Nefopam is a painkiller. It's used to treat moderate pain, for example after an operation or a serious injury, dental pain, joint pain or muscle pain, or pain from cancer.

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.

• 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 aren't there (hallucinations) and numbness or tingling in your hands and feet.
• Nefopam might colour your pee pink, but this is harmless.
• Don't give nefopam to children under 12 years old.
• Nefopam is also called by the brand name Acupan.

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 isn't suitable for some people. To make sure nefopam is safe for you, tell your doctor if you have:

• had an allergic reaction to nefopam or any other medicines in the past
• epilepsy, or have ever had a fit or convulsion
• liver or kidney problems
• a kind of glaucoma called angle closure glaucoma
• difficulty peeing
• lactose intolerance (where your body can't digest the sugar, lactose). Some nefopam tablets contain small amounts of lactose.

Nefopam is generally not recommended in pregnancy and while breastfeeding. Tell your doctor before taking nefopam if you're trying to get pregnant, are already pregnant or if you are breastfeeding.

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 isn't 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 accidentally 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.

If you take too much nefopam by accident, call your doctor.

You can take nefopam with painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen.

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.

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 to nefopam.

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

What to do about:

• feeling sick - it may help if you don't 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 don't faint, then sit until you feel better. Don't 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 doesn't go away
• a dry mouth - chew sugar-free gum or suck sugar-free sweets
• difficulty peeing - relax when you try to pee. Don't 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 doesn't go away, talk to your doctor

Nefopam isn't 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 isn't usually recommended during breastfeeding. Other painkillers, such as paracetamol, are safer.

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.