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At least 19 recordsLinked to original sources
PubMed1995

Control of post anaesthetic shivering with nefopam hydrochloride in mildly hypothermic patients after neurosurgery.

Postoperative shivering may be prevented by maintaining normothermia intraoperatively or it may be treated using specific drugs. The aim of this study was to compare the efficacy of nefopam hydrochloride (nefopam) to that of clonidine and meperidine in patients undergoing elective neurosurgical procedures. Three groups of patients were included in the study. Patients in group A (60) received i.v., at random, 20 mg of nefopam, 50 mg of meperidine or 150 micrograms of clonidine in the immediate postoperative period. The incidence of shivering and the time at which shivering ceased were noted, along with central temperature and main haemodynamic changes. Group B (20) received i.v., at random, either 10 mg of nefopam or saline before awakening from anaesthesia. The effects of nefopam on central temperature, oxygen consumption (Vo2), carbon dioxide production (VcO2), basal metabolic rate (BMR) and energy expenditure (EE) were investigated. Group C (10) received i.v. 20 mg of nefopam during surgery: cerebrospinal fluid pressure (CSFP), cerebral perfusion pressure (CPP) and electroencephalogram (EEG) were monitored. In group A nefopam stopped shivering in 95% of patients when compared to meperidine and clonidine, which were effective in 32% and 40% of patients respectively. In group B, only 10% of patients receiving nefopam had postoperative shivering, Vo2, VcO2 and EE were significantly lower in patients treated with nefopam than those in the control group. No changes in CSFP, CPP or EEG were observed in group C. In conclusion, nefopam seems to be more effective than clonidine or meperidine in quickly suppressing shivering, without producing significant adverse reactions.

Adult↗
PubMed1987

A comparative assay of nefopam, morphine and d-amphetamine.

Nefopam is a non-opioid analgesic reported to have some stimulant properties. The subjective, behavioral and physiological effects of nefopam, morphine and d-amphetamine were compared in seven non-dependent substance abusers to assess the abuse potential of nefopam. Morphine and d-amphetamine had significant effects on a number of measures generally consistent with the effects of drugs of the opioid and psychomotor stimulant drug classes. Subjects correctly discriminated between morphine and d-amphetamine. Nefopam was most frequently identified by subjects as being amphetamine-like, though several measures indicated that nefopam produced some sedation. Little or no "liking" of the effects of nefopam was reported by subjects. Overall, nefopam was one fifth as potent as morphine and one quarter as potent as d-amphetamine in producing subjective and physiological effects. The results indicate that nefopam is neither entirely morphine-like nor d-amphetamine-like. In our opinion, nefopam has a lesser potential to be abused than morphine or d-amphetamine.

Behavior↗
PubMed1993

Evaluation of nefopam as a monoamine uptake inhibitor in vivo in mice.

Nefopam antagonized 6-hydroxydopamine-induced depletion of heart norepinephrine in mice with an ED50 value of 12 mg/kg. Nefopam was ineffective in antagonizing p-chloroamphetamine-induced depletion of brain serotonin in our standard assay in mice, apparently due to a short duration of action. Brain concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) were decreased after a 32 mg/kg, i.p., dose of nefopam at 1 and 2 hr but not at 4 hr. When nefopam was injected simultaneously with p-chloroamphetamine, it prevented brain serotonin depletion initially, but by 6 hr the protective effect was essentially lost, suggesting that p-chloroamphetamine persisted in mouse brain longer than did nefopam. Nefopam caused a dose-related antagonism of brain serotonin depletion at 2 hr after injection of a low dose of p-chloroamphetamine hydrochloride (10 mg/kg, i.p.), with a calculated ED50 value of 11 mg/kg. The lowering of brain 5-HIAA concentration 2 hr after nefopam injection occurred after a 32 mg/kg dose but not after a 3 or 10 mg/kg dose. These data suggest that nefopam is effective as an inhibitor of norepinephrine and serotonin uptake at doses previously shown to be analgesic in mice, consistent with uptake inhibition being a postulated mechanism important in its analgesic effect. Nonetheless, nefopam is a relatively weak inhibitor of monoamine uptake with a short duration of action in mice.

