Adult: For relief of pain, including postoperative pain: 20 mg 6 hourly as necessary, given via deep IM inj. Max: 120 mg daily. Patient must lie down when receiving the inj and must remain so for 15-20 minutes after administration.
Intravenous Acute pain
Adult: For relief of pain, including postoperative pain: 20 mg 4 hourly as necessary, given via slow IV infusion over at least 15 minutes. Max: 120 mg daily. Patient must lie down when receiving the inj and must remain so for 15-20 minutes after administration.
Oral Acute pain, Chronic pain
Adult: For relief of pain, including postoperative, dental, musculoskeletal, acute traumatic and cancer pain: Initially, 60 mg tid, then adjust according to patient response. Usual dose: 30-90 mg tid. Elderly: Initially, 30 mg tid, then adjust according to patient response.
Renal Impairment
Oral:
Patient with ESRD: Dose reduction may be required.
Administration
Nefopam May be taken with or without food. May be taken w/ meals if GI discomfort occurs.
Reconstitution
IV infusion: May be diluted in NaCl 0.9% solution or dextrose 5% in water.
Contraindications
History of convulsive disorders. IV/IM: Urinary retention linked to urinary or prostate disorders, angle-closure glaucoma. Concomitant use with MAOIs.
Special Precautions
Patient with CV disease; urinary retention, angle-closure glaucoma (oral). Not indicated for use in the treatment of MI. Renal and hepatic impairment. Elderly (avoid IV or IM use). Pregnancy and lactation. Concomitant use with TCAs.
Adverse Reactions
Significant: Anticholinergic effects (e.g. blurred vision, xerostomia, constipation, urinary retention), drug dependence and abuse. Rarely, transient pink discolouration of urine. Cardiac disorders: Tachycardia, palpitations. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain. General disorders and administration site conditions: Pain at the inj site (IV/IM). Immune system disorders: Angioedema, allergic reactions. Nervous system disorders: Dizziness, drowsiness, headache, paraesthesia, tremor, lightheadedness, convulsion. Psychiatric disorders: Insomnia, confusion, nervousness, hallucination. Skin and subcutaneous tissue disorders: Diaphoresis. Vascular disorders: Hypotension, syncope.
Patient Counseling Information
This drug may cause drowsiness or dizziness, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor hepatic and renal function. Assess for anticholinergic adverse effects (e.g. dizziness, nausea, sweating), particularly within 15 minutes of IV or IM administration.
Overdosage
Symptoms: Tachycardia with hyperdynamic circulation; agitation, hallucinations, convulsions, and coma. Management: Supportive and symptomatic treatment. Perform gastric lavage, induce vomiting, or initiate forced diuresis. May give activated charcoal to prevent absorption. Administer diazepam via IV or rectal route for convulsions and hallucinations. β-adrenergic blockers may be used to help control CV complications.
Drug Interactions
May increase the risk of serotonin syndrome with MAOIs, TCAs and SSRIs. Concomitant use with other drugs with anticholinergic or sympathomimetic activity may result in enhanced adverse effects. May increase CNS depression with CNS depressants.
Food Interaction
May increase sedative effect with alcohol.
Lab Interference
May give false-positive results for urine detection of benzodiazepines and opioids.
Action
Description: Mechanism of Action: Nefopam is a centrally acting, non-opioid analgesic with anticholinergic and sympathomimetic actions. Its exact mechanism is unclear; however, it has been suggested to inhibit the reuptake of norepinephrine, serotonin and dopamine. Pharmacokinetics: Absorption: Absorbed from the gastrointestinal tract. Bioavailability: 40% (oral). Time to peak plasma concentration: Approx 1-3 hours (oral); 0.5-1 hour (IM). Distribution: Enters breast milk. Plasma protein binding: Approx 73%. Metabolism: Extensively metabolised in the liver into desmethylnefopam, N-oxide-nefopam, and nefopam N-glucuronide. Excretion: Mainly via urine (87%; <5% as unchanged drug); faeces (approx 8%). Elimination half-life: Approx 4 hours.
Chemical Structure
Nefopam Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4450, Nefopam. https://pubchem.ncbi.nlm.nih.gov/compound/Nefopam. Accessed Aug. 26, 2025.
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