Nefopam 30mg Tablets is a UK Prescription Only Medicine, a centrally acting non-opioid, non-NSAID analgesic of the benzoxazocine class.
Licensed for relief of moderate pain in adults. Nefopam works through descending pain pathway modulation (serotonin and noradrenaline reuptake inhibition) with weak NMDA receptor effects, distinct from opioid receptor binding (codeine, tramadol) or prostaglandin inhibition (ibuprofen, naproxen).
Key advantages: no respiratory depression, no constipation, no dependence, no GI bleeding risk. Useful for patients where opioids or NSAIDs are unsuitable.
Available from Courier Pharmacy after online consultation reviewed by a UK-qualified prescriber.
Nefopam 30mg Tablets are a UK Prescription Only Medicine (POM). Each tablet contains nefopam hydrochloride 30mg. Nefopam is a non opioid painkiller. It is also not an NSAID, so it does not work like ibuprofen or naproxen. Instead, it acts in the brain and spinal cord to help reduce pain signals.
Although clinicians have used nefopam in the UK since the 1970s, many people only come across it when other pain options do not suit them.
What Nefopam is used for
Nefopam is licensed for the relief of moderate pain in adults. For example, it may be used for:
post?operative pain
acute injury (traumatic) pain
dental pain
musculoskeletal pain
some chronic pain, when other painkillers have not helped enough or are not suitable
How Nefopam works
Nefopam works centrally, which means it acts on the nervous system rather than directly on inflamed tissue. It helps modulate pain pathways and can reduce how strongly the body “turns up” pain signals.
Because it does not act like an opioid, it does not bind to opioid receptors. Also, because it is not an NSAID, it does not reduce prostaglandins in the same way.
Why Nefopam can be a useful option
Nefopam can be helpful when standard options do not fit. For example, it may suit people who need pain relief but want to avoid:
opioids, due to sedation, constipation, dependence risk, or past opioid problems
NSAIDs, due to stomach ulcers, kidney issues, heart risks, asthma sensitivity, or blood thinners
In addition, some prescribers use nefopam alongside other pain medicines as part of a wider plan.
Where Nefopam fits in a stepped pain plan
Pain treatment often follows a step-by-step approach. The right plan depends on the cause of pain.
Many people start with:
paracetamol, plus self care and lifestyle steps
Then, if needed, clinicians may add:
topical NSAIDs for local joint or muscle pain, or
oral NSAIDs or a short course of a weak opioid, when suitable
However, if NSAIDs or opioids are not suitable, a prescriber may consider nefopam as an alternative.
For long?term pain, guidance often focuses on a broader approach too. This may include movement, sleep support, and selected medicines where appropriate.
Nefopam from Courier Pharmacy
Courier Pharmacy supplies Nefopam 30mg Tablets from a UK GPhC registered pharmacy after an online consultation. A UK qualified prescriber reviews your answers. We also check your current medicines and your treatment goals.
A 90 tablet pack can cover around 30 days at a common dosing pattern of one tablet three times daily, if prescribed.
Key features and specifications
Active ingredient: nefopam hydrochloride 30mg per tablet
Form: film coated tablet (swallow whole with water)
Indication: relief of moderate pain in adults
Typical adult dose: 30–60mg (1–2 tablets) three times daily
Maximum dose: 90mg three times daily (270mg per day)
Onset: often within 30–60 minutes
Duration: around 4–6 hours
Legal category: Prescription Only Medicine (POM)
Supplied by: Courier Pharmacy with prescriber consultation and pharmacist support
Additional information
Quantity
30 tablets, 60 tablets, 90 tablets
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When acute or persistent moderate pain hasn’t responded well to paracetamol and isn’t quite suited to NSAIDs or opioids, nefopam offers a genuinely different approach. As a centrally acting non-opioid, non-NSAID analgesic, nefopam works through pathways that neither paracetamol nor codeine nor ibuprofen reach, with a side effect profile that is its own. The 90-pack provides a sensible larger supply for patients managing chronic pain conditions where nefopam has been a useful part of their regimen.
At Courier Pharmacy, we believe treatment that fits the person, not the marketing budget. Nefopam is one of the less well-known UK analgesics, often overlooked despite being a clinically useful option for the right patient. This page covers where nefopam fits, how to use it well, and how it compares to other moderate analgesics so you can make an informed choice with our pharmacist.
Five key takeaways
Nefopam 30mg Tablets is a UK Prescription Only Medicine (POM), a centrally acting non-opioid, non-NSAID analgesic licensed for relief of moderate pain in adults. The 90-pack provides approximately 30 days at typical adult dosing of one tablet three times daily
Nefopam works through descending pain pathway modulation (serotonin and noradrenaline reuptake inhibition) and weak NMDA receptor effects, rather than the opioid receptor binding (codeine, tramadol) or prostaglandin inhibition (ibuprofen, naproxen, diclofenac) mechanisms used by other moderate analgesics
Key clinical advantages: no respiratory depression, no constipation, no dependence or tolerance, no GI bleeding risk, no significant renal or cardiovascular concerns at standard doses. Useful for patients where opioids or NSAIDs are unsuitable
Standard adult dose is 30 to 60mg (one to two tablets) three times daily. The 90-pack provides approximately 30 days at the most common dose of one tablet three times daily
Common side effects include nausea, dry mouth, sweating, light-headedness, urinary retention, and the distinctive “pink urine” effect (harmless but worth knowing about in advance). Anticholinergic effects mean caution in older patients, those with glaucoma, prostate enlargement, or epilepsy
Product description: Nefopam 30mg Tablets
Nefopam 30mg Tablets is a UK Prescription Only Medicine (POM) containing nefopam hydrochloride 30mg per tablet. Nefopam is a centrally acting non-opioid, non-NSAID analgesic introduced into UK clinical practice in the 1970s. The medicine has spent its clinical life in a slightly unusual position: well-known to anaesthetists, pain specialists, and palliative care teams, but less familiar in general practice and community pharmacy than its therapeutic profile would justify.
