Fatal nefopam overdose

Urwin, S C; Smith, H S

doi:10.1093/bja/83.3.501

Cited by 21 publications

(11 citation statements)

References 3 publications

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“…(1,27,28). To our knowledge, there have been only two cases of fatal nefopam overdosage previously reported in the literature (Table I) (29,30). Both followed a voluntary, massive ingestion of nefopam tablets and were clinically well-documented.…”

Section: Resultsmentioning

confidence: 92%

Fatal Overdosage with Nefopam (Acupan®)

Tracqui

Berthelon

Ludes

2002

Journal of Analytical Toxicology

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This paper presents a fatality due to massive, intravenous self-administration of nefopam (Acupan), a non-opiate central analgesic, in a 37-year-old female. Nefopam was measured in various postmortem samples by means of high-pressure liquid chromatography coupled to mass spectrometry via an ionspray interface. Heart blood concentration was 4.38 microg/mL and exceeded by approximately 30 times the highest therapeutic levels with the usual reservations concerning possible postmortem redistribution. This is only the third case of death following nefopam overdose reported in the literature.

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Section: Resultsmentioning

confidence: 92%

Fatal Overdosage with Nefopam (Acupan®)

Tracqui

Berthelon

Ludes

2002

Journal of Analytical Toxicology

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“…The neuropsychiatric and cardiovascular ADRs are mainly known as signs of overdose. They include confusion, convulsions, hallucinations, tachycardia, bundle branch block or cardiac arrest [8–11]. Three fatal cases after nefopam overdose, have been reported in the literature [8–10].…”

Section: Discussionmentioning

confidence: 99%

Overview of adverse reactions to nefopam: an analysis of the French Pharmacovigilance database

Durrieu

Olivier‐Abbal

Bagheri

et al. 2007

Fundamemntal Clinical Pharma

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Nefopam is widely used for the relief of moderate acute pain. Its safety profile remains to be specified. The objective of the study was to review adverse reactions to nefopam spontaneously reported to the French Pharmacovigilance system. All cases of adverse drug reactions (ADRs) associated with nefopam, registered in the French Pharmacovigilance database from January 1, 1995 to December 31, 2004, were reviewed. For each reported ADR, information about patient (age, gender, medical history), drug exposure (suspected and concomitantly used drugs), characteristics of ADRs (imputability score, time of onset, seriousness, outcome) were collected. A total of 114 ADRs with an imputability rated from 'plausible' (I2) to 'likely' (I3) and 'very likely' (I4) was analysed. The most frequent ADRs included 'expected' ADRs such as sweating, nausea, tachycardia, malaise or vomiting; 61 ADRs were 'unexpected. No overdose was reported; 26 ADRs (23%) were considered as 'serious'. Most of them were 'unexpected', including neuropsychiatric (hallucinations, convulsions) or cutaneous (pruritus, erythema, urticaria) ADRs. Six cases of anaphylactic ADRs (two angioedema and four anaphylactic shocks) were reported, all occurring shortly after use of nefopam during the post-operative period. Physicians should be aware of the possible occurrence of some serious ADRs when using nefopam such as convulsions and anaphylactic shocks, especially when the drug is used in special medical conditions, like post-operative periods.

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“…8 Life-threatening effects have been reported in relation to nefopam overdose, however, including rare fatal overdoses characterized by convulsions and arrhythmia. 26,27 An accidental overdose was reported in a 77-year-old man who developed acute neurological impairment and renal failure. 28 Overdose was unlikely in the present study, however, since a low dose was used and all patients were closely observed in the ICU after surgery.…”

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confidence: 99%

The analgesic efficacy and safety of nefopam in patient-controlled analgesia after cardiac surgery: A randomized, double-blind, prospective study

Kim

Choi

et al. 2014

J Int Med Res

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Objective: The efficacy and side-effects of nefopam were prospectively compared with those of fentanyl for patient-controlled analgesia (PCA) following cardiac surgery. Methods: Patients scheduled to undergo cardiac surgery were randomly assigned between three PCA groups (nefopam, fentanyl or nefopam þ fentanyl). Pain was assessed at rest and during movement at 12, 24, 36, 48 and 72 h after surgery using a visual analogue scale (VAS). Total infused PCA volume, number of rescue drug injections, duration of intubation and length of stay in the intensive care unit were recorded. The incidence of adverse effects was noted at 48 h postoperatively. Results: There were no significant between-group differences in VAS score, total PCA infusion volume or number of rescue injections (n ¼ 92 per group). Nausea was significantly more common in the fentanyl group compared with both other groups. Conclusions: PCA with nefopam alone provides suitable postoperative analgesia after cardiac surgery.

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Fatal nefopam overdose

Cited by 21 publications

References 3 publications

Fatal Overdosage with Nefopam (Acupan®)

Fatal Overdosage with Nefopam (Acupan®)

Overview of adverse reactions to nefopam: an analysis of the French Pharmacovigilance database

The analgesic efficacy and safety of nefopam in patient-controlled analgesia after cardiac surgery: A randomized, double-blind, prospective study

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