Fatal Overdosage with Nefopam (Acupan®)

Tracqui, A.; Berthelon, Laurent; Ludes, Bertrand

doi:10.1093/jat/26.4.239

Cited by 20 publications

(13 citation statements)

References 30 publications

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“…There are some cases reported in literature of Nefopam fatal overdoses characterized by disorientation, aggressive convulsions, cardiac arrhythmia and respiratory depression [40]. Important cerebral edema was found postmortem in these patients [41].…”

Section: Adverse Effects and Contraindicationsmentioning

confidence: 91%

Nefopam and its Role in Modulating Acute and Chronic Pain

Ţigliş¹,

Neagu²,

Elfara³

et al. 2018

Rev. Chim.

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Pain is a very important issue to take into account during hospitalization. Nefopam, a centrally acting analgesic, has a relative safety pharmacological profile with few and well-tolerated side effects, being used to treat acute or chronic pain. It inhibits the central reuptake of serotonin, norepinephrine and dopamine and modulates the sodium and calcium channels having only few contraindications. Nefopam can be part of balanced analgesia along with others non-opioids agents in order to reduce the opioid consumption and their complications, to control postoperative pain and to reduce the risk of neuropathic pain appearance. In order to avoid its adverse reactions, a slow infusion is always recommended. Nefopam has its role in preventing the shivering appearance during neuraxial or general anesthesia, can modulate the emergence agitation after nasal and maxillofacial surgery and can inhibit the sever hiccup during mechanical ventilation. Some cases about fatal overdoses are reported in the literature.

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Section: Adverse Effects and Contraindicationsmentioning

confidence: 91%

Nefopam and its Role in Modulating Acute and Chronic Pain

Ţigliş¹,

Neagu²,

Elfara³

et al. 2018

Rev. Chim.

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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.…”

mentioning

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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“…In cases of generalized tonic-clonic seizure followed by fatality, the serum concentration of nefopam was in the range of 4.3 to 11.9 mg/L. [ 13 , 14 ] There has also been a case report of status epilepticus occurring in a patient who was treated with a continuous infusion of nefopam. [ 6 ] In this case, the patient was treated with various pain relievers because of back pain, and 80 mg of nefopam was mixed with 1 L of plasma solution and administered at an infusion rate of 42 mL/h.…”

Section: Discussionmentioning

confidence: 99%

Myoclonic movement after general anesthesia

Lee

Lim²,

Lee³

et al. 2018

Medicine

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Rationale:Myoclonic movement is a rare side effect after general anesthesia. Since we use various intravenous agents during general anesthesia recently, it is troublesome to find out the exact cause of this neurologic complication.Patient concerns:A 31-year-old female patient without any past medical history underwent hip arthroscopic surgery under general anesthesia.Diagnoses:Although there was no specific event during the operation, she showed a sudden myoclonic movement confined to left upper extremity in recovery room.Interventions:We administered anticonvulsant agents intrvenously, the myoclonus was stopped shortly but recurred over again. As we stopped the patient-controlled analgesia due to nausea, the symptom halted.Outcomes:There was no significant abnormality in electroencephalography or brain diffusion magnetic resonance imaging, which was taken after the event.Lessons:Clinicians should carefully consider the pharmacologic characteristics and neurologic adverse effects of all administered agents when myoclonus occurs after general anesthesia.

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Fatal Overdosage with Nefopam (Acupan®)

Cited by 20 publications

References 30 publications

Nefopam and its Role in Modulating Acute and Chronic Pain

Nefopam and its Role in Modulating Acute and Chronic Pain

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

Myoclonic movement after general anesthesia

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