Bupivacaine
Pronunciation: (byoo-PIV-uh-kane).
- Generic name
- Bupivacaine
- Brand names
- Exparel, Sensorcaine, Bupivacaine Heavy, Sensovac, Bupivacaine Hydrochloride, Bupivacaine Sandoz
- Drug class
- Local Anesthetic (Amide-type)
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What Bupivacaine is and how it works
Uses, formulations, monitoring, and supply rules can differ by patient, product, and country. Follow the exact local product information and professional advice.
Mechanism of action: how Bupivacaine works
Bupivacaine is an amide-type local anesthetic that blocks voltage-gated sodium channels in neuronal membranes. This inhibition prevents the initiation and conduction of nerve impulses, resulting in reversible loss of sensation in the targeted area. (1) (2)
What Bupivacaine is used for
Pain management
Regional anesthesia
Before taking Bupivacaine
Do not take / not appropriate for
- Hypersensitivity to amide-type anesthetics, severe heart block, active infection at injection site, and intravenous regional anesthesia (Bier block). (Contraindication) (2)
Tell your clinician about
(2) (3)How to take Bupivacaine
- General Instructions: Bupivacaine is administered by a healthcare professional, usually as an injection near nerves, into the epidural space, or around the surgical site.. Adult Dosing: Typical doses vary by procedure and route. For epidural anesthesia, initial doses range from 10–20 mg, with maximum total doses not exceeding 175 mg for a single injection or 400 mg in 24 hours.. Pediatric Dosing: Current FDA labeling states that use of bupivacaine hydrochloride injection in pediatric patients younger than 12 years is not recommended; a specialist would only consider use below that age in exceptional circumstances. Administration: Given by slow injection by a trained professional. Never self-administer.. When To Stop: Treatment is stopped after the procedure or when anesthesia is no longer needed. Notify your provider if you experience adverse effects.. Storage: Store vials at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C; protect from light and moisture; do not freeze; single-dose vials are discarded after initial use. Keep out of reach of children.
- This page does not provide a dose calculator. Dosing must follow the prescriber, pharmacist, or product label.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (2) (3)
Missed dose
Bupivacaine is usually given as a single dose or as needed during procedures, so missed doses are not typical. If you are on a continuous infusion and a dose is missed, notify your healthcare provider immediately.
Overdose
Symptoms of overdose include seizures, severe hypotension, irregular heartbeat, or cardiac arrest. Seek emergency medical help immediately. Supportive care and lipid emulsion therapy may be required. (2) (3)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms to a healthcare professional.
Temporary numbness, tingling, or weakness in the area treated, and low blood pressure or slowed heart rate (more likely with epidural or spinal use)
Incidence: Expected with normal dosing
Nausea, dizziness, or drowsiness shortly after the injection
Incidence: Common
Ringing in the ears, metallic taste, numbness around the mouth, restlessness, tremors, blurred vision, confusion, seizures, an irregular or racing heartbeat, or difficulty breathing — these can be signs of local anesthetic toxicity and need urgent medical attention.
(2)Signs of an allergic reaction — hives, itching, swelling of the face/throat, or wheezing.
(2)Serious warnings
Boxed warning — serious
Symptoms: Boxed warning: reports of cardiac arrest with difficult or impossible resuscitation, and death, have occurred during epidural anesthesia in obstetric patients, most following use of the 0.75% concentration of bupivacaine hydrochloride injection. Cardiac arrest occurred after convulsions resulting from systemic toxicity, presumably following unintentional injection into a blood vessel. The 0.75% concentration is not recommended for obstetric anesthesia.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2) (3)
For professional use only — serious
Symptoms: For professional use only; not for self-administration. May cause serious heart or nervous system side effects if overdosed. Use caution in elderly, debilitated, or acutely ill patients. Not recommended for intravenous regional anesthesia (Bier block). Monitor for signs of allergic reaction or toxicity.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2) (3)
Contraindications recorded in the clinician database — serious
Symptoms: Contraindications recorded in the clinician database: Contraindications: Hypersensitivity to amide-type anesthetics, severe heart block, active infection at injection site, and intravenous regional anesthesia (Bier block). Precautions: Use with caution in patients with hepatic or renal impairment, cardiovascular disease, elderly, and debilitated patients.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2) (3)
Obstetrical paracervical block anesthesia is a contraindicated use of bupivacaine because it has been associated with fetal bradycardia and fetal death — serious
Symptoms: Obstetrical paracervical block anesthesia is a contraindicated use of bupivacaine because it has been associated with fetal bradycardia and fetal death.
