Nefopam Hydrochloride is indicated for the relief of acute pain, including post-operative, dental, musculoskeletal, and acute traumatic pain. It is also indicated for chronic pain conditions such as cancer pain.

Nefopam Hydrochloride is a centrally acting analgesic with a rapid onset of action. Its primary site of action is the central nervous system, both at the brain and spinal cord levels. In vitro studies have shown that nefopam inhibits the reuptake of catecholamines, including noradrenaline, serotonin, and dopamine. Its analgesic effect is believed to be partly due to modulation of these neurotransmitters in the brain and spinal cord.

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 used in patients receiving monoamine oxidase (MAO) inhibitors. It is also contraindicated in the treatment of myocardial infarction.

Nefopam Hydrochloride is generally well tolerated. The most common side effects include nausea, nervousness, dry mouth, lightheadedness, and urinary retention. Less common effects include vomiting, blurred vision, drowsiness, sweating, insomnia, headache, confusion, hallucinations, tachycardia, and worsening of angina.

Nefopam Hydrochloride is not recommended during pregnancy. It is excreted in human breast milk. A decision should be made either to discontinue breastfeeding or discontinue the drug, considering the importance of treatment for the mother and potential risk to the fetus or infant.

Nefopam Hydrochloride should be used cautiously in patients with glaucoma and those at risk of urinary retention. Caution is required when used with tricyclic antidepressants. It should also be used carefully in patients with a history of ischemic heart disease.

Nefopam toxicity may cause neurological symptoms such as convulsions, hallucinations, and agitation, as well as cardiovascular effects like tachycardia and hyperdynamic circulation. Treatment includes supportive care such as gastric lavage, induced vomiting, and diuresis. Activated charcoal may reduce absorption. Diazepam may be used for convulsions and hallucinations, and beta-blockers may help manage cardiovascular effects.

Non-opioid analgesics

Store below 30°C, protect from light and moisture, and keep out of reach of children.