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
- agitation
- anaphylactoid reactions
- anemia
- angioedema
- anorexia
- anxiety
- apnea
- arthralgia
- asthenia
- atrial fibrillation
- AV block
- back pain
- blurred vision
- bradycardia
- bundle-branch block
- cardiac arrest
- chills
- chondrolysis
- coma
- confusion
- constipation
- cough
- delirium
- depression
- dizziness
- drowsiness
- dysgeusia
- dyspnea
- dysuria
- elevated hepatic enzymes
- erythema
- fatigue
- fever
- headache
- hematoma
- hiccups
- hyperhidrosis
- hypertension
- hyperthermia
- hypoesthesia
- hypokalemia
- hypotension
- hypoxia
- infection
- injection site reaction
- insomnia
- laryngeal edema
- laryngospasm
- lethargy
- metallic taste
- methemoglobinemia
- muscle cramps
- muscle paralysis
- musculoskeletal pain
- nausea
- orthostatic hypotension
- pallor
- palpitations
- paresthesias
- peripheral edema
- pruritus
- rash
- respiratory arrest
- respiratory depression
- restlessness
- seizures
- sinus tachycardia
- sneezing
- syncope
- thrombosis
- tinnitus
- tremor
- urinary incontinence
- urinary retention
- urticaria
- ventricular fibrillation
- ventricular tachycardia
- vomiting
- 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