Action: Follow the urgency stated and seek prompt or emergency care when indicated. (2) (3)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Recorded interactions | Bupivacaine may interact with other local anesthetics, antiarrhythmic drugs (such as amiodarone, lidocaine), beta-blockers, and certain antidepressants. These interactions can increase the risk of toxicity or cardiac effects. Always inform your healthcare provider about all medications and supplements you are taking. | (1) |
| Methemoglobinemia-inducing drugs | Nitrates/nitrites, certain antineoplastic agents, certain antibiotics, antimalarials, anticonvulsants, and acetaminophen can increase the risk of methemoglobinemia when combined with bupivacaine. Tell your healthcare provider about all medicines and supplements you are taking. | (2) |
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Local anesthetics such as bupivacaine cross the placenta and can cause maternal, fetal, and neonatal toxicity. Obstetrical paracervical block anesthesia with bupivacaine is contraindicated, and the 0.75% concentration is not recommended for obstetric anesthesia because of the risk of cardiac arrest. During regional anesthesia in pregnancy, the clinical team maintains positioning to avoid compression of the major blood vessels. Discuss the risks and benefits with the treating clinician. (2) (3)
Breastfeeding
Bupivacaine passes into breast milk only in minimal amounts and is poorly absorbed orally by an infant; no adverse effects have been reported in breastfed infants of treated mothers, and it is generally considered compatible with breastfeeding. Discuss individual circumstances with the treating clinician. (2) (3)
Children
Current FDA labeling states that use of bupivacaine hydrochloride injection in pediatric patients younger than 12 years is not recommended; safety and an established dose have not been defined for this age group. (2) (3)
Renal_impairment
The FDA label notes bupivacaine is substantially excreted by the kidney and that patients with renal impairment may have a greater risk of adverse reactions, so dose selection should take kidney function into account, although no specific reduced-dose table is given. Because amide-type local anesthetics such as bupivacaine are metabolized in the liver, the label recommends reduced dosing and increased monitoring for systemic (local anesthetic) toxicity in patients with moderate to severe hepatic impairment, especially with repeat dosing. Debilitated, elderly, or acutely ill patients should also receive reduced doses appropriate to their age and physical condition. Discuss individual kidney or liver disease with the treating clinician before the procedure. (2) (3)
Hepatic_impairment
The FDA label notes bupivacaine is substantially excreted by the kidney and that patients with renal impairment may have a greater risk of adverse reactions, so dose selection should take kidney function into account, although no specific reduced-dose table is given. Because amide-type local anesthetics such as bupivacaine are metabolized in the liver, the label recommends reduced dosing and increased monitoring for systemic (local anesthetic) toxicity in patients with moderate to severe hepatic impairment, especially with repeat dosing. Debilitated, elderly, or acutely ill patients should also receive reduced doses appropriate to their age and physical condition. Discuss individual kidney or liver disease with the treating clinician before the procedure. (2) (3)
Monitoring
(2) (3)Storage
Store at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F to 86°F). Protect from light and moisture. Do not freeze. Single-dose vials are discarded after initial use. Keep out of reach of children.
Professional information
Clinician-facing context only. This section does not replace current product labeling.
General
Indication: Pain management
Dose summary: For infiltration anesthesia, the standard dose is 5-10 mL of a 0.25% to 0.5% solution. Maximum recommended dose across techniques: 400 mg per 24 hours; individual single doses range 12.5-175 mg depending on technique and concentration.
Renal context: The FDA label states bupivacaine is substantially excreted by the kidney and that the risk of adverse reactions may be greater in patients with renal impairment; consideration should be given to dose selection, though no specific numeric dose-reduction table is given. The label separately notes that amide-type local anesthetics such as bupivacaine undergo hepatic metabolism, so reduced dosing and increased monitoring for systemic toxicity are recommended in patients with moderate to severe hepatic impairment, particularly with repeat doses. Debilitated, elderly, or acutely ill patients should be given reduced doses commensurate with their age and physical status. (1) (2)
Frequently asked questions
What is bupivacaine used for?
