Nefopam For Pain Relief: Essential Guide To Uses And Dosage

Authored by Medical Review Team | Last Updated: January 2026

About nefopam tablets

Nefopam is a

non-opioid painkiller

used to treat moderate pain when standard pain relievers like paracetamol or ibuprofen prove ineffective. It belongs to a class of centrally acting analgesics with stimulant properties, distinguishing it from opioids by lacking addiction potential and respiratory depression risks. Commonly sold under the brand name

Acupan

, nefopam targets pain signals in the brain and spinal cord, providing relief for conditions such as postoperative pain, dental pain, muscle strains, joint issues, and certain chronic pains.

Developed in the 1960s from benzoxazocine compounds, nefopam was initially explored for muscle relaxation and antidepressants before establishing its role in analgesia. It is prescription-only, available as 30 mg film-coated tablets, and typically starts working within 1-2 hours, with effects lasting several hours. Unlike NSAIDs, it lacks significant anti-inflammatory action but excels in neuropathic and nociceptive pain modulation.

Key facts about nefopam

• Nefopam relieves

  moderate pain

  from surgery, injury, dental issues, joints, muscles, or cancer when weaker painkillers fail.
• It is a

  non-opioid

  analgesic, avoiding addiction, drowsiness, or breathing issues common with opioids.
• Dosage: Usually 30-90 mg three times daily, max 270 mg/day; relief begins in 1-2 hours.
• Common side effects:

  Nausea, dizziness, dry mouth, sweating

  ; urine may turn pink harmlessly.
• Not for long-term use without medical advice; evidence for chronic pain is limited.
• Take with food to reduce stomach upset; swallow whole with water.

How does nefopam work?

Nefopam exerts its analgesic effects through multiple mechanisms in the central nervous system, primarily by inhibiting reuptake of key neurotransmitters:

serotonin, norepinephrine, and dopamine

(acting as a triple reuptake inhibitor or SNDRI). This enhances descending pain modulation pathways, reducing pain signal transmission.

Additionally, it demonstrates antihyperalgesic properties by modulating glutamatergic transmission through blockade of voltage-sensitive

sodium and calcium channels

, inhibiting NMDA receptor-mediated long-term potentiation and calcium influx. These actions mimic antidepressants for descending inhibition and anticonvulsants like gabapentinoids or carbamazepine for neuropathic pain relief.

Unlike opioids, nefopam does not bind mu-receptors, explaining its non-addictive profile. It also exhibits sympathomimetic effects, potentially aiding in shivering prevention post-surgery. Research confirms a ceiling effect around 60-90 mg/day for postoperative pain, beyond which benefits plateau.

When will nefopam start to work?

Patients typically notice pain improvement

1-2 hours

after taking nefopam tablets. Peak effects occur within 30-60 minutes for oral forms, lasting 4-8 hours depending on dose and individual metabolism. Intravenous administration acts faster (over 15-20 minutes infusion), ideal for acute settings. For chronic use, consistent dosing three times daily maintains steady relief, though full benefits may take days.

If no improvement after 2-3 doses, consult a doctor, as nefopam suits moderate pain unresponsive to first-line treatments.

Common questions about nefopam

How much to take?

Adults start at

30 mg three times daily

, increasing to 60-90 mg if needed (max 90 mg per dose, 270 mg/day). Elderly or those with liver/kidney issues begin at 30 mg. Children under 12: Not recommended.

How to take it?

Swallow tablets whole with water, preferably with or after food to minimize nausea. Space doses evenly (every 6-8 hours). Do not crush or chew.

How long to take it for?

Use short-term (up to 7-10 days) for acute pain; longer for chronic under supervision. Evidence for extended chronic use is limited and not guideline-endorsed.

Dosage

The standard oral dose is

30-90 mg three times daily

(total 90-270 mg/day), adjusted based on response and tolerance. A ceiling effect limits benefits above 60-180 mg/day.

Patient Group	Starting Dose	Max Daily Dose
Adults	30 mg TDS	270 mg
Elderly/Debilitated	30 mg TDS	180 mg
IV (Acute)	20 mg slow IV	120 mg/day infusion
Children <12	Not recommended	–

Reduce dose in hepatic/renal impairment; avoid abrupt cessation to prevent withdrawal-like symptoms.

Who can and cannot take nefopam tablets

Who can take nefopam

• Adults over 12 years with moderate pain unresponsive to paracetamol/NSAIDs.
• Suitable for postoperative, dental, musculoskeletal, or neuropathic pain.

Who cannot take it

• Children under 12 years.
• People with epilepsy (risk of convulsions).
• Those with heart rhythm issues, glaucoma, prostate enlargement, or severe liver/kidney disease.
• Pregnant/breastfeeding women (limited data).

Nefopam with food, drinks, and alcohol

Take with or after food to reduce nausea. Avoid alcohol, as it heightens dizziness and sedation risks. No known interactions with caffeine or grapefruit, but inform doctor of all intake.

Taking nefopam with other medicines and herbal supplements

Nefopam may interact with:

• Antidepressants/MAOIs: Risk of serotonin syndrome.
• Anticholinergics: Worsens dry mouth, constipation.
• Opioids: Enhanced sedation.
• Tricyclics: Increased side effects.

Always disclose full medication list, including herbals like St. John’s Wort.

Pregnancy, breastfeeding and fertility while taking nefopam tablets

Avoid in pregnancy (category not fully established; animal studies show risks). Limited data on breastfeeding—do not use. No proven fertility impact, but consult doctor if planning pregnancy.

Side effects of nefopam tablets

Common (>1/100):

• Nausea, indigestion, dry mouth, dizziness, nervousness, sweating.

Serious (seek help):

• Convulsions, hallucinations, tachycardia, urinary retention.
• Rare: Pink urine (harmless), rash, confusion.

Most resolve on stopping; report persistent issues.

What to do if you’re sick after taking nefopam

Wait until next dose if mild nausea. If vomiting occurs soon after, dose may be lost—take another after 1 hour if needed, but don’t exceed daily max. Persistent sickness: See GP.

Stopping nefopam tablets

Taper gradually if used >1 week to avoid rebound pain or anxiety. Short-term use allows abrupt stop.

Frequently asked questions (FAQs)

Is nefopam stronger than paracetamol?

Yes, for moderate pain unresponsive to paracetamol; not for mild pain.

Does nefopam cause drowsiness?

Rarely; more likely dizziness or stimulation.

Can nefopam treat neuropathic pain?

Yes, via SNDRI and channel blockade mechanisms.

Is nefopam addictive?

No, non-opioid with no dependence risk.

What if nefopam doesn’t work?

Consult doctor; may need alternative or combination therapy.