bupivacaine

Generic Name: bupivacaine (bue PIV a kane)Brand names: Marcaine HCl, Marcaine Spinal, Sensorcaine, Sensorcaine-MPF, Sensorcaine-MPF Spinal

What is bupivacaine?

Bupivacaine is an anesthetic (numbing medicine) that blocks the nerve impulses that send pain signals to your brain.

Bupivacaine is used as a local (in only one area) anesthetic for a spinal block.

Bupivacaine may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about bupivacaine?

You should not receive bupivacaine if you have ever had an allergic reaction to any type of numbing medicine.

Before receiving this medication, tell your doctor if you have liver disease, a bleeding or blood clotting disorder, syphilis, polio, a brain or spinal cord tumor, chronic back pain, a headache, low or high blood pressure, a curved spine, or arthritis.

This medication can cause numbness over a large portion of your body. Take care to avoid injury before the feeling has returned completely.

Spinal numbing medications can have long-lasting or permanent effects on certain body processes such as sexual function, bowel or bladder control, and movement or feeling in your legs or feet. Talk with your doctor about your specific risk of nerve damage from bupivacaine.

What should I discuss with my health care provider before receiving bupivacaine?

You should not receive bupivacaine if you have ever had an allergic reaction to any type of numbing medicine.

Before receiving bupivacaine, tell your doctor if you are allergic to any drugs, or if you have:

• liver disease;

• a bleeding or blood clotting disorder;

• syphilis, polio, or a brain or spinal cord tumor;

• chronic back pain or a headache;

• low or high blood pressure;

• curvature of the spine; or

• arthritis.

If you have any of these conditions, you may not be able to receive bupivacaine, or you may need dosage adjustments or special tests during treatment.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Before you receive bupivacaine, tell your doctor if you are pregnant. Bupivacaine can pass into breast milk and may harm a nursing baby. Before you receive bupivacaine, tell your doctor if you are breast-feeding a baby.

How is bupivacaine given?

Bupivacaine is given as an injection placed into an area of your lower back near your spine. You will receive this injection in a hospital or surgical setting.

Spinal numbing medications can have long-lasting or permanent effects on certain body processes such as sexual function, bowel or bladder control, and movement or feeling in your legs or feet. Talk with your doctor about your specific risk of nerve damage from bupivacaine.

What happens if I miss a dose?

Since bupivacaine is given as needed before a surgery or other medical procedure, you are not likely to be on a dosing schedule.

What happens if I overdose?

Tell your caregivers right away if you think you have received too much of this medicine.

Overdose symptoms may include extreme drowsiness, fainting, seizure (convulsions), shallow breathing, or breathing that stops.

What should I avoid after receiving bupivacaine?

This medication can cause numbness over a large portion of your body. Take care to avoid injury before the feeling has returned completely.

Bupivacaine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have any of these serious side effects:

• weak or shallow breathing;

• fast heart rate, gasping, feeling unusually hot;

• slow heart rate, weak pulse;

• feeling restless or anxious, ringing in the ears, metallic taste, speech problems, numbness or tingling around your mouth, tremors, feeling light-headed, or fainting; or

• problems with urination.

Less serious side effects include:

• nausea, vomiting;

• headache, back pain;

• dizziness;

• or problems with sexual function.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Bupivacaine Dosing Information

Usual Adult Dose for Local Anesthesia:

Bupivacaine: Most experience to date is with single doses up to 175 mg; more or less drug may be used to individualize doseDoses may be repeated up to once every 3 hours.Maximum dose: 400 mg per 24 hoursLocal infiltration:0.25% concentration: Inject up to the maximum doseEpidural block:0.75% concentration: Inject 75 to 150 mg (10 to 20 mL) once for complete motor block; not for obstetrical anesthesia0.5% concentration: Inject 50 to 100 mg (10 to 20 mL) for moderate to complete motor block; repeat doses increase the degree of motor block0.25% concentration: Inject 25 to 50 mg (10 to 20 mL) for partial to moderate motor block; repeat doses increase the degree of motor blockEpidural anesthesia: 0.5% and 0.75% solutions should be administered in 3 to 5 mL increments with sufficient time between doses to detect toxicity or accidental intravascular or intrathecal injectionEpidural anesthesia in obstetrics: Only 0.5% and 0.25% concentrations should be used; 0.5% solution should be administered in 3 to 5 mL increments not exceeding 50 to 100 mg at any dosing interval; repeat doses should follow a test dose containing epinephrine if not contraindicated; preservative-free product should be usedCaudal block:0.5% concentration: Inject 75 to 150 mg (15 to 30 mL) for moderate to complete motor block; repeat doses increase the degree of motor block0.25% concentration: Inject 37.5 to 75 mg (15 to 30 mL) for moderate motor block; repeat doses increase the degree of motor blockPeripheral nerve block:0.5% concentration: Inject 25 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block0.25% concentration: Inject 12.5 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor blockRetrobulbar block:0.75% concentration: Inject 15 to 30 mg (2 to 4 mL) for complete motor block; repeat doses increase the degree of motor blockSympathetic block:0.25% concentration: Inject 50 to 125 mg (20 to 50 mL)Bupivacaine in dextrose injection:Spinal anesthesia: Inject 7.5 mg (1 mL) for lower extremity and perineal procedures (including transurethral resection of the prostate and vaginal hysterectomy); 12 mg (1.6 mL) has been used for lower abdominal procedures (such as abdominal hysterectomy, tubal ligation, and appendectomy); doses as low as 6 mg have been used for vaginal deliveryThese dosages are recommended as a guide for use in an average adult.

Usual Adult Dose for Cesarean Section:

Bupivacaine in dextrose injection:Spinal anesthesia: 7.5 to 10.5 mg (1 to 1.4 mL) has been used

Usual Pediatric Dose for Local Anesthesia:

Bupivacaine:12 years or older: Most experience to date is with single doses up to 175 mg; more or less drug may be used to individualize doseDoses may be repeated up to once every 3 hours.Maximum dose: 400 mg per 24 hoursLocal infiltration:0.25% concentration: Inject up to the maximum doseEpidural block:0.75% concentration: Inject 75 to 150 mg (10 to 20 mL) once for complete motor block; not for obstetrical anesthesia0.5% concentration: Inject 50 to 100 mg (10 to 20 mL) for moderate to complete motor block; repeat doses increase the degree of motor block0.25% concentration: Inject 25 to 50 mg (10 to 20 mL) for partial to moderate motor block; repeat doses increase the degree of motor blockEpidural anesthesia: 0.5% and 0.75% solutions should be administered in 3 to 5 mL increments with sufficient time between doses to detect toxicity or accidental intravascular or intrathecal injectionEpidural anesthesia in obstetrics: Only 0.5% and 0.25% concentrations should be used; 0.5% solution should be administered in 3 to 5 mL increments not exceeding 50 to 100 mg at any dosing interval; repeat doses should follow a test dose containing epinephrine if not contraindicated; preservative-free product should be usedCaudal block:0.5% concentration: Inject 75 to 150 mg (15 to 30 mL) for moderate to complete motor block; repeat doses increase the degree of motor block0.25% concentration: Inject 37.5 to 75 mg (15 to 30 mL) for moderate motor block; repeat doses increase the degree of motor blockPeripheral nerve block:0.5% concentration: Inject 25 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor block0.25% concentration: Inject 12.5 mg up to the maximum dose (5 mL up to the maximum dose) for moderate to complete motor block; repeat doses increase the degree of motor blockRetrobulbar block:0.75% concentration: Inject 15 to 30 mg (2 to 4 mL) for complete motor block; repeat doses increase the degree of motor blockSympathetic block:0.25% concentration: Inject 50 to 125 mg (20 to 50 mL)Bupivacaine in dextrose injection: Not recommended in pediatric patients less than 18 years of age

What other drugs will affect bupivacaine?

Before receiving bupivacaine, tell your doctor if you are using any of the following drugs:

• a blood thinner such as warfarin (Coumadin);

• ergot medicine such as ergotamine (Ergomar, Cafergot), dihydroergotamine (D.H.E. 45, Migranal), ergonovine (Ergotrate), or methylergonovine (Methergine);

• an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate); or

• antidepressants such as amitriptyline (Elavil, Etrafon), amoxapine (Ascendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Janimine, Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), or trimipramine (Surmontil).

If you are using any of these drugs, you may not be able to receive bupivacaine, or you may need dose adjustments or extra monitoring during anesthesia.

This list is not complete and there may be other drugs that can interact with bupivacaine. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

• Your doctor or pharmacist can provide more information about bupivacaine.

• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.04. Revision Date: 4/12/2009 4:36:17 PM.