Nefopam Hydrochloride: A Fatal Overdose

Seetohul, L. Nitin; Paoli, Giorgia De; Drummond, Gail; Maskell, Peter

doi:10.1093/jat/bkv036

Cited by 11 publications

(5 citation statements)

References 21 publications

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“…No studies have yet been reported on the effect of acute toxic dose of Nefopam on this respect. However, this finding may be contrary to Moini et al that the proposed IL-1β can affect significantly after taking opioid or Nefopam (20)(21)(22)(23), but more research must be done.…”

Section: B-contrasting

confidence: 78%

“…The resulting supernatant was then directly fed into the HPLC, yielding 30 μl. Before HPLC analysis, the samples were not diluted (18,22).…”

Section: Collection and Preparation Of Liver Heart And Brain Tissues ...mentioning

confidence: 99%

“…In the present study, there were no significant difference (P>0.05) in serum CK-MB level in rats injected with an acute toxic dose of IP Nefopam (40mg/kg) compared to control animals. It can be suggested that acute intoxication with nefopam may not affect CK-MB in myocytes; as no study has yet been reported to assess this effect, however, a case report on nefopam toxicity proposed that nefopam may cause death due to atherosclerosis (22,24).…”

Section: C-mentioning

confidence: 99%

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The Effect of Nefopam Hydrochloride on the Liver, Heart, and Brain of Rats: Acute Toxicity and Mechanisms of Nefopam Toxicity

2022

pnr

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Nefopam hydrochloride (Acupan) is commonly used to relieve moderate to severe postoperative pain. This drug is generally well tolerated; however, it has been associated with cardiac conduction problems, cerebral edema, fever, and renal failure when taken in excess. The aim is to investigate the effect of toxic doses of nefopam on the liver, heart, and brain of rats after exposure (acute toxicity of nefopam and concentration in these organs. Demonstrate whether TNF-α and NF-κB, and some selected interleukins (IL1β and IL-10) have a role in the mechanism of organ injury induced by nefopam Methods: Fourteen( 14) adult rats, Group I controls n = 7: Rats were administered a single intraperitoneal injection (IP) with normal saline Group II Nefopam-treated animals: each rat injected with a one toxic dose IDP (40 mg/kg) Nefopam and then sacrificed 24 hours after drug administration, and whole blood and organs were collected. Results: After injection of a toxic dose of nefopam showing a decrease in serum level of TNF-α (17.96 Pg per ml to 14.53 Pg per ml) and a decrease in IL 10 (from 36.26 to 23.22) and IL from (6.0 to 5.3 pg/ml) and an increase in NF-κB (396.314 TO 416.266 Pg/ml), the cardiac marker also changed CK-MB. Conclusion: Nefopam(acute toxic model) produced various effects on serum levels of cytokines (whether inflammatory or anti-inflammatory markers), in addition, it did not have significant effects on CK-MB, ALT, AST, and ALP; this may indicate that this acute toxic dose of Nefopam did not have significant effects on heart and liver tissues.

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Section: B-contrasting

confidence: 78%

“…The resulting supernatant was then directly fed into the HPLC, yielding 30 μl. Before HPLC analysis, the samples were not diluted (18,22).…”

Section: Collection and Preparation Of Liver Heart And Brain Tissues ...mentioning

confidence: 99%

Section: C-mentioning

confidence: 99%

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The Effect of Nefopam Hydrochloride on the Liver, Heart, and Brain of Rats: Acute Toxicity and Mechanisms of Nefopam Toxicity

2022

pnr

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“…The death was attributed to atherosclerotic coronary artery disease and therapeutic drug toxicity. Citalopram was quantified at 0.7 mg/L and 0.9 mg/L in unpreserved femoral and cardiac blood, respectively, whereas acetaminophen concentrations were not provided [33]. Acetaminophen and citalopram are among the 10 most frequently detected drugs in hanging and drug poisoning (intoxication) suicides.…”

Section: Discussionmentioning

confidence: 99%

Forensic Aspects of a Fatal Intoxication Involving Acetaminophen, Citalopram and Trazodone: A Case Report

Mannocchi

Tittarelli

Pantano³

et al. 2022

Toxics

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We report the case of a young man, a former heroin addict, found dead at home by the Police Forces in an advanced state of decomposition. Numerous blisters and unpacked tablets of medications were found all over the bed and on the floor of the room. Multiple injuries to the face, left arm and neck of the deceased were noted. The latter damages were attributed to post-mortem dog bites, since no indications of a possible defense against the animal were observed. The autopsy findings were unremarkable. Toxicological investigations performed on peripheral blood and urine by gas chromatography-mass spectrometry (GC-MS) technique showed the presence of acetaminophen, citalopram and trazodone. Combined drug intoxication was proposed as the cause of death since acetaminophen and trazodone concentrations were comparable with the ones found in fatal cases. Moreover, citalopram concentration in peripheral blood was above the toxic range and in accordance with levels found in fatalities due to poly-drug intoxication.

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“…Nefopam is a benzoxazine that was developed in the 1960s as a muscle relaxant, but clinical use revealed that it has non-opioid, centrally acting, non-steroidal analgesic abilities, and it was used for relief of moderate pain (Seetohul et al, 2015). Its unique mode of action involves inhibition of the reuptake of serotonin, noradrenaline, and dopamine and may interact with the glutamatergic system (Saghaei et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Nefopam induced dose-related changes in renal and hepatic functions

Jamal

Muthana

Sahib

et al. 2020

ijrps

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Nefopam is a non-opioid, centrally acting, non-steroidal analgesic drug. It is used to treat mild to moderate painful conditions. Although developed about five decades ago, its use has gained resurgence in recent years. This study was designed to investigate the effects of different analgesic doses of nefopam on the liver and kidneys of mice. Forty albino mice were divided into four groups of 10 mice for each group. Group 1, 2 &3 received a daily intraperitoneal injection of Nefopam at 10, 20, and 30 mg/kg doses, respectively. The fourth group (control group) received injections of normal saline. After two weeks of treatment, the animals were weighed and sacrificed, and then blood was collected for liver enzymes analysis and renal function test as well as histological assessment. The results revealed that the bodyweight increase ratio was significantly lower in group 3 (P-value <0.01). All tested liver enzymes i.e., ALT, AST, and ALP levels showed a highly significant (P-value <0.01) change among the tested groups. Although ALT remained within normal limits in the first two groups and normal group, in group 3 (30 mg/kg), its level exceeded the normal value. Liver enzyme changes reflected and supported the histopathological findings in the liver tissue. Group 2 & 3 showed varying degrees of hepatotoxicity, ranging from granulomatous lymphocytic infiltration to micro-vesicular steatosis and apoptotic pictures. Both kidney function test and histopathological examination, on the other hand, illustrated insignificant effect (P-value >0.05) of Nefopam on the kidneys. Nefopam is well tolerable by the liver at low analgesic doses but may have detrimental effects at higher analgesic doses and prolonged duration of intake.

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Nefopam Hydrochloride: A Fatal Overdose

Cited by 11 publications

References 21 publications

The Effect of Nefopam Hydrochloride on the Liver, Heart, and Brain of Rats: Acute Toxicity and Mechanisms of Nefopam Toxicity

The Effect of Nefopam Hydrochloride on the Liver, Heart, and Brain of Rats: Acute Toxicity and Mechanisms of Nefopam Toxicity

Forensic Aspects of a Fatal Intoxication Involving Acetaminophen, Citalopram and Trazodone: A Case Report

Nefopam induced dose-related changes in renal and hepatic functions

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