Type of Spiritual Experience
Nefopam (Acupan®, Silentan®, Nefadol®, Ajan®) is a centrally-acting but non-opioid analgesic drug of the benzoxazocine chemical class which was developed by Riker Laboratories in the 1960s. It is widely used, mainly in European countries, for the relief of moderate to severe pain as an alternative to opioid analgesic drugs. The mechanism of action of nefopam is not well understood, although inhibition of serotonin, dopamine and noradrenaline reuptake is thought to be involved in its analgesic effects, and there may be other modes of action such as through histamine H3 receptors and glutamate. Recently, like its analogue orphenadrine which also has analgesic effects, nefopam has been found to act as a voltage-gated sodium channel blocker.
A description of the experience
N Z Med J. 1995 Sep 22;108(1008):382-4. Adverse reactions associated with nefopam. Pillans PI, Woods DJ. Centre for Adverse Reactions Monitoring, University of Otago Medical School, Dunedin.
AIM: To review postmarketing experience of adverse reactions associated with nefopam.
METHODS: Spontaneous reports of adverse reactions associated with nefopam over a 12 year period received by the New Zealand Centre for Adverse Reactions Monitoring were reviewed.
RESULTS: There were 70 reports of adverse reactions thought to be causally related to nefopam, most of which appear to be predictable extensions of the pharmacological effect of nefopam, and included confusion, hallucinations, convulsions, dizziness, headache, sweating, urinary retention, nausea, vomiting, tachycardia and palpitations. The first report of angina is described. Convulsions occurred in a stable epileptic in whom nefopam was contraindicated, and in another where the seizure threshold may have been lowered by a concomitant tricyclic antidepressant.
CONCLUSIONS: Nefopam can cause unpleasant adverse effects and there are important cautions and contraindications with this analgesic. A clearer presentation of its basic pharmacology in the datasheet should help to ensure appropriate use.