The licensed UK indication for Nefopam 30mg Tablets is:
Relief of moderate pain in adults, including post-operative pain, acute traumatic pain, dental pain, musculoskeletal pain, and chronic pain where other analgesics have been unsuitable or insufficient
The clinical position of nefopam in modern UK pain management is distinctive. Most analgesics fall into one of three established classes:
Non-opioid analgesics: paracetamol (acting primarily through central mechanisms not fully characterised), and NSAIDs (ibuprofen, naproxen, diclofenac, celecoxib; acting through cyclooxygenase inhibition and prostaglandin reduction)
Weak opioid analgesics: codeine, dihydrocodeine, tramadol, tapentadol (acting on opioid receptors with varying potency, with tramadol also having some serotonin and noradrenaline reuptake inhibition)
Strong opioid analgesics: morphine, oxycodone, fentanyl, buprenorphine, hydromorphone, methadone (acting on opioid receptors with full agonist or partial agonist activity)
Nefopam doesn’t fit any of these classes cleanly. It is non-opioid (no opioid receptor binding), non-NSAID (no significant cyclooxygenase inhibition), and acts centrally through modulation of descending pain inhibitory pathways. This makes it useful in several specific clinical situations:
Patients with moderate pain unsuitable for opioids (concerns about respiratory depression, constipation, dependence, sedation, history of opioid use disorder)
Patients with moderate pain unsuitable for NSAIDs (GI history, cardiovascular disease, kidney impairment, anticoagulant therapy, asthma, NSAID sensitivity)
Patients where adjunct analgesia is needed alongside other medicines that already cover the opioid and NSAID approaches
Post-operative pain in some surgical contexts where the favourable side effect profile is useful
Specific chronic pain conditions where nefopam has been part of a multi-component analgesic regimen with prescriber guidance
The position in the WHO analgesic ladder is somewhat lateral rather than fitting a specific step. Nefopam is not first-line for most pain (paracetamol or topical NSAIDs are usually the starting point), but where standard first-line and second-line options aren’t suitable, nefopam can be a clinically useful alternative without the systemic burden of opioids or oral NSAIDs.
The stepped approach to moderate pain in modern UK practice typically follows:
First-line: paracetamol regularly, plus lifestyle and self-management measures appropriate to the pain type
Second-line for localised musculoskeletal pain: topical NSAIDs (piroxicam, diclofenac, ibuprofen, ketoprofen) alongside paracetamol; NICE NG177 (chronic pain) and NG226 (osteoarthritis) position topical NSAIDs as first-line pharmacological treatment for localised pain
Second-line for systemic moderate pain: oral NSAIDs (ibuprofen, naproxen, diclofenac, celecoxib) where clinically suitable, with appropriate gastroprotection; or weak opioids (codeine 8/500 or 30/500 in combination with paracetamol as co-codamol) for short courses
Where NSAIDs and opioids aren’t suitable: nefopam can be considered as an alternative non-opioid, non-NSAID option
For chronic non-cancer pain: modern guidance (NICE NG177) moves away from long-term opioid use, gabapentinoids, and continuous NSAID monotherapy in favour of multidisciplinary approaches including exercise therapy, psychological interventions, and selective antidepressants (duloxetine, amitriptyline)
Nefopam is one of several options in the “where NSAIDs and opioids aren’t suitable” category, alongside paracetamol-only regimens, topical capsaicin, topical lidocaine plasters (Versatis), antidepressant analgesics (duloxetine, amitriptyline for chronic pain), gabapentinoids (gabapentin, pregabalin, though now used selectively because of dependence and misuse concerns), and other adjunct approaches.
We at Courier Pharmacy supply Nefopam 30mg Tablets from a UK-registered pharmacy after an online consultation reviewed by a UK-qualified prescriber. The 90-pack provides approximately 30 days of treatment at typical adult dosing, suitable for ongoing chronic pain management where nefopam has been a useful part of the patient’s analgesic regimen.
Key features and specifications
Active ingredient: nefopam hydrochloride 30mg per tablet
Form: film-coated tablet, swallowed whole with water
Pack size: 90 tablets (approximately 30 days of treatment at the most common adult dose of one tablet three times daily)
Indication: relief of moderate pain in adults
Standard adult dose: 30 to 60mg (one to two tablets) three times daily; maximum 90mg three times daily (270mg total daily)
Onset of action: typically within 30 to 60 minutes
Duration of action: approximately 4 to 6 hours, supporting three-times-daily dosing
Legal category: Prescription Only Medicine (POM)
Manufacturer: various UK-licensed manufacturers; originator brand Acupan
Supplied by: Courier Pharmacy, UK GPhC-registered, with prescriber consultation and pharmacist support
Why choose Courier Pharmacy for Nefopam 30mg tablets
At Courier Pharmacy, our whole approach is built on a simple idea: treatment that fits the person, not force the person to fit the system. For chronic pain particularly, that means honest engagement with the complexity of analgesic choice, the limitations of any single medicine, and the importance of joined-up care across multiple practitioners.
