Issues for surgery
Loss of pain control if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue.
Post-operative advice
Restart post-operatively when enteral intake resumes, if required.
If the surgery has addressed the cause of pain, nefopam should be reviewed post-operatively – consider acute pain team review if necessary.
Postoperative initiation
Avoid if patient prescribed phenelzine, isocarboxazid or tranylcypromine – concurrent use may precipitate hypertensive crisis.
Interactions with common anaesthetic agents
Antimuscarinic action
Antimuscarinic action of nefopam (e.g. blurred vision, dry mouth, urinary retention, tachycardia, confusion) may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium.
Interactions with other common medicines used in the perioperative period
Antimuscarinic action
Antimuscarinic action of nefopam (e.g. blurred vision, dry mouth, urinary retention, tachycardia, confusion) may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Further information
None relevant.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 10th April 2023]
Summary of Product Characteristics – Nefopam Hydrochloride 30mg Film coated tablets. ADVANZ Pharm. Accessed via www.medicines.org.uk 13/03/2023 [date of revision of the text February 2021]
Nefopam. In: Brayfield A (ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 9th April 2023]