define treatment goals and review benefit and tolerability regularly.
• Older people may be more susceptible to confusion, hallucinations and other central adverse effects.
• Consider altered exposure in hepatic or renal impairment, particularly terminal renal insufficiency.
• Assess substance-use and mental-health history because dependence and abuse have been reported.
• Overdose may cause agitation, hallucinations, seizures, coma and marked tachycardia.

Contraindications and cautions

• History of a convulsive disorder
• Concurrent monoamine oxidase inhibitor treatment
• Hypersensitivity to nefopam or an excipient

Monitoring

• Pain response and continuing clinical need
• Confusion, hallucinations, dizziness and sedation
• Pulse, palpitations and other cardiovascular effects
• Urinary retention and anticholinergic effects
• Signs of dependence, misuse or withdrawal

Clinical pharmacology

Nefopam is a centrally acting non-opioid analgesic. It is absorbed through the gastrointestinal tract, extensively metabolised and eliminated mainly in urine; its mechanism appears to involve monoamine reuptake inhibition and central sodium and calcium channel effects.

Formulation and product differences

• The selected product is a white to off-white, round, biconvex film-coated oral tablet engraved “20” on one side and “G” on the other.
• It is supplied in aluminium blister packaging and contains hypromellose, polyethylene glycols and titanium dioxide in the coating.

Tablet

Route: Oral

Strengths: 30 mg, 60 mg