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Bupivacaine liposome (Injection)

Medically reviewed by Last updated on Apr 21, 2022.

Commonly used brand name(s)

In the U.S.

  • Exparel

Available Dosage Forms:

  • Suspension

Therapeutic Class: Anesthetic, Local

Chemical Class: Amino Amide

Uses for bupivacaine liposome

Bupivacaine liposome injection is used to relieve pain after surgery. It is a local anesthetic that prevents pain by blocking signals at the nerve endings directly at the surgical area (local analgesia) or by blocking nerve endings (regional analgesia) of the brachial plexus (nerves that conduct signals to the shoulder, arm, and hand).

Bupivacaine liposome is to be given only by or under the direct supervision of a doctor.

Before using bupivacaine liposome

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For bupivacaine liposome, the following should be considered:


Tell your doctor if you have ever had any unusual or allergic reaction to bupivacaine liposome or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.


Appropriate studies have not been performed on the relationship of age to the effects of bupivacaine liposome injection for local analgesia in children younger than 6 years of age and for regional analgesia in children. Safety and efficacy have not been established.


Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of bupivacaine liposome injection in the elderly. However, elderly patients are more likely to have kidney problems, which may require caution for patients receiving bupivacaine liposome injection.


Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving bupivacaine liposome, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using bupivacaine liposome with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Chloroprocaine
  • Cocaine
  • Fospropofol
  • Hyaluronidase
  • Levobupivacaine
  • Lidocaine
  • Mepivacaine
  • Prilocaine
  • Procaine
  • Propofol
  • Propranolol
  • St John's Wort
  • Verapamil

Using bupivacaine liposome with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alacepril
  • Benazepril
  • Captopril
  • Cilazapril
  • Delapril
  • Enalaprilat
  • Enalapril Maleate
  • Fosinopril
  • Imidapril
  • Lisinopril
  • Moexipril
  • Pentopril
  • Perindopril
  • Quinapril
  • Ramipril
  • Spirapril
  • Temocapril
  • Trandolapril
  • Zofenopril

Interactions with food/tobacco/alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems

The presence of other medical problems may affect the use of bupivacaine liposome. Make sure you tell your doctor if you have any other medical problems, especially:

  • Glucose-6-phosphate dehydrogenase deficiency (G6PD) or
  • Heart problems or
  • Lung or breathing problems or
  • Methemoglobinemia (blood disorder), hereditary or idiopathic (unknown cause)—Use with caution. May increase risk of having methemoglobinemia.
  • Heart or blood vessel problems—May increase risk for more serious side effects.
  • Kidney disease or
  • Liver disease, moderate to severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

Proper use of bupivacaine liposome

A nurse or other trained health professional will give you bupivacaine liposome in a hospital. It is given through a needle injected into the tissue at the surgical site (eg, foot) or into the nerve endings of the brachial plexus (nerves that conduct signals to the shoulder, arm, and hand).

Bupivacaine liposome should cause numbness only to the area where it is injected. You may experience temporary loss of sensation or movement to the injected area for up to 5 days. This type of numbing procedure is called local anesthesia. It is not meant to cause you to fall asleep or become unconscious.

Bupivacaine liposome injection (Exparel®) works differently than other forms of bupivacaine, even at the same dose. You should not receive another type of bupivacaine injection or another anesthetic within 4 days (96 hours) after the injection of Exparel®.

Precautions while using bupivacaine liposome

It is very important that your doctor check your progress closely after you receive bupivacaine liposome to see if the medicine is working properly. Blood tests may be needed to check for any unwanted effects.

Bupivacaine liposome should not be given to women during labor (obstetrical paracervical block anesthesia).

Bupivacaine liposome may cause a rare, but serious blood problem called methemoglobinemia. The risk may be increased in elderly patients or patients with certain inborn defects. It is more likely to occur in patients receiving too much of the medicine, but can also occur with small amounts. Check with your doctor right away if you or your child has the following symptoms after receiving bupivacaine liposome: pale, gray, or blue-colored skin, lips, or nails, confusion, headache, lightheadedness, fast heartbeat, or unusual tiredness or weakness.

Tell your doctor or nurse right away if you have the following symptoms with bupivacaine liposome: anxiety, blurred vision, depression, drowsiness, lightheadedness, nausea or vomiting, numbness and tingling of the mouth or lips, restlessness, ringing in the ears, speech problems, or tremors.

Bupivacaine liposome may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, mouth, or throat after receiving bupivacaine liposome.

Bupivacaine liposome may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how bupivacaine liposome affects you.

Bupivacaine liposome may also increase your risk of having serious heart and blood vessel problems (eg, heart attack, heart rhythm changes, or low blood pressure). Check with your doctor if you have chest pain or discomfort, pain or discomfort in the arms, jaw, back, or neck, dizziness, fainting, pounding, slow heartbeat, trouble breathing, or unusual tiredness or weakness.

Check with your doctor if you have joint pain, stiffness, or loss of motion of the shoulder. This may be symptoms of a serious bone or joint problem called chondrolysis.

Check with your doctor before receiving bupivacaine liposome with other medicines that affect the central nervous system (CNS). The use of other medicines that affect the CNS with bupivacaine liposome injection may worsen the side effects of bupivacaine liposome, including dizziness, poor concentration, drowsiness, unusual dreams, and trouble with sleeping. Some examples of medicines that affect the CNS are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicines, medicine for depression, medicine for anxiety, prescription pain medicine or narcotics, medicine for attention deficit and hyperactivity disorder, medicine for seizures or barbiturates, or muscle relaxants.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Bupivacaine liposome side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

  • Blurred vision
  • chills
  • confusion
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fast, pounding, or irregular heartbeat or pulse
  • fever
  • sweating

Less common

  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain or discomfort
  • collection of blood under the skin
  • decrease in frequency of urination
  • decrease in urine volume
  • deep, dark purple bruise
  • difficulty in passing urine (dribbling)
  • dry mouth
  • headache
  • increased thirst
  • irregular heartbeat
  • itching, pain, redness, or swelling
  • loss of appetite
  • mood changes
  • muscle pain, cramp, spasm, or twitching
  • nausea
  • nervousness
  • painful urination
  • pale skin
  • pounding in the ears
  • rapid weight gain
  • seizures
  • slow or fast heartbeat
  • tingling of the hands or feet
  • trouble breathing
  • unusual bleeding or bruising
  • unusual weight gain or loss
  • vomiting

Incidence not known

  • Loss of consciousness
  • no blood pressure or pulse
  • stopping of the heart
  • weakness of the muscles in your face

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Motor dysfunction
  • trouble sleeping

Less common

  • Anxiety
  • belching
  • change in taste
  • constipation
  • decreased appetite
  • falls
  • feeling hot
  • heartburn
  • hiccups
  • indigestion
  • itching in the genitals or other skin areas
  • loss of taste
  • scaling
  • seeing double
  • sensory loss
  • stomach discomfort, upset, or pain
  • swelling at the surgical site


  • Increased sweating

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Further information

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