Bupivacaine Pregnancy and Breastfeeding Warnings
Bupivacaine Pregnancy Warnings
Bupivacaine has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of embryolethality at doses exceeding the maximum recommended daily human dose and developmental toxicity when administered subcutaneously at clinically relevant doses. There are no controlled data in human pregnancy. Bupivacaine in only recommended for use during pregnancy when benefit outweighs risk. This recommendation does not exclude the use of bupivacaine at term for obstetrical anesthesia or analgesia.
Bupivacaine with a high protein binding capacity has a low fetal/maternal ratio of 0.2 to 0.4. Local anesthetics rapidly cross the placenta. Adverse reactions in the mother and/or neonate are dependent upon the route of administration, procedure, and amount of drug used. Toxic reactions may include alterations in the central nervous system, peripheral vascular tone, and cardiac function. Maternal hypotension during obstetrical procedures has occurred during regional anesthesia. Elevating the patient's legs and positioning on the left side will help to prevent this effect. The fetal heart rate should be continuously monitored.
Bupivacaine Breastfeeding Warnings
Bupivacaine is excreted into human milk. The manufacturer recommends that due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or not administer the drug, taking into account the importance of the drug to the mother.
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