Our service is shaped by the philosophy of Dr Ada Jex-Cori, our brand pharmacist. Dr Ada represents the spirit of the pharmacy: evidence-led, community-rooted, and willing to challenge the one-size-fits-all approach to medicine. She is named in honour of three pioneering women in science: Ada Lovelace, the mathematician and visionary; Sophia Jex-Blake, the first female doctor in the UK who fought the medical establishment; and Gerty Cori, the biochemist and Nobel Prize winner. In our fictional world of Ethrewell, Dr Ada fights against pharma’s standardised approach to medicine. In the real world, she represents what we stand for. Her view is straightforward: you are not broken. The system is. And we are here to change that.
Honest framing of where nefopam fits
For patients with moderate pain where NSAIDs or opioids are unsuitable, nefopam is a clinically useful option that delivers genuine analgesic effect through a different mechanism. We supply it for patients who have been initiated on the medicine by a prescriber and need ongoing supply, or where a prescriber consultation through our service identifies nefopam as the right choice.
For patients with mild pain easily managed with paracetamol or topical NSAIDs, we won’t push a prescription analgesic when it isn’t needed. The right answer depends on your pain pattern and your wider clinical picture, not on what’s most expensive.
Treatment that fits, not one-size-fits-all
Most online pharmacies deliver the same protocol to everyone. Courier Pharmacy is different. For chronic pain particularly, we recognise that the same diagnosis can need very different treatment in different patients, depending on what’s tolerable, what works, what fits alongside other medicines, and what fits with the patient’s wider life. Nefopam may be the right answer for you; a different analgesic may suit better; a multidisciplinary approach may be what’s really needed. We’ll think through this with you honestly.
Care that takes chronic pain seriously
Chronic pain is one of the most dismissed conditions in standard healthcare, often treated as a single-problem suitable for a single-medicine solution rather than the complex multifaceted condition it actually is. We take chronic pain seriously. We support patients dealing with:
Pain alongside CFS, MCAS, or other long-term conditions where standard pain management hasn’t worked well
Pain alongside complex psychological or social factors that need integrated care
Patients transitioning away from long-term opioid use as part of a structured plan
Patients managing pain with multiple medicines where polypharmacy review and coordination matter
Pharmacist and prescriber support before and after purchase
Our prescriber is available to review your consultation thoroughly, considering not just the suitability of nefopam but the broader picture of your pain management plan. Our pharmacist is available for advice on:
Whether nefopam is the right option for your situation, or whether another approach would suit you better
How to take the medicine for best effect, including timing, food considerations, and what to expect
Managing common side effects (nausea, sweating, dry mouth, the pink urine effect)
How to combine nefopam with paracetamol, topical NSAIDs, and other analgesics safely
When your situation warrants pain specialist referral or multidisciplinary pain service input
Coordination with your GP and any other healthcare professionals involved in your care
This is free and available before and after purchase. Get in touch if you have any questions.
Care for specific patient groups
We are happy to provide tailored support for:
Patients with chronic pain where opioids and NSAIDs have not been suitable and a non-opioid, non-NSAID centrally acting analgesic adds value
Patients with CFS, fibromyalgia, MCAS, or chronic widespread pain where standard analgesic ladders haven’t fit and personalised approaches matter
Patients transitioning from long-term opioid use where alternative non-opioid analgesics support the transition
Older patients with chronic pain where careful interaction review and dose titration matter
Patients with post-surgical chronic pain where multi-component analgesia produces better outcomes
Patients with significant cardiovascular, renal, or GI history where NSAIDs are unsuitable
Coordination with your GP and other care
If you have a GP, pain consultant, rheumatologist, or other healthcare professional involved in your care, we are happy to coordinate. For patients with chronic pain, joined-up care across primary care, pharmacy, and specialist pain services produces substantially better outcomes than fragmented care.
Trust earned, not claimed
We are GPhC-regulated, we ground our content in NHS, NICE, BNF, and EMC guidance, and we will tell you honestly if nefopam isn’t the right answer for your situation. We would rather give you the right advice than a quick sale.
How to buy Nefopam 30mg tablets (90 pack) from Courier Pharmacy
Nefopam 30mg Tablets is a UK Prescription Only Medicine (POM). It can only be supplied after a UK-qualified prescriber has reviewed your online consultation. The consultation covers your pain history, what you’ve previously tried, any cardiovascular or seizure history, any prostate, eye, or cognitive considerations, your current medicines (particularly any MAOIs, serotonergic medicines, or anticholinergics), and your wider clinical picture.
