Experiences with
Nefopam

About nefopam

Nefopam is a painkiller. It treats moderate pain, for example after an operation or a serious injury, dental pain, joint pain and muscle pain, or pain from cancer.

You can also take nefopam for other types of long-term pain when weaker painkillers no longer work.

Nefopam is available on prescription only. It comes as tablets.

Who can and cannot take nefopam

Nefopam can be taken by adults and children aged 12 years and above.

Do not take nefopam for pain caused by a heart attack.

Nefopam is not suitable for some people. To make sure nefopam is safe for you, tell your doctor if you:

have ever had an allergic reaction to nefopam or any other medicine
have epilepsy, or have ever had a seizure or fit
have liver or kidney problems
have difficulty peeing
have an uncommon kind of glaucoma called angle closure glaucoma
are trying to get pregnant, are pregnant or breastfeeding – nefopam is generally not recommended in pregnancy or while breastfeeding

How and when to take nefopam

You can take nefopam with or without food.

Swallow the tablets whole, with a drink of water.

Each tablet contains 30mg of nefopam. The usual dose for adults and children aged 12 years or older is one to two 30mg tablets, taken 3 times a day. Your doctor might increase your dose to a maximum of 3 tablets, taken 3 times a day.

If you are aged over 65 or have severe kidney failure, your doctor may prescribe a lower dose.

Always follow the advice from your doctor or pharmacist.

Will my dose go up or down?

Sometimes your doctor will increase your dose of nefopam if it is not working well enough to control your pain.

If you are bothered by side effects, they might reduce your dose.

What if I forget to take it?

If you forget to take nefopam, take it as soon as you remember, unless it is nearly time for your next dose. In this case, skip the missed dose and take the next one at the usual time.

Do not take a double dose to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicine.

What if I take too much?

Taking more than your prescribed dose of nefopam can be dangerous.

If you've taken too much, you may feel very sleepy or agitated, see things that are not there and your heart may beat very fast. In serious cases you can have seizures or fits or become unconscious. You may need emergency treatment in hospital.

The amount of nefopam that can lead to an overdose varies from person to person.

Call your doctor if you take too much nefopam.

you've taken too much nefopam and feel unwell

Find your nearest A&E

Do not drive yourself to hospital – get someone else to drive you or call for an ambulance.

Take the nefopam packet or the leaflet inside it, plus any remaining medicine, with you.

Taking nefopam with painkillers

You can take nefopam with everyday painkillers, such as paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen.

Some opioid painkillers (like codeine, dihydrocodeine and morphine) have similar side effects to nefopam. This means if you take them together you are more likely to get more side effects such as feeling sick, confusion or dizziness.

Speak to your doctor or pharmacist before taking any painkillers along with nefopam.

Side effect

Like all medicines, nefopam can give you side effects. However many people have no side effects at all.

Talk to your doctor or pharmacist if these side effects bother you or do not go away:

feeling sick (nausea)
feeling dizzy or lightheaded
feeling nervous, confused or shaky
a dry mouth
difficulty peeing
seeing things that are not there (hallucinations)
numbness or tingling in your hands and feet

Nefopam may also colour your pee pink. But do not worry, this is harmless.

If you are aged over 65 years, you may be more likely to get some side effects, such as feeling confused or having hallucinations.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to nefopam.

you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
you're wheezing
you get tightness in the chest or throat
you have trouble breathing or talking
your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of nefopam. For a full list see the leaflet inside your medicine packet.

How to cope with side effects of nefopam

What to do about:

feeling sick – it may help if you take nefopam after eating and avoid eating rich or spicy food.
feeling dizzy or lightheaded – if nefopam makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you still feel dizzy, lie down so that you do not faint, then sit up for a while until you feel better. Do not drive, ride a bike or use tools or machinery if you're feeling dizzy. Do not drink alcohol as it will make you feel worse.
feeling nervous, confused or shaky – stop what you're doing and sit or lie down until you feel better. Speak to your doctor if the feeling lasts for more than a couple of days.
a dry mouth – chew sugar-free gum or suck sugar-free sweets.
difficulty peeing – relax when you try to pee. Do not try to force the flow of urine. If it does not happen, try again later. Talk to your doctor if this does not get better after a few days. Contact your doctor urgently if you cannot pee at all.
seeing things that are not there (hallucinations) – stop taking your tablets and contact your doctor.
numbness or tingling in your hands and feet – talk to your doctor if it does not go away or lasts for more than a week.

Pregnancy and breastfeeding

Nefopam is not usually recommended during pregnancy. This is because there's little information to know how the medicine might affect your baby.

Paracetamol is generally the first choice of painkiller for pregnant women. Stronger painkillers are available which can be used in pregnancy after discussion with your doctor.

Talk to your doctor who will advise you about the most suitable medicine for you and your baby.

Nefopam and breastfeeding

Nefopam passes into breast milk in very small amounts but it is unlikely to harm your baby so you can continue breastfeeding if your doctor says you need to take it.

If you notice that your baby is not feeding as well as usual, or if you have any other concerns about your baby, talk to your health visitor, midwife, pharmacist or doctor as soon as possible.

Cautions with other medicines

Some medicines and nefopam can interfere with each other and make it more likely that you will have side effects.

Tell your doctor if you're taking any of these medicines before you start taking nefopam:

an antidepressant, such as a monoamine oxidase inhibitor like phenelzine, or a tricyclic like amitriptyline
any medicine (including some antihistamines and antidepressants) that makes you sleepy, gives you a dry mouth, or makes it difficult for you to pee – taking nefopam might make these side effects worse

There might be a problem taking some herbal remedies and supplements alongside nefopam – especially ones that cause sleepiness, a dry mouth or make it difficult to pee.

Ask your pharmacist for advice.