Formulary
Bupivacaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Bupivacaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Bupivacaine hydrochloride: Indications, Dosing, Side Effects and Interactions
Bupivacaine hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Surgical anaesthesia, Acute pain for bupivacaine hydrochloride**
- **Child** (By regional administration): Doses adjusted according to child's physical status and nature of procedure, seek expert advice (consult product literature or local protocols).
Cautions
Cardiovascular disease; cerebral atheroma; complete heart block; debilitated patients (consider dose reduction); elderly (consider dose reduction); epilepsy; hypertension; hypotension; hypovolaemia; impaired cardiac conduction; impaired respiratory function; myasthenia gravis; myocardial depression may be more severe and more resistant to treatment; shock
Contraindications
Avoid injection into infected tissues; avoid injection into inflamed tissues; intravenous regional anaesthesia (Bier's block); preparations containing preservatives should not be used for caudal, epidural, or spinal block Contra-indications, further information Injection site Manufacturer advises local anaesthetics should not be injected into inflamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.
Side effects
Common or very common Arrhythmias; dizziness; hypertension; hypotension; nausea; paraesthesia; urinary retention; vomiting Uncommon Neurotoxicity Rare or very rare Arachnoiditis; cardiac arrest; diplopia; nerve disorders; paraplegia; paresis; respiratory depression Side-effects, further information Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection. The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.
Interactions
**Severe interactions:**
- Antihypertensive agents: Adrenaline specifically reverses the antihypertensive effects of adrenergic neurone blockers such as guanethidine, with the risk of severe hypertension.
**Other interactions (13):**
- Bupivacaine should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type local anaesthetics, e.g.
- Specific interaction studies with bupivacaine and anti-arrhythmic drugs class III (e.g.
- Beta-blockers, especially non-cardioselective agents, also antagonise the cardiac and bronchodilator effects of adrenaline.
- General Anaesthetics: Administration of Adrenaline in patients receiving halogenated hydrocarbon general anaesthetics that increase cardiac irritability and seem to sensitise the myocardium to...
- Adrenaline increases blood pressure and may antagonise the effects of antihypertensive drugs.
- Antidepressant agents: Tricyclic antidepressants such as imipramine inhibit reuptake of directly acting sympathomimetic agents, and may potentiate the effect of adrenaline, increasing the risk of...
Pregnancy
Large doses during delivery can cause neonatal respiratory depression, hypotonia, and bradycardia after epidural block. Use lower doses for intrathecal use during late pregnancy.
Breast feeding
Amount too small to be harmful.
Hepatic impairment
Manufacturer advises use with caution in advanced liver dysfunction.
Renal impairment
Use with caution in severe impairment.
Medicinal forms
Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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