Here is how our service works:
Complete a quick online consultation answering questions about your pain pattern, previous treatments, current medicines, and relevant medical history
A UK-qualified prescriber reviews your answers to confirm nefopam is suitable for you, including the interaction profile, seizure threshold considerations, and anticholinergic burden review
If approved, a prescription is issued and your order is prepared for dispatch
We dispense and deliver discreetly to your door
Free pharmacist support is available before and after your purchase for any questions
If nefopam isn’t the right product for your situation, we will explain why and suggest the next best option. That might be:
Paracetamol regularly plus self-management if you have not yet had a fair trial of these
Topical NSAID gel (Piroxicam 0.5% Gel, Voltarol Pain Relief Gel, Movelat) for localised musculoskeletal pain
An oral NSAID with appropriate gastroprotection if topical treatment is insufficient and you are clinically suitable
Co-codamol or co-dydramol for short-term moderate pain not adequately controlled by other measures
Duloxetine or amitriptyline for chronic pain where antidepressant analgesics fit the picture, particularly chronic primary pain
Topical capsaicin for some chronic pain conditions
Topical lidocaine plasters (Versatis) for localised neuropathic pain
A referral to physiotherapy for guided exercise and movement-based management
A referral to a pain specialist or multidisciplinary pain service for refractory or complex chronic pain
A GP appointment if your situation has features warranting broader medical assessment
Our free fortnightly drop-in clinics at Insomnia, Derby run every other week from 10am to 12pm. Healthcare shouldn’t only happen when you’re paying for it. We cover chronic pain, fibromyalgia, CFS, MCAS, musculoskeletal injuries, osteoarthritis, allergies, hair loss, men’s health, weight management, and whatever else people bring through the door. We show up, even when it’s free. No appointment needed, no charge, no pressure.
Active ingredients
Each tablet contains:
Nefopam hydrochloride 30mg (active ingredient): a centrally acting non-opioid, non-NSAID analgesic of the benzoxazocine class. Nefopam works primarily through inhibition of serotonin, noradrenaline, and dopamine reuptake in the descending pain pathways, with additional weak NMDA receptor modulation. The mechanism is distinct from opioid analgesics (codeine, tramadol, morphine), NSAIDs (ibuprofen, naproxen, diclofenac), and paracetamol
Patients with lactose intolerance, galactose intolerance, or glucose-galactose malabsorption should check the patient information leaflet of the specific pack supplied. The tablets do not contain gluten, soya, sucrose, or aspartame. Patients with concerns about specific excipients should contact our pharmacist before purchase.
Nefopam 30mg tablets is supplied by various UK-licensed pharmaceutical manufacturers. The originator brand was Acupan, although generic nefopam is now the standard supply. Generic and brand are bioequivalent and meet identical regulatory standards.
Where nefopam fits in moderate pain management
Moderate pain is one of the most common reasons UK adults seek prescriber input. Whether the cause is acute (post-operative, traumatic injury, dental, musculoskeletal flare) or chronic (persistent musculoskeletal pain, chronic primary pain, post-surgical chronic pain, specific neuropathic conditions), the treatment landscape includes a spectrum of pharmacological and non-pharmacological options that need matching to the specific clinical situation.
Modern UK guidance positions analgesic choice carefully:
NICE NG193 (Chronic pain assessment): highlights the importance of distinguishing chronic primary pain from chronic secondary pain (with an identifiable underlying cause that warrants treatment)
WHO analgesic ladder: still influential but increasingly questioned for chronic non-cancer pain because of opioid dependence and harm concerns
Within this landscape, nefopam occupies a useful niche for patients who need a centrally acting analgesic without the opioid or NSAID burden.
First-line: paracetamol and lifestyle
For most moderate pain, paracetamol regularly (1g four times daily for short courses) plus appropriate lifestyle measures (rest in acute injury, activity modification in chronic conditions, physiotherapy, sleep, stress management) is the starting point. Around half of patients respond well enough that further pharmacological treatment isn't needed.
Second-line: topical NSAIDs for localised pain
For localised musculoskeletal pain (osteoarthritis flares, soft tissue injuries, sports injuries), topical NSAID gels (piroxicam, diclofenac, ibuprofen, ketoprofen) are first-line pharmacological treatment under modern UK guidance. They deliver effective pain relief with substantially lower systemic risk than oral NSAIDs.
Second-line: oral NSAIDs or weak opioids for systemic moderate pain
For systemic or severe-enough localised pain where topical treatment isn't sufficient:
Oral NSAIDs (ibuprofen, naproxen, diclofenac, celecoxib) with appropriate gastroprotection (PPI) for patients at GI risk; consider cardiovascular and renal profile
Weak opioids (codeine, dihydrocodeine, tramadol) usually combined with paracetamol (co-codamol, co-dydramol), typically for short courses
Where NSAIDs and opioids aren't suitable: nefopam
Patients where standard second-line options aren't appropriate:
NSAIDs unsuitable: significant GI history, cardiovascular disease, kidney disease, anticoagulant therapy, severe asthma, NSAID sensitivity
Opioids unsuitable: respiratory disease concerns, history of opioid use disorder, undesirable sedation, undesirable constipation (already significant), older patients sensitive to opioid effects, patients seeking alternatives for personal reasons
Combination needed: patients who need adjunct analgesia alongside other medicines that already cover the opioid and NSAID approaches
Nefopam can be a useful option in these scenarios. Its centrally acting mechanism produces meaningful analgesic effect without opioid receptor binding (no respiratory depression, no constipation, no dependence, no tolerance buildup) and without prostaglandin inhibition (no GI bleeding risk, no significant cardiovascular concerns, no kidney effects at standard doses).
