Bupivacaine Liposomal

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Bupivacaine Liposomal Brand Name– EXPAREL

What is Bupivacaine Liposomal

Bupivacaine Liposomal is an injectable, amide-type local anesthetic indicated for single-dose infiltration to produce postsurgical local analgesia and as an interscalene brachial plexus nerve block to produce postsurgical regional analgesia in adults.

Safety and efficacy have not been established in other nerve blocks.

Different formulations of bupivacaine are not bioequivalent even if the milligram strength is the same; it is not possible to convert dosing from other formulations of bupivacaine to liposomal bupivacaine.

Indications

  • postsurgical local analgesia
  • postsurgical regional analgesia

Side Effects

  1. agitation
  2. anaphylactoid reactions
  3. anemia
  4. angioedema
  5. anorexia
  6. anxiety
  7. apnea
  8. arthralgia
  9. asthenia
  10. atrial fibrillation
  11. AV block
  12. back pain
  13. blurred vision
  14. bradycardia
  15. bundle-branch block
  16. cardiac arrest
  17. chills
  18. chondrolysis
  19. coma
  20. confusion
  21. constipation
  22. cough
  23. delirium
  24. depression
  25. dizziness
  26. drowsiness
  27. dysgeusia
  28. dyspnea
  29. dysuria
  30. elevated hepatic enzymes
  31. erythema
  32. fatigue
  33. fever
  34. headache
  35. hematoma
  36. hiccups
  37. hyperhidrosis
  38. hypertension
  39. hyperthermia
  40. hypoesthesia
  41. hypokalemia
  42. hypotension
  43. hypoxia
  44. infection
  45. injection site reaction
  46. insomnia
  47. laryngeal edema
  48. laryngospasm
  49. lethargy
  50. metallic taste
  51. methemoglobinemia
  52. muscle cramps
  53. muscle paralysis
  54. musculoskeletal pain
  55. nausea
  56. orthostatic hypotension
  57. pallor
  58. palpitations
  59. paresthesias
  60. peripheral edema
  61. pruritus
  62. rash
  63. respiratory arrest
  64. respiratory depression
  65. restlessness
  66. seizures
  67. sinus tachycardia
  68. sneezing
  69. syncope
  70. thrombosis
  71. tinnitus
  72. tremor
  73. urinary incontinence
  74. urinary retention
  75. urticaria
  76. ventricular fibrillation
  77. ventricular tachycardia
  78. vomiting
  79. weakness

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • amide local anesthetic hypersensitivity
  • breast-feeding
  • cardiac disease
  • continuous intraarticular infusion administration
  • epidural administration
  • G6PD deficiency
  • hepatic disease
  • infants
  • intrathecal administration
  • intravenous administration
  • labor
  • methemoglobinemia
  • neonates
  • obstetric delivery
  • paracervical nerve block
  • pregnancy
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • requires an experienced clinician

