1. About nefopam
It's also used for other types of long-standing pain when weaker painkillers no longer work.
Nefopam is available only on prescription. It comes as tablets.
2. Key facts
- The usual dose of nefopam is one or two 30mg tablets taken 3 times a day.
- It is usually prescribed when painkillers such as paracetamol or naproxen do not help your pain.
- The most common side effects include feeling sick (nausea), dizzy or lightheaded, nervous, confused or shaky. Also, a dry mouth, difficulty peeing, seeing things that are not there (hallucinations) and numbness or tingling in your hands and feet.
- Nefopam might colour your pee pink, but this is harmless.
- Do not give nefopam to children under 12 years old.
- Nefopam is also called by the brand name Acupan.
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 fit or seizure
- have liver or kidney problems
- have a kind of glaucoma called angle closure glaucoma
- have difficulty peeing
- have a lactose intolerance (where your body can't digest the sugar, lactose) – some nefopam tablets contain small amounts of lactose
- are trying to get pregnant, are already pregnant or if you are breastfeeding – nefopam is generally not recommended in pregnancy and while breastfeeding
4. How and when to take it
Each tablet contains 30mg of nefopam. The usual dose for adults and children aged 12 years or older is one to two 30mg tablets 3 times a day.
Depending on how well it works for your pain, your doctor may tell you to take up to three 30mg tablets (90mg) 3 times a day.
If you are aged over 65 or have severe kidney failure, your doctor may prescribe a lower dose.
You can take nefopam with or without food, as food won't stop it working. Swallow tablets with a drink of water.
Will my dose go up or down?
Sometimes your doctor will increase your dose of nefopam if it is not working well enough. Or they might reduce it if you get side effects.
How long will I take it for?
Depending on why you're taking nefopam, you may only need to take it for a short time. For example, if you're in pain because you've had an operation, you may only need to take it for a day or two.
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.
Talk to your doctor if you're unsure how long you need to take nefopam for.
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. 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 too much nefopam can be dangerous.
If you've taken too much, you may feel very sleepy or agitated, hallucinate (see things that aren't there) and your heart may beat very fast. In serious cases you can have fits or become unconscious and 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.
Urgent advice: Go to A&E now if:
- you've taken too much nefopam and feel unwell
Find your nearest A&E.
Do not drive yourself – 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 other painkillers
Some painkillers, like codeine, have similar side effects to nefopam. This means you may get more side effects if you take them together.
Speak to your doctor or pharmacist before taking any painkillers along with nefopam.
6. Side effects
Common side effects
These are the most common side effects of nefopam. Talk to your doctor or pharmacist if these side effects bother you or don't go away:
- feeling sick (nausea)
- feeling dizzy or lightheaded
- feeling nervous, confused or shaky
- a dry mouth
- difficulty peeing
- seeing things that aren't there (hallucinations)
- numbness or tingling in your hands and feet
Nefopam may also colour your pee pink. But don't 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 or go to A&E if:
- 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.
You can report any suspected side effect using the Yellow Card safety scheme.
7. How to cope with side effects
What to do about:
- feeling sick – it may help if you do not eat rich or spicy food while you're taking nefopam.
- 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 begin to feel dizzy, lie down so that you do not faint, then sit until you feel better. Do not drive or use tools or machinery if you're feeling dizzy. Don't 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 does not go away
- 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 doesn't happen, try again later. Talk to your doctor urgently if you can't pee at all.
- seeing things that aren't there (hallucinations) – talk to your doctor about this.
- numbness or tingling in your hands and feet – if it does not go away, talk to your doctor.
8. Pregnancy and breastfeeding
Nefopam is not usually recommended during pregnancy. There's not enough information to know whether it's safe.
Talk to your doctor who will advise you about the best medicine for you and your baby.
Paracetamol is generally the first choice of painkiller for pregnant women.
Nefopam and breastfeeding
Nefopam passes into breast milk and is not usually recommended during breastfeeding. Other painkillers, such as paracetamol, are safer.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
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 these medicines before you start taking nefopam:
- an antidepressant, such as a monoamine oxidase inhibitor like phenelzine, or a tricyclic like amitriptyline
- any medicine that makes you sleepy, gives you a dry mouth, or makes it difficult for you to pee, for example some antihistamines or antidepressants – 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
How does nefopam work?
Nefopam is a type of medicine called a non-opioid or non-narcotic painkiller.
It is not known for certain how nefopam works, but 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.
Is it safe to take for a long time?
There's not a lot of information on the effects of taking nefopam for a long time, so it's best to only take it for as long as you need to.
If you do take nefopam for a long time, your doctor might want to check that you still need it from time to time.
Can I become addicted to nefopam?
Some people have become addicted to nefopam after taking it for a long time. If this happens, you might have withdrawal symptoms if you suddenly stop taking nefopam.
If you've taken nefopam for a long time, speak to your doctor before you stop taking it as they may want you to reduce your dose gradually.
How will I know if I'm addicted to nefopam?
If you're addicted to nefopam, you may want to take it more often or feel agitated if you delay taking a dose for any reason.
And if you stop taking it suddenly you may suffer from withdrawal symptoms.
Talk to your doctor if you're worried about becoming addicted to nefopam.
Are there other painkillers I can try?
The type of painkiller that's best for you depends on what type of pain you have, the cause of your pain, any other illness you have and any other medicines you take.
Also, 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 as there may be something else you could try.
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?
You can eat and drink normally while taking nefopam.
Can I drive or ride a bike?
Nefopam can make you feel sleepy or dizzy. If this happens to you, don't drive or ride a bike 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 interfere with some drugs 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 haven't taken them (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.