The trade-off is the distinctive side effect profile (see Side Effects section): anticholinergic effects (dry mouth, urinary retention, blurred vision in some patients), sympathomimetic effects (sweating, mild tachycardia, light-headedness), nausea, and the harmless but visually striking pink urine effect.
Specific chronic pain considerations
For chronic primary pain, modern UK guidance increasingly moves away from continuous analgesic monotherapy as a long-term solution. Nefopam can have a role within a multi-component plan that also includes:
Multidisciplinary chronic pain services with integrated physiotherapy, psychology, and medical input
Selective antidepressants (duloxetine, amitriptyline) for chronic pain modulation through serotonin and noradrenaline effects (similar mechanism overlap with nefopam, hence careful combination)
Cognitive behavioural therapy and acceptance-and-commitment therapy
Exercise therapy as the most evidence-based long-term intervention
Pacing and self-management education
When specialist input is appropriate
Several patterns warrant pain management specialist input:
Refractory moderate-to-severe chronic pain not responding to standard stepped treatment
Suspected underlying inflammatory arthritis, autoimmune conditions, or other identifiable secondary pain causes
Significant functional impairment from chronic pain
Pain alongside complex psychological or social comorbidity needing integrated care
Patients on multiple analgesics where polypharmacy review is needed
Suspected neuropathic pain not responding to standard neuropathic treatments
Patients with concerns about opioid use, dependence, or transitions in chronic pain regimens
How nefopam works
Nefopam is a centrally acting analgesic with a mechanism that is not fully characterised but involves several complementary actions on pain modulation pathways. This complexity is part of what makes the medicine clinically useful but also part of why it has a distinctive side effect profile.
Monoamine reuptake inhibition
The primary established mechanism of nefopam is inhibition of the reuptake of three monoamine neurotransmitters in the central nervous system:
Serotonin (5-HT) reuptake inhibition: increases serotonin availability in descending pain inhibitory pathways from the brainstem to the spinal cord. These pathways modulate the gain of pain signal transmission, dampening pain perception centrally
Noradrenaline reuptake inhibition: similarly increases noradrenaline availability in descending pain pathways. Noradrenaline-mediated descending inhibition is one of the major endogenous pain control systems, and is also the mechanism by which duloxetine and amitriptyline (used for chronic pain) work
Dopamine reuptake inhibition: weaker effect, but contributes to the centrally acting profile
This monoamine reuptake inhibition is the same broad mechanism by which tramadol provides part of its analgesic effect (tramadol combines opioid agonism with serotonin and noradrenaline reuptake inhibition). However, nefopam has no opioid receptor activity.
NMDA receptor modulation
Nefopam has weak modulatory effects on N-methyl-D-aspartate (NMDA) glutamate receptors in the spinal cord. NMDA receptors are central to central sensitisation, the process by which chronic pain becomes amplified and persistent through nervous system changes. Weak NMDA modulation contributes to nefopam's potential usefulness in chronic and neuropathic pain situations.
Cation channel effects
Nefopam has additional effects on voltage-gated sodium and calcium channels, contributing to its analgesic profile through reduced neuronal excitability.
What nefopam does NOT do
The mechanism explanations above are important because they explain why nefopam has the safety profile it does:
No opioid receptor binding: no respiratory depression, no constipation, no dependence, no tolerance, no euphoric effect, no addiction potential
No cyclooxygenase inhibition: no GI bleeding risk, no cardiovascular concerns from prostaglandin effects, no kidney impairment, no antiplatelet effect, no asthma exacerbation risk in NSAID-sensitive patients
The trade-off: anticholinergic and sympathomimetic effects
The downside of nefopam's mechanism is that the monoamine reuptake inhibition spills over into:
Mild anticholinergic effects: dry mouth, urinary retention (particularly in older men with prostatic enlargement), blurred vision, constipation in some patients, confusion in older patients
Other: nausea (one of the most common reasons for discontinuation), the harmless but visually striking pink urine effect
These effects are why nefopam isn't typically a first-line analgesic but is useful in specific clinical situations where the alternative profiles (opioid, NSAID) are unsuitable.
Pharmacokinetics
After oral administration, nefopam is well absorbed from the GI tract, reaching peak plasma levels within 1 to 3 hours. Food can delay absorption modestly without significantly affecting total exposure.
Nefopam is metabolised primarily in the liver, with several active metabolites contributing to its overall effect. The plasma half-life is approximately 4 hours, supporting the three-times-daily dosing schedule. Elimination is primarily through urine, with the metabolite that gives the harmless pink colouration to urine being one of the recognised markers of nefopam use.
How to take Nefopam 30mg tablets
The information below is a summary for reference. The definitive guide is the patient information leaflet supplied with the product. If you are unsure about any aspect of dosing or use, contact our pharmacist or your prescriber for support.
Dosing
Adults (18 and over): standard starting dose is 30mg (one tablet) three times daily. The dose can be titrated up to 60mg (two tablets) three times daily based on response and tolerability. Maximum dose is 90mg (three tablets) three times daily (270mg total daily), but most patients are managed at the 30 to 60mg three times daily range.
Older patients (over 65): start with lower doses (30mg two to three times daily) because of increased sensitivity to anticholinergic effects and the higher likelihood of comorbidities (prostate enlargement, narrow-angle glaucoma, cognitive impairment) that interact with nefopam's profile. Titrate carefully based on response and tolerability.
