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bupivacaine (Rx)Brand and Other Names:Marcaine, Sensorcaine

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 0.25%
  • 0.5%
  • 0.75%
more...

Local Anesthesia

Infiltration: 0.25% infiltrated locally: 175 mg maximum

Caudal Block

Preservative free: 15-30 mL of 0.25% or 0.5%

Epidural Block Other Than Caudal Block

Preservative free: 10-20 mL of 0.25% or 0.5%; administer in 3-5 mL increments allowing sufficient time to detect toxic manifestations of inadvertent IV or IT administration

Surgical procedures requiring high degree of muscle relaxation and prolonged effects: 10-20 mL of 0.75%; not to be used in obstetrical cases

Peripheral Nerve Block

5 mL of 0.25-0.5%; 400 mg/day maximum

Sympathetic Nerve Block

20-50 mL of 0.25%

Retrotubular Anesthesia

2-4 mL of 0.75%

Spinal Anesthesia

Preservative free: 0.75% bupivacaine in 8.25% dextrose

Postherpetic Neuralgia (Orphan)

Relief of persistent pain associated with postherpetic neuralgia

Administration: Transdermal

Orphan indication sponsor

  • Alpharma Pharmaceuticals, LLC; 400 Crossing Blvd, Subsidiary of King Pharmaceuticals, Inc; Bridgewater, NJ 088

Dosage Forms & Strengths

injectable solution

  • 0.25%
  • 0.5%
  • 0.75%
more...

Caudal Block, Epidural Block, Local Block

<12 years

  • Not recommended

>12 years

  • Local Anesthesia: Infiltration 0.25% infiltrated locally: 175 mg maximum
  • Caudal Block: 15-30 mL of 0.25% or 0.5% (preservative free)
  • Epidural Block Other Than Caudal Block: 10-20 mL of 0.25% or 0.5%; administer in 3-5 mL increments allowing sufficient time to detect toxic manifestations of inadvertent IV or IT administration (preservative free); for surgical procedures requiring high degree of muscle relaxation and prolonged effects administer10-20 mL of 0.75%; not to be used in obstetrical cases

Peripheral or Sympathetic Nerve Block

<12 years

  • Not recommended

>12 years

  • Peripheral Nerve Block: 5 mL of 0.25-0.5%; 400 mg/day maximum
  • Sympathetic Nerve Block: 20-50 mL of 0.25%

Retrotubular Anesthesia

<12 years

  • Not recommended

>12 years

  • 2-4 mL of 0.75%
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Interactions

Interaction Checker

bupivacaine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Anaphylactoid reactions (sometimes fatal)

            Anginal pain

            Anxiety

            Apprehension

            Blurred vision

            Bradycardia

            Cardiovascular collapse

            Cardiac arrest

            Cardiac arrhythmias

            Chills

            Confusion/disorientation

            Dizziness

            Drowsiness

            Edema

            Headache

            Hypotension

            Hypoventilation

            HTN (epinephrine-containing solutions)

            Loss of consciousness

            Miosis

            Myocardial depression

            Nausea

            Nervousness

            Palpitation

            Respiratory arrest

            Restlessness

            Shivering

            Seizures

            Status asthmaticus

            Tachycardia

            Tinnitus

            Tremors

            Vomiting

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            Warnings

            Black Box Warnings

            The 0.75% concentration of bupivacaine is not recommended for obstetrical anesthesia; cardiac arrest with difficult resuscitation or death reported when used as epidural anesthesia in obstetrical patients; reserve the 0.75% concentration for surgical procedures where a high degree of muscle relaxation and prolonged effect are necessary

            Preservative-containing solutions should not be used for caudal or epidural block

            Contraindications

            Hypersensitivity, sensitivity to parabens

            Obstetrical paracervical block anesthesia

            Intravenous regional anesthesia use

            Cautions

            History of malignant hyperthermia

            DO NOT use solutions with epinephrine in distal areas of body (eg, digit, nose, ear, etc)

            Use preservative-free preparations for spinal or epidural anesthesia

            Avoid intravascular administration

            Addition of vasoconstrictor, epinephrine, will promote local hemostasis, decrease systemic absorption, and increase duration of action

            Test dose recommended for epidural administration

            Caution in cardiovascular disease including hypotension or heart block

            Cardiac arrest, arrhythmia and death reported with use of bupivacaine containing products

            Confusion, convulsions, respiratory depression, and/or respiratory arrest, and cardiovascular stimulation or depression reported

            Use caution in patients with hepatic impairment

            Use caution in the elderly, the acutely ill or debilitated patient (may require dose reduction)

            Chondrolysis associated with intra-articular infusions following arthroscopic and other surgical procedures (off-label use)

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: excretion in milk unknown/not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Local anesthetics prevent generation/conduction of nerve impulses by reducing sodium permeability & increasing action potential threshold

            Pharmacokinetics

            Duration: 2-9 hr (The greater the degree of vasodilation produced by the local anesthetic, the faster the absorption rate & the shorter the duration of action; bupivacaine has a long duration of action)

            Protein bound: 95%

            Onset of action: 1-17 min (route and dose dependent)

            Metabolism: Liver

            Peak plasma time: 30-45 min (caudal, epidural, or peripheral nerve block)

            Half-life: 8.1 hr (neonates); 2.7 hr (adults)

            Metabolites: Ester- & amide-type local anesthetics

            Excretion: Urine (principally)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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