- nefopam hydrochloride
POM: Prescription only medicine
This information is intended for use by health professionals
Nefopam hydrochloride 30mg film-coated tablets.
Nefopam hydrochloride 30mg per tablet.
Excipients with known effect: lactose monohydrate.
For the full list of excipients, see Section 6.1.
Round, normal convex shaped, white tablets debossed with 'N30' on one side and plain on the other.
For the relief of acute and chronic pain, including post-operative pain, dental pain, musculo-skeletal pain, acute traumatic pain and cancer pain.
Nefopam hydrochloride 30mg film-coated tablets are indicated in adults, including the elderly, and children aged 12 years and older.
Adults and children aged 12 years and older:
Dosage may range from 1 to 3 tablets three times daily depending on response. The recommended starting dosage is 2 tablets three times daily.
Elderly patients may require reduced dosage due to slower metabolism.
It is strongly recommended that the starting dose does not exceed 1 tablet three times daily as the elderly appear more susceptible to, in particular, the CNS side effects of nefopam and some cases of hallucinations and confusion have been reported in this age group.
The safety and efficacy of nefopam in children under 12 years has not yet been established. No dosage recommendation can be given for patients under 12 years.
Patients with end stage renal disease might experience increased serum peak concentrations during treatment with nefopam. In order to avoid that, it is recommended that the daily dose should be reduced, not only for the elderly, but also for patients with terminal renal insufficiency.
Method of administration
For oral use.
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Nefopam is contraindicated in patients with a history of convulsive disorders and should not be given to patients taking monoamine oxidase inhibitors (see Section 4.5).
The side effects of nefopam may be additive to those of other agents with anticholinergic or sympathomimetic activity. It should not be used in the treatment of myocardial infarction since there is no clinical experience in this indication. Hepatic and renal insufficiency may interfere with the metabolism and excretion of nefopam. Nefopam should be used with caution in patients with, or at risk of, urinary retention. Rarely, a temporary harmless pink discolouration of the urine has occurred.
Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Nefopam should be used with caution in patients with angle closure glaucoma. Cases of nefopam dependence and abuse have been reported with nefopam use.
Nefopam hydrochloride 30mg film-coated tablets are contraindicated in patients receiving monoamine oxidase inhibitors (see section 4.3).
Caution should be exercised when nefopam is administered concurrently with tricyclic antidepressants.
It should be noted that nefopam may interfere with some screening tests for benzodiazepines and opioids. These tests for benzodiazepines and opioids may give false positive results for patients taking nefopam.
There is no evidence as to the drug safety in human pregnancy, nor is there evidence from animal work that it is free from hazard. Avoid in pregnancy unless there is no safer treatment.
Nefopam hydrochloride 30mg film-coated tablets may cause drowsiness. If affected do not drive and use machines.
Nausea, nervousness, dry mouth and light-headedness, urinary retention, hypotension, syncope, palpitations, gastro-intestinal disturbances (including abdominal pain and diarrhoea), dizziness, paraesthesia, convulsions, tremor, confusion, hallucination, angioedema and allergic reactions may occur. Less frequently, anaphylactic reactions, coma, vomiting, blurred vision, drowsiness, sweating, insomnia, headache and tachycardia have been reported.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professional are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.
The clinical pattern of nefopam toxicity in overdose is on the neurological (coma, convulsions, hallucinations and agitation) and cardiovascular systems (tachycardia with a hyperdynamic circulation). Routine supportive measures should be taken and prompt removal of ingested drug by gastric lavage or induced vomiting with Syrup of Ipecacuanha should be carried out. Oral administration of activated charcoal may help prevent absorption.
Convulsions and hallucinations should be controlled (e.g. with intravenously or rectally administered diazepam). Beta-adrenergic blockers may help control the cardiovascular complications.
Pharmacotherapeutic group: Other analgesics and antipyretics.
ATC code: N02BG06.
Nefopam is a potent and rapidly-acting analgesic. It is totally distinct from other centrally-acting analgesics such as morphine, codeine, pentazocine and propoxyphene.
Unlike the narcotic agents, nefopam has been shown not to cause respiratory depression. There is no evidence from pre-clinical research of habituation occurring with nefopam.
Nefopam is absorbed from the gastro-intestinal tract. Peak plasma concentrations occur about 1–3 hours after oral administration. About 73% is bound to plasma proteins. It has an elimination half-life of about 4 hours. It is extensively metabolised and excreted mainly in urine. Less than 5% of a dose is excreted unchanged in the urine. About 8% of a dose is excreted via the faeces.
There are no findings of relevance to the prescriber other than those already mentioned elsewhere in the SPC.
Tablet core constituents:
Calcium hydrogen phosphate dihydrate
Hydrogenated vegetable oil
Silica, colloidal anhydrous
Titanium dioxide (E171)
This medicinal product does not require any special storage conditions.
Pack size: 90 tablets.
No special requirements.
Seagoe Industrial Estate
30 04 2020.