Animals↗
PubMed1990

Nefopam hydrochloride degradation kinetics in solution.

A stability-indicating reversed-phase high performance liquid chromatographic method was developed for the detection of nefopam hydrochloride and its degradation products under accelerated degradation conditions. The degradation kinetics of nefopam hydrochloride in aqueous solutions over a pH range of 1.18 to 9.94 at 90 +/- 0.2 degrees C was studied. The degradation of nefopam hydrochloride was found to follow apparent first-order kinetics. The pH-rate profile shows that maximum stability of nefopam hydrochloride was obtained at pH 5.2-5.4. No general acid or base catalysis from acetate, phosphate, or borate buffer species was observed. The catalytic rate constants on the protonated nefopam imposed by hydrogen ion and water was determined to be 7.16 X 10(-6) M-1 sec-1, and 4.54 X 10(-9) sec-1, respectively. The pKa of nefopam hydrochloride in aqueous solution was determined to be 8.98 +/- 0.33 (n = 3) at 25 +/- 0.2 degrees C by the spectrophotometric method. The catalytic rate constant of hydroxyl ion on the degradation of nefopam in either protonated or nonprotonated form was determined to be 6.63 X 10(-6) M-1 sec-1 and 4.06 X 10(-6) M-1 sec-1, respectively. A smaller effect of hydroxyl ion on the degradation of nonprotonated than on the degradation of protonated nefopam was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Buffers↗
PubMed1987

Antinociceptive effects of (+/-)-, (+)- and (-)-nefopam in mice.

The antinociceptive activity of (+/-)-, (+)- and (-)-nefopam in mice has been examined using the hot-plate, formalin and tail-flick tests. Nefopam was administered by the intraperitoneal, intracerebroventricular (i.c.v.) and intrathecal (i.th.) routes. Intraperitoneal injection of (+/-)-nefopam (10-20 mg kg-1) had powerful analgesic effects in the hot-plate and formalin tests. In the tail-flick test it produced a weak, but significant elevation of the response latencies. In spinalized animals, however, the effect was abolished, indicating that nefopam prolonged the tail-flick latencies by activation of descending pain-modulating pathways. (+/-)-Nefopam (5-20 micrograms) elicited analgesia in the hot-plate test after i.c.v. or i.th. injection. These findings suggest that nefopam has both a spinal and a supraspinal site of action. (+)-Nefopam was significantly more potent than (-)-nefopam after both systemic and central administration.

Analysis of Variance↗
PubMedDate not supplied

Capacity of two forms of activated charcoal to adsorb nefopam in vitro and to reduce its toxicity in vivo.

The adsorption of nefopam hydrochloride to two different charcoals was studied in vitro at pH 1.2 and 7.4. Both forms of activated charcoal effectively adsorbed nefopam, but the adsorption was significantly (p less than 0.001) more complete to PX-21 than to Norit A and the neutral pH favored adsorption over the acid pH. The unadsorbed fraction increased steeply when the charcoal-to-nefopam ratio was decreased below 5. In mice, the administration of Norit A and PX-21 (1700 mg/kg) significantly (p less than 0.001) increased the acute LD50 of nefopam hydrochloride, by 4.3 fold and 5.8 fold, respectively. The calculated amounts of free drug in the gastrointestinal tract are in good agreement with the observed LD50 values without charcoal when the free fractions at pH 1.2 and the corresponding charcoal-to-nefopam ratios in vitro are used in the calculations. The antagonism of charcoal to nefopam toxicity was confirmed in rats, too. At charcoal-to-nefopam ratios higher than those used in the present study, an even more effective reduction of toxicity is obvious. Therefore, immediate oral administration of a high dose (50-100 g) of activated charcoal is highly recommended to prevent nefopam absorption in acute intoxications in man, too.

Adsorption↗
PubMed1986

Evidence of the involvement of dopamine in the analgesic effect of nefopam.

The involvement of brain monoamines in the mechanism of action of nefopam, a new analgesic, was investigated in rats. The study was designed to evaluate the effect of various means of impairing monoaminergic transmission on nefopam analgesia as measured with the hot plate method. Pretreatment with reserpine (2 mg/kg) significantly reduced the antinociceptive action of nefopam (40 mg/kg), indicating that the interaction of this drug with the monoaminergic systems is important for its effects. A role for serotonin (5-HT) or norepinephrine (NE) was ruled out by the fact that selective depletion of 5-HT (using 5,7-dihydroxytryptamine) or NE (using DSP-4 or FLA-63) did not affect nefopam analgesia. A significant reduction of the effect of nefopam was found in rats pretreated with 6-hydroxydopamine (6-OHDA). Also 6-OHDA plus desipramine, which selectively depleted brain DA, markedly reduced the antinociceptive effect of nefopam. The data strongly suggest that a critical dopaminergic synapse is involved in the mechanism by which nefopam inhibits nociceptive responses in rats.

5,7-Dihydroxytryptamine↗
PubMed1980

Nefopam and propoxyphene in episiotomy pain.

To evaluate relative efficacy, safety, and time course of analgesia, nefopam (45 and 90 mg), a new centrally acting nonnarcotic analgesic, was compared with propoxyphene (65 mg) and placebo in a single oral dose, parallel, stratified, randomized, double-blind trial with 100 hospitalized postpartum women with medium or severe episiotomy pain. Using subjective reports as indices of response, patients rated pain intensity and side effects at periodic interviews for 6 hr. After 45 and 90 mg nefopam, 21 of 25 and 20 of 25 patients (p less than 0.01) reported more than 50% reduction of pain, whereas after 65 mg propoxyphene 18 of 25 (p less than 0.05) and after placebo 11 of 25 reported reduction in pain. Relative efficacy, based on summed pain intensity differences, showed measurable but modest dose-dependent analgesia with nefopam, suggesting that the effectiveness of 65 mg propoxyphene lay between 45 mg nefopam and placebo. Side effects included mild dizziness and hypothermia after nefopam and mild elevation of diastolic arterial pressure after nefopam and propoxyphene. Our results suggest that 45- and 90-mg doses of nefopam induced more analgesia than 65 mg propoxyphene in the relief of episiotomy pain.

Adolescent↗
PubMed1975

Nefopam and morphine in man.

A new analgesic, nefopam, is chemically distinct and pharmacologically unrelated to any presently known analgesic. A comparison was made of morphine and nefopam in 74 patients who required parenteral analgesia for moderate to severe postoperative and somatic pain, using a single administration, 2-dose level, double-blind design. A significant dose-response curve was obtained with nefopam and with morphine, and there was no significant deviation from parallelism. The time-effect curves for the 2 drugs were similar. The estimated relative potency of nefopam to morphine indicates that 20 mg of nefopam HCl is the approximate analgesic equal of 12 mg of morphine SO4. There were no adverse effects with nefopam and one adverse reaction to morphine.

Adult↗
PubMed1976

Controlled clinical trial of oral and parenteral nefopam hydrochloride. A novel and potent analgesic drug.

The results of a controlled, double-blind clinical trial are reported demonstrating the potency of analgesia produced by orally and parenterally administered nefopam HCl in hospitalized patients with pain principally of skeletal and neuromuscular origin. The drug is an analogue of orphenadrine, consisting of a cyclization of the diphenhydramine molecule. A double-blind, crossover study was made of the analgesic effects of intramuscular doses of 20 mg nefopam HCl, 50 mg pethidine, and saline placebo in 20 patients. Nefopam and pethidine were found to be equally effective and statistically superior to placebo. A double-blind, randomized study was made of orally administered nefopam HCl, 60 mg t.i.d., for three days and of placebo t.i.d. for three days in 80 patients. Nefopam was distinctly superior to placebo in analgesic effectiveness, both in the initial single dose and in maintaining therapeutic benefit for the duration of the three-day trial. It was concluded that nefopam is a potent analgesic of novel structure and unique physiologic properties.