Interactions

  • Acebutolol
  • Acetaminophen
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Pentazocine
  • Acetaminophen; Propoxyphene
  • Acetaminophen; Pseudoephedrine
  • Acetaminophen; Tramadol
  • Alfentanil
  • Ambenonium Chloride
  • Aminosalicylate sodium, Aminosalicylic acid
  • Amitriptyline
  • Amitriptyline; Chlordiazepoxide
  • Amobarbital
  • Amprenavir
  • Amyl Nitrite
  • Aprepitant, Fosaprepitant
  • Articaine; Epinephrine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Oxycodone
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atenolol
  • Atenolol; Chlorthalidone
  • Atracurium
  • Atropine; Edrophonium
  • Atropine; Hyoscyamine; Phenobarbital; Scopolamine
  • Barbiturates
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Belladonna; Opium
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Benzocaine
  • Benzocaine; Butamben; Tetracaine
  • Benzonatate
  • Betaxolol
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Boceprevir
  • Brimonidine; Timolol
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Bupivacaine; Lidocaine
  • Butabarbital
  • Caffeine; Ergotamine
  • Carbamazepine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carteolol
  • Carvedilol
  • Chloroprocaine
  • Chloroquine
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Cholinesterase inhibitors
  • Ciprofloxacin
  • Cisatracurium
  • Clomipramine
  • Cobicistat
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Conivaptan
  • Cyclophosphamide
  • Dapsone
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Desipramine
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dihydroergotamine
  • Diltiazem
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Donepezil
  • Donepezil; Memantine
  • Dorzolamide; Timolol
  • Doxacurium
  • Doxepin
  • Edrophonium
  • Elbasvir; Grazoprevir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Enflurane
  • Ergoloid Mesylates
  • Ergonovine
  • Ergot alkaloids
  • Ergotamine
  • Erythromycin; Sulfisoxazole
  • Esmolol
  • Etomidate
  • Fentanyl
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Flutamide
  • Fluvoxamine
  • Fosamprenavir
  • Fospropofol
  • Galantamine
  • General anesthetics
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Halothane
  • Homatropine; Hydrocodone
  • Hyaluronidase
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydantoins
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Hydroxyurea
  • Ibuprofen; Oxycodone
  • Idelalisib
  • Ifosfamide
  • Imatinib
  • Imipramine
  • Indinavir
  • Isavuconazonium
  • Isocarboxazid
  • Isoflurane
  • Isosorbide Dinitrate, ISDN
  • Isosorbide Mononitrate
  • Itraconazole
  • Ketamine
  • Ketoconazole
  • Labetalol
  • Lesinurad
  • Lesinurad; Allopurinol
  • Levomethadyl
  • Levorphanol
  • Lidocaine
  • Lopinavir; Ritonavir
  • Magnesium Salts
  • Meperidine
  • Meperidine; Promethazine
  • Mephobarbital
  • Mepivacaine
  • Mepivacaine; Levonordefrin
  • Methadone
  • Methohexital
  • Methylergonovine
  • Methysergide
  • Metoclopramide
  • Metoprolol
  • Minocycline
  • Mitotane
  • Mivacurium
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Nefazodone
  • Nelfinavir
  • Neostigmine
  • Neuromuscular blockers
  • Nevirapine
  • Nitrates
  • Nitrofurantoin
  • Nitroglycerin
  • Nortriptyline
  • Ombitasvir; Paritaprevir; Ritonavir
  • Oritavancin
  • Oxycodone
  • Oxymorphone
  • Pancuronium
  • Pazopanib
  • Penbutolol
  • Penicillin G Benzathine; Penicillin G Procaine
  • Penicillin G Procaine
  • Pentobarbital
  • Pergolide
  • Perphenazine; Amitriptyline
  • Phenelzine
  • Phenobarbital
  • Physostigmine
  • Pindolol
  • Posaconazole
  • Povidone-Iodine
  • Prilocaine
  • Prilocaine; Epinephrine
  • Primaquine
  • Primidone
  • Procarbazine
  • Propofol
  • Propoxyphene
  • Propranolol
  • Protriptyline
  • Pyridostigmine
  • Pyrimethamine; Sulfadoxine
  • Quinine
  • Rapacuronium
  • Rasburicase
  • Remifentanil
  • Rifamycins
  • Ritonavir
  • Rituximab; Hyaluronidase
  • Rivastigmine
  • Rocuronium
  • Ropivacaine
  • Secobarbital
  • Selegiline
  • Sevoflurane
  • Simeprevir
  • Succinylcholine
  • Sufentanil
  • Sulfadiazine
  • Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
  • Sulfasalazine
  • Sulfisoxazole
  • Sulfonamides
  • Tacrine
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Tetracaine
  • Thiopental
  • Timolol
  • Tipranavir
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trastuzumab; Hyaluronidase
  • Tricyclic antidepressants
  • Trimipramine
  • Tubocurarine
  • Valproic Acid, Divalproex Sodium
  • Vecuronium
  • Verapamil
  • Voriconazole

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