← Search & browse all drugs

bupivacaine

N01BB01

Forms & Strengths

Injectable solution: 0.25%, 0.5%, 0.75%
Injectable solution with epinephrine: 0.25%, 0.5% (1:200,000)
Liposomal injectable suspension: 1.33 mg/mL

Adult Dosing

Local infiltration: 5 mg to 150 mg (0.25% or 0.5%), individualized based on area
Epidural block: 10 mg to 150 mg depending on segment and desired depth of anesthesia
Spinal block: 7.5 mg to 15 mg (typically 0.75% in dextrose 8.25%)
Maximum safe dose (plain): 2 mg/kg (not to exceed 175 mg) without epinephrine
Maximum safe dose (with epinephrine): 3 mg/kg (not to exceed 225 mg)

Pediatric Dosing

Not recommended for children under 12 years for certain regional blocks
Caudal block (children > 1 year): 1 to 2 mg/kg of 0.125% or 0.25% solution
Peripheral nerve block: 1 to 1.25 mg/kg of 0.25% solution

Indications

Local or regional anesthesia for surgery
Dental procedures
Labor and delivery (epidural/caudal)
Postoperative pain management

Mechanism of Action

Amide-type local anesthetic that reversibly binds to voltage-gated sodium channels in nerve fibers
Blocks the influx of sodium ions, preventing depolarization and propagation of nerve impulses

Contraindications

Known hypersensitivity to local anesthetics of the amide type
Obstetric paracervical block (associated with fetal bradycardia and death)
Intravenous regional anesthesia (Bier block) due to risk of systemic toxicity

Adverse Reactions

Central nervous system: Tinnitus, metallic taste, dizziness, circumoral numbness, tremors, seizures
Cardiovascular: Myocardial depression, hypotension, bradycardia, ventricular arrhythmias, cardiac arrest
Neurologic: Transient root symptoms, arachnoiditis (with spinal use)
Other: Urinary retention, nausea, vomiting, pruritus

Drug Interactions

Class III antiarrhythmics (e.g., amiodarone): Additive cardiac depressant effects
Other local anesthetics or structurally related agents: Additive systemic toxicity
CNS depressants (sedatives, opioids): Enhanced central nervous system depression
Vasopressors (when used with epinephrine): Severe persistent hypertension or cerebrovascular accidents

Curated Content: Needs Vetting Before Put to Clinical Use