Children under 18: nefopam is not licensed for children. Paediatric pain management uses other approaches.
Patients with hepatic impairment: nefopam is metabolised in the liver; significant hepatic impairment may warrant dose reduction or alternative agents. Discuss with the prescriber.
Patients with renal impairment: nefopam metabolites are excreted in urine; significant renal impairment may warrant dose adjustment. Discuss with the prescriber.
When to take
Three times daily at evenly spaced intervals (typically morning, mid-afternoon, evening). Take at consistent times to maintain analgesic effect. The 4 to 6 hour duration means that missing a dose by an hour or two doesn't significantly affect overall control.
How to take
Swallow the tablet whole with a glass of water
Take with or without food; food can delay onset slightly but doesn't significantly affect total effect
The tablet can be taken with paracetamol, with topical NSAIDs, and (with prescriber guidance) with selected other analgesics
Avoid combining with strong serotonergic medicines without prescriber review (see Drug Interactions)
When to expect results
Onset of analgesic effect is typically within 30 to 60 minutes of dosing. Full effect develops over the first few days of regular use as steady-state plasma levels are established.
How long to take nefopam
Duration depends on the underlying clinical situation:
Short courses (days to weeks) for acute pain, post-operative pain, or specific acute conditions
Longer courses (weeks to months) for ongoing chronic pain where nefopam has been useful, under prescriber review
Chronic ongoing use is appropriate in some patients under prescriber supervision, with periodic review (every 6 to 12 months) to confirm ongoing benefit and reassess the wider pain management plan
The 90-pack supplied here provides approximately 30 days at the most common dose. Patients on ongoing nefopam therapy may use multiple packs across the year with periodic prescriber review.
Missing a dose
If you miss a dose, take it as soon as you remember unless it is nearly time for the next dose. Do not double-dose to catch up.
Stopping nefopam
Nefopam does not cause physical dependence and can be stopped without a taper. Underlying pain will return if the medicine was effectively controlling it. For patients who have been on long-term nefopam, gradual reduction over a week or two is sometimes preferred to monitor return of symptoms and consider alternative approaches.
Storage
Store at room temperature, below 25°C, in the original packaging to protect from moisture. Keep out of sight and reach of children. Do not use after the expiry date printed on the pack.
Warnings and precautions for Nefopam 30mg tablets
When not to use nefopam
Nefopam should not be used in:
Patients with known hypersensitivity to nefopam or any tablet excipient
Patients with a history of seizures or epilepsy (nefopam can lower the seizure threshold)
Patients with significant urinary retention or severe prostatic enlargement (anticholinergic effects can precipitate acute retention)
Patients with narrow-angle glaucoma (anticholinergic effects can precipitate acute angle-closure)
Patients on monoamine oxidase inhibitors (MAOIs: phenelzine, tranylcypromine, isocarboxazid, moclobemide, selegiline, rasagiline, linezolid) within 2 weeks
Patients with myocardial infarction in the last 6 months or unstable cardiac disease
Children under 18
Pregnancy and breastfeeding (limited safety data)
Seizure threshold
Nefopam can lower the seizure threshold in susceptible patients. Caution is appropriate in:
Patients with a personal history of epilepsy or seizures
Patients on other medicines that lower the seizure threshold (tramadol, bupropion, some antidepressants, some antipsychotics)
Patients with significant electrolyte disturbance (hyponatraemia, hypoglycaemia)
Heavy alcohol use or alcohol withdrawal
Significant brain injury history
Anticholinergic considerations
Nefopam has mild anticholinergic activity. The clinical situations where this matters most:
Prostatic enlargement (BPH): urinary retention risk; particularly relevant in older men
Narrow-angle glaucoma: anticholinergic effects can precipitate acute angle-closure
Significant cognitive impairment or dementia: anticholinergic burden may worsen cognition
Older patients generally: cumulative anticholinergic burden across multiple medicines (the "anticholinergic burden score") is increasingly recognised as a risk factor for cognitive decline and falls in older patients
Sympathomimetic considerations
The mild sympathomimetic effects (sweating, tachycardia, light-headedness) mean caution in:
Patients with significant cardiovascular disease, particularly recent MI, unstable angina, or significant arrhythmia
Patients with hyperthyroidism
Patients with phaeochromocytoma (very rare but contraindication)
Patients with significant anxiety where the sympathomimetic profile may worsen symptoms
Pregnancy and breastfeeding
Limited safety data is available on nefopam in pregnancy. Use should generally be avoided unless there is no suitable alternative. Discuss with the prescriber. In breastfeeding, limited data; discuss with the prescriber.
Start at lower doses and titrate carefully. Long-term use in older patients warrants regular review.
Driving and machinery
Nefopam can cause light-headedness, dizziness, or blurred vision in some patients, particularly when starting treatment. Avoid driving or operating machinery until you know how the medicine affects you. The DVLA does not have specific restrictions on nefopam, but it remains the patient's responsibility to ensure fitness to drive.
Alcohol
Combining nefopam with significant alcohol intake can increase the risk of seizures, light-headedness, and adverse cognitive effects. Limit alcohol or avoid significant intake while on nefopam.
