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.

Most adults can take nefopam.

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

Do not take nefopam if you:

• have ever had an allergic reaction to nefopam or any other medicine
• have epilepsy, or have ever had a seizure or fit

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

• have liver or kidney problems
• have ever had difficulty peeing
• have an uncommon kind of glaucoma (increased pressure in the eye) called angle closure glaucoma
• are trying to get pregnant, are already pregnant or breastfeeding

Each tablet contains 30mg of nefopam.

The usual dose of nefopam 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're aged over 65 years old or have severe kidney failure, your doctor may prescribe a lower dose.

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

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

You can take nefopam with or without food.

Swallow the tablets whole, with a drink of water.

Depending on why you're taking nefopam, you may only need to take if for a short time. For example, if you're in pain following an operation, you may only need to take it for a few days.

You may need to take it for longer if you have a long-term condition that causes pain, such as cancer.

It's best to take the lowest dose of nefopam for the shortest time to control your symptoms. If you need to take it for longer, your doctor will want to monitor how well it's working for you and whether you still need it.

Talk to your doctor if you're unsure how long you need to take nefopam for.

If you've taken nefopam for a long time, speak to your doctor if you want to stop taking it. They may want you to reduce your dose gradually, to prevent withdrawal symptoms.

If you forget to take nefopam, take it as soon as you remember, unless it's 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 2 doses 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 help you remember to take your medicine.

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.

• you've taken more than your prescribed dose of nefopam and feel unwell

• you take more than your prescribed dose of nefopam, even if you do not have any symptoms

Get help from 111 online or call 111.

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the nefopam packet or leaflet inside it, any remaining medicine, and any other medicines you take.

There are things you can do to help with these possible side effects of nefopam:

It may help if you take nefopam after eating and avoid eating rich or spicy food.

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.

Stop what you're doing and sit or lie down until you feel better. Speak to your doctor if the feeling does not go away.

Chew sugar-free gum or suck sugar-free sweets.

Relax when you try to pee. Do not try to force yourself to pee. If it does not happen, try again later.

Talk to your doctor if this does not get better. Contact your doctor urgently if you cannot pee at all.

Talk to your doctor if this does not go away.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

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

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

Stop taking nefopam and call your doctor or call 111 straight away if:

• you're seeing things that are not there (hallucinations)
• you get a fast heartbeat

• you have a seizure or fit

Do not drive yourself to A&E.

The person you speak to at 999 will give you advice about what to do.

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

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

If you take nefopam for a long time, it's possible to become addicted, but this is rare.

If this happens to you, you might have withdrawal symptoms if you suddenly stop taking it. These symptoms can include feeling tired, low mood, and feeling uneasy, anxious or restless.

If you've taken nefopam for a long time, speak to your doctor if you want to stop taking it. They may want you to reduce your dose gradually, to prevent withdrawal symptoms.

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

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

Paracetamol is generally the first choice of painkiller in pregnancy. 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.

You can take nefopam while breastfeeding if your doctor says you need it.

There's not much information about using nefopam while breastfeeding, but it shows that it passes into breast milk in very small amounts. It's unlikely to cause any side effects in your baby.

Paracetamol or ibuprofen are the best painkillers to take if you're breastfeeding.

As a precaution, talk to your health visitor, midwife, doctor or pharmacist or call 111 as soon as possible if you have any concerns about your baby. This includes if they're:

• not feeding as normal
• unusually sleepy or not sleeping as much
• irritable
• sweating
• being sick
• not peeing as much, for example you notice fewer wet nappies

There's no evidence to suggest that taking nefopam will reduce fertility in either men or women.

If you're trying for a baby, or having problems conceiving while on nefopam, then speak to your doctor.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Some medicines and nefopam can affect 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:

• some types of antidepressants, such as phenelzine, isocarboxazid or tranylcypromine, which belong to a group called monoamine oxidase inhibitors, or amitriptyline, which belongs to the tricyclic antidepressant group
• any medicine that makes you sleepy, gives you a dry mouth, or makes it difficult for you to pee, including some antihistamines and antidepressants, as taking nefopam might make these side effects worse

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're more likely to get more side effects such as feeling sick, confusion or feeling dizzy.

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

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.

It's not possible to say that other herbal remedies, vitamins and supplements are safe to take with nefopam. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.