Bupivacaine liposome (Injection route)

Pronunciation:

bue-PIV-a-kane LYE-poh-some

Brand Names:

  • Exparel

Dosage Forms:

  • Suspension

Classifications:

Therapeutic—

Anesthetic, Local

Chemical—

Amino Amide

Uses of This Medicine:

Bupivacaine liposome injection is used to relieve pain after surgery. It is a local anesthetic that prevents pain by blocking signals at the nerve endings directly at the surgical area or by blocking nerve endings of the brachial plexus (nerves that conduct signals to the shoulder, arm, and hand).

This medicine is to be given only by or under the direct supervision of a doctor.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of bupivacaine liposome injection in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of bupivacaine liposome injection in the elderly. However, elderly patients are more likely to have kidney problems, which may require caution for patients receiving bupivacaine liposome injection.

Breast-feeding—

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Chloroprocaine
  • Cocaine
  • Fospropofol
  • Hyaluronidase
  • Levobupivacaine
  • Lidocaine
  • Mepivacaine
  • Prilocaine
  • Procaine
  • Propofol
  • Propranolol
  • St John's Wort
  • Verapamil

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alacepril
  • Benazepril
  • Captopril
  • Cilazapril
  • Delapril
  • Enalaprilat
  • Enalapril Maleate
  • Fosinopril
  • Imidapril
  • Lisinopril
  • Moexipril
  • Pentopril
  • Perindopril
  • Quinapril
  • Ramipril
  • Spirapril
  • Temocapril
  • Trandolapril
  • Zofenopril

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Glucose-6-phosphate dehydrogenase deficiency (G6PD) or
  • Heart problems or
  • Lung or breathing problems or
  • Methemoglobinemia (blood disorder), hereditary or idiopathic (unknown cause)—Use with caution. May increase risk of having methemoglobinemia.
  • Heart or blood vessel problems—May increase risk for more serious side effects.
  • Kidney disease or
  • Liver disease, moderate to severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper Use of This Medicine:

A nurse or other trained health professional will give you this medicine in a hospital. It is given through a needle injected into the tissue at the surgical site (eg, foot) or into the nerve endings of the brachial plexus (nerves that conduct signals to the shoulder, arm, and hand).

This medicine should cause numbness only to the area where it is injected. You may experience temporary loss of sensation or movement to the injected area for up to 5 days. This type of numbing procedure is called local anesthesia. It is not meant to cause you to fall asleep or become unconscious.

Bupivacaine liposome injection (Exparel®) works differently than other forms of bupivacaine, even at the same dose. You should not receive another type of bupivacaine injection or another anesthetic within 4 days (96 hours) after the injection of Exparel®.

Precautions While Using This Medicine:

It is very important that your doctor check your progress closely after you receive this medicine to see if the medicine is working properly. Blood tests may be needed to check for any unwanted effects.

This medicine should not be given to women during labor (obstetrical paracervical block anesthesia).

This medicine may cause a rare, but serious blood problem called methemoglobinemia. The risk may be increased in elderly patients or patients with certain inborn defects. It is more likely to occur in patients receiving too much of the medicine, but can also occur with small amounts. Check with your doctor right away if you or your child has the following symptoms after receiving this medicine: pale, gray, or blue-colored skin, lips, or nails, confusion, headache, lightheadedness, fast heartbeat, or unusual tiredness or weakness.

Tell your doctor or nurse right away if you have the following symptoms with this medicine: anxiety, blurred vision, depression, drowsiness, lightheadedness, nausea or vomiting, numbness and tingling of the mouth or lips, restlessness, ringing in the ears, speech problems, or tremors.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, mouth, or throat after receiving this medicine.

This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

This medicine may also increase your risk of having serious heart and blood vessel problems such as a heart attack, heart rhythm changes, or low blood pressure. Check with your doctor if you have chest pain or discomfort, pain or discomfort in the arms, jaw, back, or neck, dizziness, fainting, pounding, slow heartbeat, troubled breathing, or unusual tiredness or weakness.

Check with your doctor if you have joint pain, stiffness, or loss of motion of the shoulder. This may be symptoms of a serious bone or joint problem called chondrolysis.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common
Blurred vision
confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
fast, pounding, or irregular heartbeat or pulse
fever
sweating
Less common
Bloating or swelling of the face, arms, hands, lower legs, or feet
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
collection of blood under the skin
decrease in frequency of urination
decrease in urine volume
deep, dark purple bruise
difficulty in passing urine (dribbling)
dry mouth
headache
increased thirst
irregular heartbeat
itching, pain, redness, or swelling
loss of appetite
mood changes
muscle pain, cramp, or twitching
nausea
nervousness
painful urination
pale skin
pounding in the ears
rapid weight gain
seizures
slow or fast heartbeat
tingling of the hands or feet
trouble breathing
trouble breathing with exertion
unusual bleeding or bruising
unusual weight gain or loss
vomiting
Incidence not known
Chest pain or discomfort
loss of consciousness
no blood pressure or pulse
stopping of the heart
weakness of the muscles in your face

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Motor dysfunction
trouble sleeping
Less common
Anxiety
belching
change in taste
constipation
decreased appetite
feeling hot
heartburn
hiccups
indigestion
itching in the genitals or other skin areas
loss of taste
scaling
sensory loss
stomach discomfort, upset, or pain
swelling at the surgical site
Rare
Increased sweating

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 9/5/2019

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.

All rights reserved.

 

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
All rights reserved.

A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.