Exparel

Pronunciation: X-pah-rell
Generic name: bupivacaine liposome
Dosage form: injection for infiltration or perineural use
Drug class: Local injectable anesthetics

Medically reviewed by Carmen Pope, BPharm. Last updated on Nov 14, 2023.

What is Exparel?

Exparel (bupivacaine) is an anesthetic (numbing medicine) that is used after surgery to provide:

• Local analgesia (pain relief in a small area) via infiltration for adults and children aged 6 and older
• Regional analgesia (pain relief in a larger area) in adults via:
• An interscalene brachial plexus nerve block
• A sciatic nerve block in the popliteal fossa
• An adductor canal block.

Exparel contains the local anesthetic bupivacaine that works to produce postsurgical analgesia by blocking the generation and the conduction of nerve impulses. Exparel uses the DepoFoam® proprietary multivesicular liposome (pMVL) technology to deliver bupivacaine for an extended period, providing analgesia for up to 72 hours after a single dose.

Exparel was first FDA-approved on October 28, 2011.

Warnings

Do not use for obstetrical paracervical block anesthesia. The safety and effectiveness of Exparel have not been established for postsurgical regional analgesia via other nerve blocks besides the ones approved above.

Your healthcare provider will monitor your cardiovascular status, neurological status, and vital signs during and after injection of Exparel. Call your doctor if you have joint pain or stiffness, or weakness in any part of your body that occurs after your surgery, even months later.

Should be used cautiously in people with liver disease because Exparel is metabolized by the liver. Patients with severe hepatic disease are at a greater risk of developing toxic plasma concentrations.

Cases of methemoglobinemia (a rare blood disorder that affects how red blood cells deliver oxygen throughout your body) have been reported in association with local anesthetic use. Seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue-colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.

Avoid using other local anesthetics within 96 hours of Exparel.

Because of the liposomal formulation, Exparel is not substitutable with other bupivacaine products even if the strength is the same.

You may still feel numb or be unable to move the numbed area for up to 5 days after you are treated with Exparel.

Before taking

You should not be treated with Exparel if you are allergic to bupivacaine.

Before receiving Exparel, tell your doctor if you have had:

• an allergic reaction to any type of numbing medicine
• liver disease
• kidney disease
• heart disease
• a heart rhythm disorder or
• seizures.

May cause fetal harm. Tell your doctor if you are pregnant.

It may not be safe to breastfeed a baby while you are using this medicine. Ask your doctor about any risks.

How is Exparel administered?

Exparel is given as an injection placed into an area near your surgical incision. You will receive this injection in a hospital or surgical setting.

See full prescribing information for dosage information.

• For local infiltration, the maximum recommended dosage in adults is 266mg.
• For local infiltration, the maximum recommended dosage in children aged 6 years to 17 years is 4mg/kg up to a maximum of 266mg.
• For interscalene brachial plexus nerve block, the maximum recommended dosage in adults is 133mg
• For sciatic nerve block in the popliteal fossa, the maximum recommended dosage in adults is 133mg
• For adductor canal block, the maximum recommended dosage in adults is 133mg (10mL) admixed with 50 mg (10 mL) 0.5% bupivacaine HCl, for a total volume of 20 mL.

For nerve blocks, additional analgesics, including immediate-release local anesthetics, may be administered.

Exparel can have long-lasting or delayed effects. For at least 4 days (96 hours) after your surgery, tell any doctor or dentist who treats you that you recently received an Exparel injection.

What happens if I miss a dose?

Since Exparel is used as a single dose, it does not have a daily dosing schedule.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving Exparel?

For at least 4 days (96 hours) after surgery, avoid using any pain or numbing medicines that contain lidocaine. This includes skin patches, sprays, creams, ointments, or gels applied to the skin. Follow your doctor's instructions.

What are the side effects of Exparel?

Get emergency medical help if you have signs of an allergic reaction to Exparel: hives, red rash, itching; sneezing, difficulty breathing; severe dizziness, vomiting; swelling of your face, lips, tongue, or throat.

You will be watched closely after receiving Exparel, to make sure you do not react to the medicine. Tell your caregivers at once if you have any of these signs of a serious side effect:

• ringing in your ears
• drowsiness, feeling restless or anxious
• feeling like you might pass out
• speech or vision problems, a metallic taste in your mouth
• numbness or tingling around your mouth
• fast or slow heart rate, feeling short of breath, feeling unusually hot or cold
• tremors, twitching, mood changes
• ongoing numbness, weakness, or loss of movement where the medicine was injected or
• joint pain or stiffness, or weakness in any part of your body for months after your surgery.

You may still feel numb or be unable to move the numbed area for up to 5 days after you are treated with bupivacaine.

Common Exparel side effects occurring in 10% or more adults include:

• nausea
• vomiting
• headache
• constipation
• fever.

Common Exparel side effects occurring in 10% or more children aged 6 to less than 17 years include nausea, vomiting, constipation, hypotension, anemia, muscle twitching, blurred vision, itching, and a fast heartbeat.

To report suspected side effects, contact Pacira Pharmaceuticals, Inc. at 1-855-RX-EXPAREL (1-855-793-9727) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Exparel?

Other drugs may interact with Exparel, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using including:

• Lidocaine or other non-bupivacaine local anesthetics: Do not mix. Exparel may be administered at least 20 minutes or more following local administration of lidocaine
• Bupivacaine HCl: Do not exceed a milligram dose of bupivacaine HCl solution to Exparel of 1:2 when admixing, as this may impact the pharmacokinetics and/or physicochemical properties of the drugs.

Ingredients

Active: Bupivacaine liposome

Inactive: cholesterol, 4.7 mg/mL; 1, 2-dipalmitoyl-sn-glycero-3 phospho-rac-(1-glycerol) sodium salt (DPPG), 0.9 mg/mL; tricaprylin, 2.0 mg/mL; 1, 2-dierucoylphosphatidylcholine (DEPC), 8.2 mg/mL; phosphoric acid to adjust pH; and sodium chloride to adjust tonicity.

The pH range is 5.8 to 7.4.

Exparel different functional, pharmacokinetic, and systemic properties relative to those of the unencapsulated or nonlipid-associated bupivacaine products.

Available as:

• 1.3% (266 mg/20 mL) (13.3 mg/mL) in a single-dose vial
• 1.3% (133 mg/10 mL) (13.3 mg/mL) in a single-dose vial

Storage

Store refrigerated between 2°C to 8°C (36°F to 46°F). May be stored at room temperature of 20°C to 25°C (68°F to 77°F) for up to 30 days in sealed, intact (unopened) vials. Do not re-refrigerate vials.

Do not freeze or expose Exparel to high temperatures (greater than 40°C or 104°F) for an extended period. Do not administer if it is suspected of having been frozen or exposed to high temperatures. Do not use the vial if the stopper is bulging.

Manufacturer

Pacira Pharmaceuticals, Inc.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer