1. 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.
2. Key facts
- Nefopam is usually prescribed when other painkillers such as paracetamol or naproxen do not help your pain.
- Your pain should start to improve 1 to 2 hours after taking the tablets.
- The most common side effects include feeling sick or dizzy.
- Nefopam might colour your pee pink, but this is harmless.
3. 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
4. How and when to take nefopam
You can take nefopam with or without food.
Swallow the tablets whole, with a drink of water.
Dosage
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.
Immediate action required: Call 999 or go to A&E now if:
- you've taken too much nefopam and feel unwell
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.
5. 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.
6. Side effect
Common side effects
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.
Immediate action required: 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.
These are not all the side effects of nefopam. For a full list see the leaflet inside your medicine packet.
You can report any suspected side effect using the Yellow Card safety scheme.
7. 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.
8. Pregnancy and breastfeeding
Nefopam and pregnancy
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.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
9. 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
Mixing nefopam with herbal remedies and supplements
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.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
10. Common questions about nefopam
How does nefopam work?
Nefopam is a type of medicine called a non-opioid or non-narcotic painkiller.
No one knows for certain how nefopam works. However it seems to block pain messages sent to your brain, or stops your brain from noticing the pain messages.
How long will it take to work?
Your pain should start to improve 1 or 2 hours after taking nefopam.
How long will I take it for?
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 nefopam for longer, your doctor will want to monitor how well it is 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.
Can I become addicted to nefopam?
Some people have become addicted to nefopam after taking it for a long time. If this happens to you, you might have withdrawal symptoms if you suddenly stop taking nefopam. These symptoms can include feeling anxious or restless or having problems sleeping.
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 you having extra side effects.
How will I know if I'm addicted to nefopam?
If you're addicted to nefopam, you may want to take it more often than prescribed. You may feel agitated if you delay taking a dose for any reason.
If you stop taking it suddenly you may suffer from withdrawal symptoms such as feeling restless or anxious or problems sleeping.
Talk to your doctor if you're worried about becoming addicted to nefopam.
Are there other painkillers I can try?
The best painkiller for you depends on what type of pain you have, the cause of your pain, any other illnesses you have and other medicines you take.
People can respond to painkillers differently – for example, one painkiller may help with your pain, but another may not.
If you are taking a painkiller and feel that it is not helping your pain, speak to your doctor or pharmacist for advice. There may be something else that could help such as exercise or mindfulness.
Can I drink alcohol with it?
Drinking alcohol while you're on nefopam may make you feel more sleepy.
It's best to stop drinking alcohol during the first few days of treatment until you see how nefopam affects you.
If you feel sleepy with nefopam, stop drinking alcohol while you are taking it.
Is there any food or drink I need to avoid?
Apart from watching your alcohol intake, you can eat and drink normally while taking nefopam.
Will it affect my contraception?
Nefopam does not affect any type of contraception, including the combined pill or emergency contraception.
Will it affect my fertility?
There's no clear 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.
Can I drive or ride a bike?
Nefopam can make you feel sleepy or dizzy. If this happens to you, do not drive or ride a bike, or operate tools or machinery, until you feel better.
Will recreational drugs affect it?
It is not known if taking recreational drugs affects nefopam. There may be more chance of unpleasant side effects, such as feeling sleepy or dizzy or a very fast heartbeat.
Nefopam may affect some drugs tests, such as tests for benzodiazepines (like diazepam) and opioids (like codeine). If you're taking nefopam, the test might show you have these drugs in your body even if you have not taken them (this is called a false positive result).
This could be important if you need to take a drug test at work, for example. Let the person doing the test know that you take nefopam.