Nefopam is a non-opioid analgesic and though it acts centrally, its mechanism is not defined. It also exerts antimuscarinic and sympathomimetic actions.

Nefopam Hydrochloride is indicated for the relief of acute pain, including post-operative, dental, musculo-skeletal and acute traumatic pain. It is also indicated in chronic pain like cancer pain.

Tablet-

• Adults: Dosage may range from 30 to 90 mg three times daily depending on response. The recommended starting dosage is 2 tablets three times daily. 
• Elderly: Elderly patients may require reduced dosage due to slower metabolism. It is strongly recommended that the starting dose does not exceed 1 tablet 3 times daily.

Injection-

• Adult: 20 mg by IM injection, repeated every 6 hours if necessary. It also be given by slow IV injection in similar dose.
• Children: Not recommended for children under the age of 12 years. 

Nefopam Hydrochloride is contraindicated in patients with a history of convulsive disorders and should not be given to patients taking monoamine oxidase (MAO) inhibitors. It is also should not be used in the treatment of myocardial infarction.

Nefopam Hydrochloride is generally well tolerated. However the most common side-effects are nausea, nervousness, dry mouth, lightheadedness and urinary retention.The less common side-effects are vomiting, blurred vision, drowsiness, sweating, insomnia, headache, confusion, hallucinations, tachycardia and aggravation of angina.

Overdose Effects

Nefopam toxicity is manifested by neurological symptoms (convulsions, hallucinations, agitation) and cardiovascular response (tachycardia with hyperdynamic circulation). Supportive treatment is suggested including gastric lavage, forced emesis and diuresis. Oral administration of activated charcoal may help prevent absorption. Convulsions and hallucinations may be controlled with diazepam. Beta-adrenergic blockers may be of use in controlling the cardiovascular complications.

Nefopam Hydrochloride should be used with caution in patients with glaucoma and with or at risk of urinary retention. Caution should be exercised when Nefopam is administered concurrently with tricyclic antidepressants. Caution should also be exercised in patients with a history of ischaemic heart disease.

Pregnancy & Lactation

Pregnancy: Nefopam Hydrochloride is not recommended for pregnant women.

Lactation: Evidence suggests that nefopam is excreted in human milk. A decision should made whether to discontinue nursing or discontinue the medication, taking into account the potential for adverse effects for the foetus and the importance of treatment to the mother.