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Is Nefopam Safe For A Pregnant Woman?

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Posted on Thu, 7 Apr 2016
Question: Hi there...I am a midwife researching the use of Acupan (nefopam) for postnatal analgesia. I need to find out what FDA category it is. Also if midwives can prescribe it in NZ..it is classed as not safe for use when lactating ..but many drugs are..eg Tramadol...and that is frequently prescribed by anaesthetists for use post Caesarian Section...We are trying to get our anaesthetists to prescribe Acupan instead of Tramadol...please advise
Regards
XXXX
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Answered by Dr. Diptanshu Das (1 hour later)
Brief Answer:
Tramadol is a better alternative.

Detailed Answer:
Nefopam Hydrochloride belongs to FDA category D or X and is not recommended for pregnant women. Moreover, evidence suggests that nefopam is excreted in human milk and hence is not advocated unless the benefits outweigh the risks.

Tramadol on the other hand comes under FDA Category C and with usual maternal dosage, the amount excreted into breastmilk is much less than the dose given to newborn infants for analgesia. Tramadol is unlikely to adversely affect nursing infant and is acceptable to use during breastfeeding.

So, in a nutshell, I find no justification to shift to Acupan from Tramadol. However, I would suggest considering Morphine and other opioids for postnatal analgesia if you really want to change over.

Let me know if I could help further.

Regards
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Diptanshu Das

Pediatrician

Practicing since :2005

Answered : 3877 Questions

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Is Nefopam Safe For A Pregnant Woman?

Brief Answer: Tramadol is a better alternative. Detailed Answer: Nefopam Hydrochloride belongs to FDA category D or X and is not recommended for pregnant women. Moreover, evidence suggests that nefopam is excreted in human milk and hence is not advocated unless the benefits outweigh the risks. Tramadol on the other hand comes under FDA Category C and with usual maternal dosage, the amount excreted into breastmilk is much less than the dose given to newborn infants for analgesia. Tramadol is unlikely to adversely affect nursing infant and is acceptable to use during breastfeeding. So, in a nutshell, I find no justification to shift to Acupan from Tramadol. However, I would suggest considering Morphine and other opioids for postnatal analgesia if you really want to change over. Let me know if I could help further. Regards