Patients with bladder or prostate problems
Anticholinergic effects can precipitate acute urinary retention, particularly in older men with prostatic enlargement (benign prostatic hyperplasia, BPH). If you have BPH symptoms (slow urinary flow, hesitancy, incomplete emptying, frequency, nocturia), discuss with the prescriber before starting nefopam.
Patients with eye conditions
Patients with narrow-angle glaucoma or family history of acute angle-closure glaucoma should mention this; nefopam's anticholinergic effects can precipitate acute angle-closure in susceptible patients.
The pink urine effect
A distinctive feature of nefopam is the harmless pink colouration of urine that develops in most patients on treatment. This is caused by one of nefopam's urinary metabolites and is not a sign of blood in the urine or any concerning process. The pink colour disappears within a day or two of stopping the medicine. Worth knowing about in advance to avoid alarm.
Side effects of Nefopam 30mg tablets
Nefopam has a distinctive side effect profile. Most effects are mild and tolerable, but they are common enough to be the main reason some patients don't continue.
Common side effects (affecting up to 1 in 10 patients)
Nausea (one of the main reasons for discontinuation; usually settles with continued use or with food)
Dry mouth
Sweating (sometimes profuse, particularly in the first few weeks)
Light-headedness or dizziness
Pink urine (harmless cosmetic effect)
Insomnia (especially with evening dosing)
Headache
Drowsiness (occasionally, particularly in older patients)
Palpitations or mild tachycardia
Blurred vision
Confusion (especially in older patients)
Less common side effects
Vomiting
Constipation
Urinary retention (particularly in older men with prostatic enlargement)
Anxiety or nervousness
Mood changes
Tremor
Skin rash or itching
Allergic dermatitis
Rare but more significant side effects
Severe allergic reactions including angio-oedema or anaphylaxis (rare)
Serotonin syndrome (rare; risk increased with combination of serotonergic medicines)
Hallucinations (uncommon, more in older patients or with overdose)
Seizures (uncommon; risk increased with predisposing factors or overdose)
Acute urinary retention requiring catheterisation
Acute angle-closure glaucoma in susceptible patients
Hepatic enzyme elevation (uncommon, usually mild and reversible)
Significant cardiac effects (uncommon; tachyarrhythmia or hypertension)
Stop and seek urgent help if
You develop signs of severe allergic reaction (significant swelling, difficulty breathing, severe rash)
You develop signs of serotonin syndrome (high fever, severe agitation, muscle rigidity, rapid heart rate, significant blood pressure changes, particularly when combined with other serotonergic medicines)
You develop new seizure activity
You develop acute eye pain with visual disturbance (possible acute angle-closure glaucoma)
You develop acute urinary retention with significant abdominal pain
You develop significant chest pain or cardiac symptoms
You develop severe confusion, agitation, or hallucinations
Yellow Card reporting
Suspected adverse drug reactions can be reported to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk. Reporting helps build the safety picture for everyone.
Drug interactions with Nefopam 30mg Tablets
Nefopam has several clinically significant drug interactions, primarily related to its serotonergic and noradrenergic effects, anticholinergic activity, and seizure threshold considerations.
Significant interactions
Monoamine oxidase inhibitors (MAOIs) are an absolute contraindication. Avoid nefopam in patients on or within 2 weeks of:
Phenelzine, tranylcypromine, isocarboxazid (classical MAOIs for depression)
Moclobemide (reversible inhibitor of monoamine oxidase A)
Selegiline, rasagiline (used for Parkinson's disease)
Linezolid (antibiotic with MAOI activity)
The combination can precipitate serotonin syndrome or severe hypertensive reactions.
Serotonergic medicines require careful consideration because of additive serotonergic effect and serotonin syndrome risk:
Paracetamol: no interaction; paracetamol can be combined with nefopam safely and is often used together
NSAIDs: no significant pharmacological interaction; combination is sometimes used clinically for additive analgesic effect
Opioids: no contraindication; nefopam can be combined with opioids under prescriber supervision for additive analgesic effect
Most blood pressure medicines, statins, hormonal contraceptives: no significant interaction
Most antibiotics: no significant interaction (with the linezolid MAOI consideration noted above)
Antiplatelets and anticoagulants: no significant interaction (unlike NSAIDs, nefopam has no antiplatelet activity)
For patients on any of the significant-interaction medicines above, our prescriber will check the picture during your consultation.
Frequently asked questions about Nefopam 30mg Tablets
What is nefopam used for?
Nefopam 30mg Tablets is licensed in the UK for relief of moderate pain in adults, including post-operative pain, acute traumatic pain, dental pain, musculoskeletal pain, and chronic pain situations where other analgesics have been unsuitable or insufficient.
How is nefopam different from other moderate analgesics?
Nefopam acts centrally through serotonin and noradrenaline reuptake inhibition with weak NMDA receptor effects. It is not an opioid (no respiratory depression, no constipation, no dependence) and not an NSAID (no GI bleeding risk, no cardiovascular concerns, no kidney effects). This makes it useful where opioids or NSAIDs are unsuitable.
Is nefopam an opioid?
No. Nefopam has no opioid receptor binding. It does not produce the typical opioid effects (sedation, constipation, respiratory depression, euphoria, dependence, tolerance). It is sometimes mistakenly grouped with opioids because of its centrally acting analgesic nature, but the mechanism is entirely different.
Is nefopam addictive?