Bupivacaine is used to numb specific areas of the body during surgery, dental procedures, or childbirth. It provides long-lasting local or regional anesthesia.
How long does the numbing effect of bupivacaine last?
The effects can last from 2 to 8 hours, depending on the dose, site of injection, and individual patient factors.
Is bupivacaine safe during pregnancy?
Bupivacaine is commonly used for epidural anesthesia during labor. It should only be used under medical supervision, as it crosses the placenta.
Can bupivacaine cause allergic reactions?
Allergic reactions are rare but possible. Seek immediate help if you develop rash, swelling, or difficulty breathing.
What should I tell my doctor before receiving bupivacaine?
Inform your doctor about any allergies, heart, liver, or kidney problems, and all medications or supplements you are taking.
What are the signs of bupivacaine toxicity?
Symptoms include ringing in the ears, metallic taste, numbness around the mouth, confusion, seizures, or irregular heartbeat. Seek emergency care if these occur.
Can I drive after receiving bupivacaine?
Do not drive or operate machinery until you are fully alert and the effects of anesthesia have worn off.
What happens if I take too much Bupivacaine?
Taking too much Bupivacaine can lead to serious adverse effects, including central nervous system toxicity (e.g., seizures, dizziness, tremors) and cardiovascular toxicity (e.g., irregular heartbeat, low blood pressure). If you suspect an overdose, seek immediate emergency medical attention. Prompt intervention is crucial to manage these potentially life-threatening complications.
Can I drink alcohol while taking Bupivacaine?
It is generally advisable to avoid alcohol while receiving Bupivacaine. Alcohol can depress the central nervous system, and when combined with local anesthetics, it may exacerbate side effects such as dizziness or drowsiness. This combination could also potentially mask symptoms of local anesthetic systemic toxicity, making it harder to detect and manage. Always consult your healthcare provider for personalized advice.
What is the mechanism of action of Bupivacaine?
Bupivacaine is an amide-type local anesthetic that blocks voltage-gated sodium channels in neuronal membranes. This inhibition prevents the initiation and conduction of nerve impulses, resulting in reversible loss of sensation in the targeted area. (1) (2)
What is the generic name of Bupivacaine?
The generic name is Bupivacaine. It is sold under brand names including Exparel, Sensorcaine, Bupivacaine Heavy, Sensovac, Bupivacaine Hydrochloride, Bupivacaine Sandoz.
What class of drug is Bupivacaine?
Bupivacaine is classed as: Local Anesthetic (Amide-type).
References
- Bupivacaine clinician-authored medicine recordMedGuideGlobal · Global · accessed 2026-08-06 · source 1
- Bupivacaine Hydrochloride Injection prescribing informationU.S. Food and Drug Administration · United States · accessed 2026-08-06 · source 2
- Bupivacaine monograph — Drugs and Lactation Database (LactMed)National Institutes of Health · United States · accessed 2026-08-06 · source 3
- NOCITA (BUPIVACAINE) INJECTION, SUSPENSION [ELANCO US INC.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 4
- Bupivacaine Injection — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 5
- Bupivacaine — RxNorm normalized drug concept (RXCUI 1815)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 6
Brand names by country
Single-ingredient Bupivacaine names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Marcaine225 mg/30mL, 150 mg/30mL, 5 mg/mL, 7.5 mg/mL, 75 mg/30mL, 2.5 mg/mL, 50 mg0mL, 250 mg/50mL · hospira, inc.
- Sensorcaine MPF5 mg/mL, 2.5 mg/mL, 7.5 mg/mL · fresenius kabi usa, llc
- Sensorcaine5 mg/mL, 2.5 mg/mL · henry schein, inc.
- EXPAREL13.3 mg/mL · pacira pharmaceuticals, inc.
- Bupivacaine Spinal7.5 mg/mL · hospira, inc.
- BUPIVACAINE HCI2.5 mg/mL · hf acquisition co llc, dba healthfirst
- Bupivacine HCl7.5 mg/mL · xellia pharmaceuticals usa llc
- Marvona-25 SUIK2.5 mg/mL · asclemed usa, inc.
- Marvona SUIK5 mg/mL · asclemed usa, inc.
- BUPIVICAINE HYDROCHLORIDE2.5 mg/mL · hf acquisition co llc, dba healthfirst
Canada
- MARCAINE
- SENSORCAINE
- MARCAINE SPINAL 7.5 MG/ML