From the Research
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 1. If nefopam is prescribed to a patient with gastroparesis, it should be started at a lower dose (such as 30mg three times daily instead of the usual 60mg three times daily) and the patient should be monitored closely for worsening gastroparesis symptoms.
Key Considerations
- The most recent and highest quality study on pharmacologic treatments for gastroparesis does not specifically address the use of nefopam in gastroparesis, but highlights the importance of individualized treatment approaches 2.
- Alternative pain medications without significant anticholinergic effects, such as acetaminophen or certain non-steroidal anti-inflammatory drugs, may be preferable first-line options for these patients.
- The decision to use nefopam in gastroparesis should involve weighing the potential benefits for pain management against the risk of worsening gastrointestinal symptoms, and should be individualized based on the severity of the patient's gastroparesis and their pain management needs.
Monitoring and Dose Adjustment
- Patients with gastroparesis who are prescribed nefopam should be closely monitored for signs of worsening gastroparesis symptoms, such as nausea, vomiting, and abdominal discomfort.
- Dose adjustments may be necessary to minimize the risk of adverse effects and optimize pain management.
- The use of prokinetic agents, such as metoclopramide, may be considered in patients with gastroparesis who are experiencing significant gastrointestinal symptoms 3.