Drugs List

Therapeutic Indications

Uses

Pain - moderate

Contraindications

Children under 12 years
Within 2 weeks of discontinuing MAOIs
History of seizures
Myocardial infarction

Precautions and Warnings

Elderly
Breastfeeding
Hepatic impairment
Pregnancy
Renal impairment
Urinary retention

Advise ability to drive/operate machinery may be affected by side effects
Advise patient that this medicine may discolour the urine pink or orange
May affect results of some laboratory tests
Reduce dose in elderly

Pregnancy and Lactation

Pregnancy

Use nefopam with caution in pregnancy.

Safety has not been established. Avoid in pregnancy unless there is no alternative

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Nefopam is contraindicated in breastfeeding.

No information available so avoid breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Allergic reaction
Angioedema
Blurred vision
Confusion
Convulsions
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Gastro-intestinal disturbances
Hallucinations
Headache
Hypotension
Insomnia
Light-headedness
Nausea
Nervousness
Palpitations
Paraesthesia
Pink/orange urine
Sweating
Syncope
Tachycardia
Tremor
Urinary retention
Vomiting

Presentation

Oral formulation of nefopam

Drugs List

Therapeutic Indications

Uses

Pain - moderate

Dosage

Adults

Elderly

Children

Contraindications

Children under 12 years
Within 2 weeks of discontinuing MAOIs
History of seizures
Myocardial infarction

Precautions and Warnings

Elderly
Breastfeeding
Hepatic impairment
Pregnancy
Renal impairment
Urinary retention

Advise ability to drive/operate machinery may be affected by side effects
Advise patient that this medicine may discolour the urine pink or orange
May affect results of some laboratory tests
Reduce dose in elderly

Pregnancy and Lactation

Pregnancy

Use nefopam with caution in pregnancy.

Safety has not been established. Avoid in pregnancy unless there is no alternative

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Nefopam is contraindicated in breastfeeding.

No information available so avoid breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal pain
Allergic reaction
Angioedema
Blurred vision
Confusion
Convulsions
Diarrhoea
Dizziness
Drowsiness
Dry mouth
Gastro-intestinal disturbances
Hallucinations
Headache
Hypotension
Insomnia
Light-headedness
Nausea
Nervousness
Palpitations
Paraesthesia
Pink/orange urine
Sweating
Syncope
Tachycardia
Tremor
Urinary retention
Vomiting

Effects on Laboratory Tests

Nefopam may interfere with some screening tests for benzodiazepines and opioids. These tests for benzodiazepines and opioids may give a false positive result.

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet (https://www.toxbase.org/).

Further Information

Last Full Review Date: September 2014

Reference Sources

Summary of Product Characteristics, Acupan Tablets, 3M health Care Limited, February 25, 2013

Joint Formulary Committee. British National Formulary. 66th ed. London: BMJ Group and Pharmaceutical Press; 2013. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press Accessed on November 26, 2013.

Paediatric Formulary Committee. BNF for Children 2013-2014. London: BMJ Group, Pharmaceutical Press, and RCPCH Publications; 2013.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications Accessed on November 26, 2013.

The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.