ropivacaine (Rx)

Brand and Other Names:Naropin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 2mg/mL
  • 5mg/mL
  • 7.5mg/mL
  • 10mg/mL

Epidural/Caudal Anesthesia

75-200 mg (15-30 mL of 0.5%-1% solution)

Major Nerve Block

175-250 mg (35-50 mL) of 0.5% solution

75-300 mg (10-40 mL) of 0.75% solution

Field Block

5-200 mg (1-40 mL) of 0.5% solution

Labor Pain

20-40 mg (10-20 mL) initial of 0.2% solution, THEN

12-28 mg/hr (6-14 mL/hr) of 0.2% solution OR

20-30 mg/hr (10-15 mL/hr) continuous infusion of 0.2% solution

Post-Op Pain

Peripheral Nerve Block

  • 5-10 mL/hr continuous infusion of 0.2% solution

Lumbar or Thoracic Epidural

  • 6-14 mL/hr continuous infusion of 0.2% solution

Infiltration/ Minor Nerve Block

  • 1-100 mL dose of 0.2% solution
  • 1-40 mL dose of 0.5% solution

Administration

Doses should not be repeated more frequently than q3hr, no more than 400 mg (770 mg for post-op pain) in 24 hr

Dosage Forms & Strengths

injectable solution

  • 2mg/mL
  • 5mg/mL
  • 7.5mg/mL
  • 10mg/mL

Caudal Epidural Block (Off-Label)

1.25-6.5 mg/kg or 1 mL/kg of 0.2% strength  

Epidural Continuous Infusion (Off-Label)

< 4 Months

  • Safety and efficacy not established

4 Months to 7 years

  • 1 mg/kg loading dose; follow with 0.2-0.4 mg/kg/hr for 48 hr  

7-12 years

  • 3.6 mg loading dose; follow with 3.2 mg/hr infusion; may titrate up to 27.2 mg/hr PRN  

>12 years

  • 75-200 mg (15-30 mL of 0.5%-1% solution)
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Interactions

Interaction Checker

and ropivacaine

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Bradycardia, myocardial depression, , cardiac arrhythmias, edema, hypotension, cardiovascular collapse, cardiac arrest, palpitation, tachycardia, anginal pain, hypertension (epinephrine-containing solutions)

            Anxiety, apprehension, chills, headache, restlessness, nervousness, disorientation, confusion, dizziness, tremors, twitching, shivering, seizures; CNS depression manifested restlessness, tremors, drowsiness, unconsciousness, tinnitus

            Nausea, vomiting

            Blurred vision, miosis

            Respiratory arrest, status asthmaticus

            Anaphylactoid reactions (sometimes fatal)

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            Warnings

            Contraindications

            Hypersensitivity to ropivacaine or amide-type local anesthetics, sensitivity to parabens

            Obstetrical paracervical block anesthesia

            Cautions

            History of malignant hyperthermia

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

            Use preservative-free preparations for spinal or epidural anesthesia

            Monitor patient's state of consciousness following the injection; anxiety, dizziness, restlessness, tremors, depression, or blurred vision may be signs of CNS toxicity

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

            Respiratory arrest reported with use

            Seizures reported with systemic toxicity

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

            Methemoglobinemia

            • Use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly; patients with glucose-6-phosphate dehydrogenase deficiency, congenital or idiopathic methemoglobinemia, cardiac or pulmonary compromise, infants under 6 months of age, and concurrent exposure to oxidizing agents or their metabolites are more susceptible to developing clinical manifestations of the condition
            • Advise patients or caregivers to seek immediate medical attention if patient experiences the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue; discontinue Bicillin C-R and any other oxidizing agents; depending on severity of signs and symptoms, patients may respond to supportive care, including oxygen therapy and hydration; a more severe clinical presentation may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen
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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known if excreted in breast milk

            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.

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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: 3-15 hr; dose and route dependent; the greater the degree of vasodilation produced by the local anesthetic, the faster the rate of absorption & shorter the duration of action

            Onset of action: 3-15 min (route dependent)

            Protein bound: 94%

            Metabolism: Liver

            Half-life: 5-7 hr (IV)

            Metabolites: ester- & amide-type local anesthetics

            Excretion: Urine (86%)

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            Formulary

            FormularyPatient Discounts

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            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.