Levobupivacaine

Levobupivacaine Brand Name– Chirocaine

What is Levobupivacaine

NOTE: This drug is discontinued in the US.

Levobupivacaine is an amino amide type of local anesthetic. Levobupivacaine is the S (-)-enantiomer of bupivacaine. Levobupivacaine produces sensory and motor blockade that is similar to bupivacaine.

In a randomized, double blind study, there was no significant difference in onset time, maximum spread of sensory block, or intensity of motor block in patients receiving lumbar epidural anesthesia with either levobupivacaine or bupivacaine.

The duration of sensory block was significantly longer in the levobupivacaine 0.75% group than in the levobupivacaine 0.5% or bupivacaine 0.5% groups.

Levobupivacaine exhibits less cardiotoxicity than bupivacaine. In studies of levobupivacaine in healthy volunteers, levobupivacaine had less effect of myocardial contractility, stroke volume, and a weaker effect on the corrected QT interval than the same doses of bupivacaine.

The threshold for CNS effects of levobupivacaine is higher than that of bupivacaine, and levobupivacaine is associated with fewer central or peripheral nervous system effects.

The FDA approved levobupivacaine in August 1999 for the production of local or regional surgical or obstetric anesthesia, and for post-operative pain management. Purdue Pharma discontinued the manufacture of levobupivacaine injection in 2004.

Celltech now owns the rights to the product, but it has no plans to manufacture or distribute the drug at this time.

Indications

  1. Caesarean section anesthesia
  2. epidural anesthesia
  3. infiltration anesthesia
  4. intraabdominal anesthesia
  5. local anesthesia
  6. obstetric anesthesia
  7. ophthalmic anesthesia
  8. peripheral nerve block
  9. regional anesthesia
  10. severe pain

For use as local anesthesia or regional anesthesia

Side Effects

  1. anemia
  2. anxiety
  3. apnea
  4. atrial fibrillation
  5. AV block
  6. blurred vision
  7. cardiac arrest
  8. constipation
  9. decreased uterine contractility
  10. depression
  11. dizziness
  12. drowsiness
  13. fever
  14. headache
  15. hypotension
  16. injection site reaction
  17. metabolic acidosis
  18. metallic taste
  19. nausea
  20. PR prolongation
  21. pruritus
  22. QT prolongation
  23. respiratory arrest
  24. respiratory depression
  25. seizures
  26. tinnitus
  27. vomiting

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • amide local anesthetic hypersensitivity
  • anticoagulant therapy
  • AV block
  • breast-feeding
  • cardiac disease
  • children
  • coagulopathy
  • dehydration
  • eclampsia
  • fetal distress
  • fetal prematurity
  • geriatric
  • head and neck anesthesia
  • heart failure
  • hepatic disease
  • hypertension
  • hypotension
  • hypovolemia
  • infection
  • intraarterial administration
  • intrathecal administration
  • intravenous administration
  • labor
  • myasthenia gravis
  • neurological disease
  • obstetric delivery
  • ocular surgery
  • paracervical nerve block
  • pregnancy
  • pudendal nerve block
  • QT prolongation
  • sepsis
  • shock
  • thrombocytopenia

Interactions

  • Acebutolol
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Codeine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Acetaminophen; Propoxyphene
  • Alfentanil
  • Ambenonium Chloride
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • 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
  • Barbiturates
  • Belladonna; Opium
  • Bendroflumethiazide; Nadolol
  • Benzhydrocodone; Acetaminophen
  • Benzonatate
  • Beta-adrenergic blockers
  • Betaxolol
  • Bisoprolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Brimonidine; Timolol
  • Brompheniramine; Guaifenesin; Hydrocodone
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Carbamazepine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carteolol
  • Carvedilol
  • Chlorpheniramine; Codeine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Cholinesterase inhibitors
  • Cimetidine
  • Ciprofloxacin
  • Cisatracurium
  • Clarithromycin
  • Codeine
  • Codeine; Guaifenesin
  • Codeine; Phenylephrine; Promethazine
  • Codeine; Promethazine
  • Conivaptan
  • Daratumumab; Hyaluronidase
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Donepezil
  • Donepezil; Memantine
  • Dorzolamide; Timolol
  • Doxacurium
  • Edrophonium
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Esmolol
  • Fentanyl
  • Fluconazole
  • Fluvoxamine
  • Fosamprenavir
  • Galantamine
  • Guaifenesin; Hydrocodone
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Homatropine; Hydrocodone
  • Hyaluronidase
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrocodone
  • Hydrocodone; Ibuprofen
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Hydromorphone
  • Ibuprofen; Oxycodone
  • Imatinib
  • Indinavir
  • Isocarboxazid
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Itraconazole
  • Labetalol
  • Levobetaxolol
  • Levobunolol
  • Levomethadyl
  • Levorphanol
  • Lopinavir; Ritonavir
  • Magnesium Salts
  • Meperidine
  • Meperidine; Promethazine
  • Methadone
  • Metoprolol
  • Minocycline
  • Mivacurium
  • Monoamine oxidase inhibitors
  • Morphine
  • Morphine; Naltrexone
  • Nadolol
  • Nebivolol
  • Nebivolol; Valsartan
  • Nefazodone
  • Nelfinavir
  • Neostigmine
  • Neuromuscular blockers
  • Nevirapine
  • Ombitasvir; Paritaprevir; Ritonavir
  • Omeprazole; Amoxicillin; Rifabutin
  • Oxycodone
  • Oxymorphone
  • Pancuronium
  • Penbutolol
  • Phenelzine
  • Physostigmine
  • Pindolol
  • Procarbazine
  • Propoxyphene
  • Propranolol
  • Pyridostigmine
  • Quinine
  • Rapacuronium
  • Remifentanil
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Ritonavir
  • Rituximab; Hyaluronidase
  • Rivastigmine
  • Rocuronium
  • Rufinamide
  • Saquinavir
  • Succinylcholine
  • Sufentanil
  • Tacrine
  • Timolol
  • Tipranavir
  • Tranylcypromine
  • Trastuzumab; Hyaluronidase
  • Tubocurarine
  • Vecuronium
  • Venlafaxine