No. Nefopam does not produce physical or psychological dependence. There is no tolerance development requiring dose escalation, no withdrawal syndrome on stopping, and no addictive potential.
How quickly does nefopam work?
Onset is typically within 30 to 60 minutes of dosing. Full effect develops over the first few days of regular use as steady-state plasma levels are established.
How long does the effect last?
Approximately 4 to 6 hours, which is why it's taken three times daily.
When should I take nefopam?
Three times daily at evenly spaced intervals (typically morning, mid-afternoon, evening). Take at consistent times to maintain analgesic effect.
Can I take nefopam with food?
Yes. Food can delay onset slightly but doesn't significantly affect total effect. Take with food if you find nefopam causes nausea on an empty stomach.
Can I take nefopam with paracetamol?
Yes. Paracetamol and nefopam work through different mechanisms and combine safely. This combination is often used clinically for moderate pain.
Can I take nefopam with NSAIDs?
Yes. Nefopam can be combined with NSAIDs (oral or topical) for additive analgesic effect. There is no significant pharmacological interaction.
Can I take nefopam with opioids?
Yes, under prescriber supervision. The non-overlapping mechanisms mean nefopam can add useful analgesic effect to an opioid regimen without significantly increasing opioid-related risks.
Why does my urine turn pink?
This is a harmless cosmetic effect caused by one of nefopam's urinary metabolites. The pink colour is not blood and is not a sign of anything concerning. It disappears within a day or two of stopping the medicine.
Can I take nefopam if I have epilepsy?
No. Nefopam can lower the seizure threshold and is contraindicated in patients with a history of seizures or epilepsy. Discuss alternatives with your prescriber.
Can I take nefopam if I have prostate problems?
Caution. Nefopam's anticholinergic effects can precipitate urinary retention, particularly in older men with prostatic enlargement (BPH). Discuss with the prescriber before starting; sometimes nefopam can be used with careful monitoring, sometimes alternatives are preferable.
Can I take nefopam if I have glaucoma?
Patients with narrow-angle glaucoma should avoid nefopam because of the anticholinergic effects on the eye. Patients with open-angle glaucoma can usually use nefopam, but discuss with your ophthalmologist or prescriber.
Can I take nefopam if I'm on antidepressants?
It depends on the antidepressant. SSRIs (sertraline, citalopram, fluoxetine), SNRIs (venlafaxine, duloxetine), and tricyclics (amitriptyline) have additive serotonergic effects with nefopam and require careful management with monitoring for serotonin syndrome. MAOIs (phenelzine, tranylcypromine, moclobemide, selegiline, rasagiline) are an absolute contraindication. Discuss with the prescriber.
Can I take nefopam during pregnancy?
Limited safety data is available. Nefopam should generally be avoided in pregnancy unless there is no suitable alternative. Discuss with the prescriber.
Can I take nefopam while breastfeeding?
Limited data. Discuss with the prescriber.
Can children take nefopam?
Nefopam is not licensed for children under 18.
Can older patients take nefopam?
Yes, but with caution. Start at lower doses (30mg two to three times daily) and titrate carefully. Older patients are more sensitive to anticholinergic effects, sympathomimetic effects, and drug interactions. Regular review is important.
Can I drink alcohol while taking nefopam?
Limit alcohol significantly. Combining nefopam with significant alcohol can increase the risk of seizures, light-headedness, and adverse cognitive effects.
Can I drive while taking nefopam?
Avoid driving until you know how the medicine affects you. Nefopam can cause light-headedness, dizziness, or blurred vision in some patients, particularly when starting treatment.
What if nefopam doesn't work for me?
If standard adult doses don't provide adequate relief over 1 to 2 weeks of regular use, discuss with the prescriber. Options include dose titration up to the maximum, considering whether the pain pattern fits nefopam's profile, adding adjunct analgesics, or considering alternative approaches.
Can I stop nefopam suddenly?
Yes. Nefopam does not cause physical dependence and can be stopped without a taper. Underlying pain will return if the medicine was effectively controlling it.
How should I store nefopam?
Store at room temperature, below 25°C, in the original packaging to protect from moisture. Keep out of sight and reach of children. Do not use after the expiry date.
How do I order Nefopam 30mg Tablets from Courier Pharmacy?
Complete the online consultation at courierpharmacy.co.uk. A UK-qualified prescriber will review your answers, assess the interaction and contraindication profile, and issue a prescription if appropriate. Free pharmacist support is available before and after your order.
More than a prescription: our community
Healthcare shouldn't only happen when you're paying for it. Every fortnight we run free drop-in talks and clinics at Insomnia, Derby, from 10am to 12pm. We show up, even when it's free. Bring a question, bring a friend, bring a stack of bewildering letters from another clinic; we'll sit with you. We cover chronic pain, fibromyalgia, CFS, MCAS, osteoarthritis, musculoskeletal injuries, allergies, hair loss, men's health, weight management, and whatever else people bring through the door. No appointment. No cost. No pressure. Just real support and treatment that fits.
Disclaimer: This article is for information only and isn't a substitute for personal medical advice. Always speak to a qualified prescriber before starting or changing treatment.
How this content was created
Written by the Courier Pharmacy editorial team and reviewed by a GPhC-registered pharmacist. Grounded in the latest NHS, BNF, and EMC guidance, and the real questions patients bring to our drop-in clinics in Derby.