Adult↗
PubMed1979

Comparison of the discriminative stimulus properties of nefopam and morphine.

Separate groups of rats were trained to discriminate nefopam or morphine from saline in a two-lever operant task. Nefopam produced saline-appropriate responding in morphine-trained rats. The highest dose of morphine tested in nefopam-trained rats produced responding appropriate for neither training treatment. This intermediate morphine responding was antagonized by a naloxone treatment that had no effect on the nefopam discrimination. These results suggest that the stimulus properties of nefopam and morphine are qualitatively different but also that morphine produces effects related to those that result in stimulus control by nefopam.

Animals↗
PubMed1994

Modulation of nitric oxide effects by flurbiprofen enantiomers and nefopam and its relation to antinociception.

We have examined the interactions of the analgesics, R- and S-flurbiprofen and nefopam, with nitric oxide (NO) in several experimental systems. Phenylephrine-precontracted rat aortic strips with intact endothelium were relaxed by R- and S-flurbiprofen and nefopam in a concentration-dependent manner. Removal of endothelium, inhibition of guanylate cyclase, inhibition of NO biosynthesis and inactivation of NO significantly reduced these relaxations. R- and S-flurbiprofen as well as nefopam enhanced the inhibition of platelet aggregation caused by rat peritoneal neutrophils or 3-morpholinosydnonimine. The antinociceptive effects of R- and S-flurbiprofen in the mouse writhing test as well as those of nefopam in the hot plate test were not significantly affected by administration of NO synthase inhibitors. We conclude that the increase in the biological activity of NO by R- and S-flurbiprofen and nefopam does not play a major role in the antinociceptive activity of the drugs, but might contribute to acute hypotension, a side-effect occasionally seen with flurbiprofen and nefopam.

Analgesics↗
PubMed1981

Quantitative determination of nefopam in human plasma, saliva and cerebrospinal fluid by gas-liquid chromatography using a nitrogen-selective detector.

A sensitive and selective gas-liquid chromatographic method for the determination of nefopam in human plasma, saliva and cerebrospinal fluid has been developed. The method includes the selective extraction of nefopam and the internal standard, orphenadrine, from biological fluids by a double extraction procedure. The extracted nefopam and internal standard are analyzed by a gas chromatograph equipped with a 3% OV-17 glass column and a nitrogen-phosphorus flame ionization detector (NPFID) operated in the nitrogen mode. The detector provides the needed high sensitivity and also selectivity due to the inherent characteristics of NPFID to discriminate against non-nitrogen containing materials. Five nanograms nefopam per ml plasma or saliva are routinely quantitated with a 1-ml sample or as little as 2 ng per ml cerebrospinal fluid with a 3-ml sample. The intra-day reproducibilities, expressed as the relative standard deviation, are 5, 2 and 3% at 10, 35 and 75 ng/ml plasma levels, respectively. The accuracies expressed by relative error at these levels are 12, -4 and -2%, respectively. The inter-day reproducibility is demonstrated by the small relative standard, deviation, 2%, of the slopes from ten plasma standard curves run on ten different days. In various clinical studies in humans the method has been successfully applied to the study of single-dose pharmacokinetics of nefopam and the monitoring of nefopam concentrations in saliva and cerebrospinal fluids.

Gas Chromatography-Mass Spectrometry↗
PubMed1977

Comparison of nefopam and pethidine in postoperative pain.

A double-blind, between-patient, two-dose comparison was comparison was performed with pethidine and nefopam in 100 subjects, the majority of whom were recovering from upper abdominal surgery. Either 15 or 30 mg of nefopam or 50 or 100 mg of pethidine were given by i.m. injection in a random order. All assessments were made by the same observer on the first day after operation, at least 4 h after the previous analgesic injection. Nefopam 15 mg was equipotent with pethidine 50 mg, peak analgesia being achieved 1 h after the i.m. injection. Pethidine 100 mg provided significantly better pain relief than nefopam 30 mg, the latter being not more effective than nefopam 15 mg apart from the duration of analgesia which was longer. The incidence of nausea and vomiting was similar after both drugs. Sweating and tachycardia were observed more frequently after nefopam, whereas sedative side-effects were more common after pethidine.

