From the Guidelines
Nefopam hydrochloride should be used with caution in patients with gastroparesis, though it is not absolutely contraindicated. Patients with gastroparesis may experience worsened symptoms when taking nefopam due to its anticholinergic properties, which can further delay gastric emptying and exacerbate nausea, vomiting, and abdominal discomfort. If nefopam is prescribed for pain management in a patient with gastroparesis, start with a lower dose (such as 30mg three times daily instead of the typical 60mg three times daily) and monitor closely for worsening gastroparesis symptoms. The medication works as a centrally-acting, non-opioid analgesic that inhibits serotonin, norepinephrine, and dopamine reuptake while also having moderate anticholinergic effects. These anticholinergic properties are the primary concern in gastroparesis patients as they can reduce gastrointestinal motility.
According to the most recent study 1, treatment of diabetic gastroparesis may be very challenging, and withdrawing drugs with adverse effects on gastrointestinal motility, including opioids, anticholinergics, TCAs, GLP-1 RAs, and pramlintide, may also improve intestinal motility. However, the risk of removal of GLP-1 RAs should be balanced against their potential benefits.
Some key points to consider when managing gastroparesis include:
- A small-particle diet may provide some symptom relief
- Withdrawing drugs with adverse effects on gastrointestinal motility may improve intestinal motility
- Only metoclopramide, a prokinetic agent, is approved by the FDA for the treatment of gastroparesis
- Alternative pain medications with fewer anticholinergic effects, such as acetaminophen or certain NSAIDs (if not otherwise contraindicated), may be preferable first-line options for pain management in patients with gastroparesis.
It is essential to weigh the benefits and risks of using nefopam hydrochloride in patients with gastroparesis and to closely monitor for any adverse effects on gastrointestinal motility.
From the Research
Nefopam Hydrochloride and Gastroparesis
- There is no direct evidence in the provided studies that suggests Nefopam Hydrochloride is contraindicated with gastroparesis 2, 3, 4, 5, 6.
- However, it is noted that nefopam can cause nausea and vomiting as side effects 3, 5, which may exacerbate symptoms of gastroparesis.
- Gastroparesis is a neurogastrointestinal motility disorder characterized by delayed gastric emptying without mechanical obstruction, and its management involves nutritional support, medications, and procedures 2.
- Nefopam is a non-narcotic analgesic that is effective in treating moderate acute pain, but its safety profile and potential interactions with other conditions like gastroparesis need to be considered 3, 4, 5, 6.
- Further studies are needed to evaluate the safety and efficacy of nefopam in patients with gastroparesis, as well as its potential interactions with other medications used to treat this condition 2, 4, 6.