Clinical Trials as Topic↗
PubMed1990

Postoperative nefopam and diclofenac. Evaluation of their morphine-sparing effect after upper abdominal surgery.

The aim of the study was to assess the relative morphine-sparing effects of nefopam and diclofenac when used singly or in combination after upper abdominal surgery. Eighty-four patients of ASA grade 1 or 2 were allocated randomly to one of three groups. Group A received nefopam 20 mg by intramuscular injection 6 hourly after surgery for the 24-hour study period. Group B received diclofenac 75 mg 12-hourly and placebo injections at 6 and 18 hours after surgery. Group C received both 6-hourly nefopam and 12-hourly diclofenac. Supplemental analgesia was given on demand via a patient-controlled analgesia system which delivered intravenous morphine. Morphine requirements in the diclofenac group were significantly lower than in either of the other groups (p less than 0.01). Patients who received the combination of nefopam and diclofenac required significantly less morphine than those who received nefopam alone (p less than 0.01). Pain scores assessed 6 hours after surgery were significantly lower in the diclofenac and combination groups compared with the nefopam group (p less than 0.01).

Abdomen↗
PubMed1979

Comparison of the analgesic dose-effect relationships of nefopam and oxycodone in postoperative pain.

The analgesic dose-effect relationship of nefopam was compared in a double-blind randomised trial with that of oxycodone in immediate postoperative pain. Nefopam 15 mg or oxycodone 4 mg was given every 10 min i.v. (maximum six times) to patients in pain after upper abdominal surgery until their wound pain (scored 0-3) disappeared. The mean pain intensity (PI), initially 2.2 in both groups, descreased by approximately the same extent for up to two doses in both groups (to 1.5 after nefopam 30 mg and to 1.1 after oxycodone 8 mg). Thereafter PI was significantly less in the oxycodone group and diminished almost linearily to 0.1 after the sixth dose (24 mg). In the nefopam group, the PI score fell to 1.1 after the fourth dose (60 mg). This seemed to be the "ceiling" effect since additional doses up to 90 mg did not result in greater pain relief. In the oxycodone group, only two patients (12%) needed maximal dosage (6 x 4 mg), one of them requiring 32 mg of oxycodone. In the nefopam group, 12 patients (75%) needed further pain relief after the maximal dosage (6 x 15 mg). In these patients, oxycodone (maximally 16 mg) gave satisfactory analgesia. Drowsiness and a decrease in the respiratory rate were the principal side-effects of oxycodone, whereas tachycardia, restlessness, sweating and nausea were more frequent after nefopam.

Adult↗
PubMed1995

Adverse reactions associated with nefopam.

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.

Adolescent↗
PubMed1980

The analgesic and hypothermic effects of nefopam, morphine, aspirin, diphenhydramine, and placebo.

One hundred and ninety-six hospitalized patients were randomly assigned to one of eight treatment groups consisting of oral or intramuscular analgesics and placebo. Patients were monitored for 6 hours for pain relief, vital signs, and side effects. No statistically significant differences in pain intensity or relief were seen for nefopam (Acupan), diphenhydramine (Benadryl), aspirin, or placebo despite a numerically higher score for nefopam. This is attributed to an unexpectantly high placebo response. Significant pain relief and reduction of pain intensity were seen with both parenteral nefopam and morphine. Side effect incidence, in general, paralleled analgesic efficacy and was higher in patients receiving parenteral drugs. An early hypothermic effect was noted with oral and parenteral nefopam, aspirin, and morphine. Lower temperatures persisted to a statistically significant degree only in nefopam-treated patients.

Administration, Oral↗