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Bupivacaine / Meloxicam Dosage

Medically reviewed by Drugs.com. Last updated on Jul 26, 2022.

Applies to the following strengths: 400 mg-12 mg/14 mL; 200 mg-6 mg/7 mL

Usual Adult Dose for Pain

Bunionectomy: up to 2.3 mL (60 mg bupivacaine / 1.8 mg meloxicam)

Open inguinal herniorrhaphy: up to 10.5 mL (300 mg bupivacaine / 9 mg meloxicam)

Total knee arthroplasty: up to 14 mL (400 mg bupivacaine / 12 mg meloxicam)

Comments:

  • This drug is only intended for single-dose administration.
  • Due to the potential for severe, life-threatening reactions to bupivacaine, only administer where trained personnel and equipment are available for prompt treatment of those who show evidence of neurologic or cardiac toxicity.
  • The toxic effects of local anesthetics are additive; avoid use of other local anesthetics within 96 hours of use of this product.

Uses: For soft tissue or periarticular instillation to produce postsurgical analgesia for up to 72 hours after bunionectomy, open inguinal herniorrhaphy, and total knee arthroplasty.

Limitations of Use: Safety and efficacy have not been established in highly vascular surgeries, such as intrathoracic, large multilevel spinal, and head and neck procedures.

Usual Adult Dose for Local Anesthesia

Bunionectomy: up to 2.3 mL (60 mg bupivacaine / 1.8 mg meloxicam)

Open inguinal herniorrhaphy: up to 10.5 mL (300 mg bupivacaine / 9 mg meloxicam)

Total knee arthroplasty: up to 14 mL (400 mg bupivacaine / 12 mg meloxicam)

Comments:

  • This drug is only intended for single-dose administration.
  • Due to the potential for severe, life-threatening reactions to bupivacaine, only administer where trained personnel and equipment are available for prompt treatment of those who show evidence of neurologic or cardiac toxicity.
  • The toxic effects of local anesthetics are additive; avoid use of other local anesthetics within 96 hours of use of this product.

Uses: For soft tissue or periarticular instillation to produce postsurgical analgesia for up to 72 hours after bunionectomy, open inguinal herniorrhaphy, and total knee arthroplasty.

Limitations of Use: Safety and efficacy have not been established in highly vascular surgeries, such as intrathoracic, large multilevel spinal, and head and neck procedures.

Renal Dose Adjustments

Mild to Moderate Renal Dysfunction: Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution is recommended.
Severe Renal Dysfunction: Use is not recommended.

  • Bupivacaine and meloxicam and their metabolites are renally excreted, increasing the risk of toxic reactions in patients with renal dysfunction.
  • Consider a dose reduction for mild to moderate renal dysfunction.
  • Patients with severe renal dysfunction may be more susceptible to amide-type local anesthetic toxicities.
  • Patients with severe renal dysfunction have not been adequately studied.

Liver Dose Adjustments

Mild to Moderate Liver Dysfunction (Child-Pugh class 1 to 2): No adjustment recommended.
Severe Liver Dysfunction (Child-Pugh class 3): Use is not recommended; use only if benefits outweigh risks.

  • Amide-type local anesthetics like bupivacaine are primarily hepatically metabolized.
  • Patients with severe liver disease are at greater risk of toxicities and developing toxic plasma concentrations due to their inability to metabolize local anesthetics normally.
  • Monitor patients with hepatic impairment for worsening hepatic impairment.
  • Consider monitoring patients with moderate to severe liver dysfunction for local anesthetic systemic toxicity.
  • This product has not been adequately studied in severe liver impairment.

Dose Adjustments

Poor Metabolizers of CYP450 2C9 Substrates:

  • Poor CYP450 2C9 metabolizers may have abnormally high meloxicam plasma levels due to reduced metabolic clearance.
  • Consider a dose reduction for known or suspected poor CYP450 2C9 metabolizers (based on genotype or experience with other CYP450 2C9 substrates like warfarin or phenytoin).
  • Monitor for adverse effects.

Precautions

US BOXED WARNING(S):
Risk of Serious Cardiovascular and Gastrointestinal Events:

  • NSAIDs increase the risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk occurs early in treatment and may increase with duration of use.
  • This drug is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.
  • NSAIDs increase the risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, or perforation of the stomach or intestines, which may be fatal. These events may occur any time during treatment without warning symptoms.
  • Elderly patients and patients with a history of peptic ulcer disease and/or GI bleeding are at increased risk of serious GI events.

CONTRAINDICATIONS:
  • Serious hypersensitivity (e.g. anaphylactic reaction, serious skin reaction) to any amide-type local anesthetic agent, NSAIDs, or any other ingredient in the formulation
  • History of asthma, urticaria, or other allergic-type reaction after aspirin or other NSAIDs. Severe, sometimes fatal, anaphylactic reactions to NSAIDs have been reported in such patients.
  • Use for obstetrical paracervical block anesthesia: use of bupivacaine in this technique has led to fetal bradycardia and death.
  • Use for coronary artery bypass graft (CABG) surgery

Safety and efficacy have not been established in patients younger than 18 years.
This drug is not recommended for use in children.

Consult WARNINGS section for additional precautions.

Dialysis

Use is not recommended in severe renal impairment.

  • Meloxicam is not dialyzable.

Hemodialysis: Do not exceed maximum recommended dose or use with other meloxicam-containing products.
Peritoneal dialysis: Data not available

Other Comments

Administration advice:

  • Avoid intravascular administration: convulsions and cardiac arrest have occurred after accidental intravascular injection of bupivacaine and other amide-containing products.
  • Do not give via the following routes: epidural, intrathecal, intravascular, intra-articular, regional nerve blocks, pre-incisional or pre-procedural locoregional anesthetic techniques
  • Bunionectomy: apply to proximal distal ends (beyond the bony repair) of the wound.
  • Open inguinal herniorrhaphy: apply above and below fascial repair.
  • Total knee arthroplasty: apply directly to posterior capsule, anteromedial tissues and periosteum, and anterolateral tissues and periosteum after cementation of components.
  • Only apply to tissue layers below the skin incision and not directly onto the subdermal layer or the skin.
  • Use only enough to coat tissues so it does not leak from the closed surgical wound.
  • Apply without a needle into the surgical site after final irrigation and suction, and prior to suturing of each layer when multiple tissue layers are involved.
  • If a topical antiseptic (e.g. povidone) is applied, allow site to dry before applying this product.

Storage requirements: Store at controlled room temperature; protect from moisture and light.

Reconstitution/preparation techniques:
  • Do not dilute.
  • Do not mix with water, saline, or other local anesthetics: product may become more viscous and difficult to administer.

Compatibility:
  • Surgical mesh materials, including polypropylene, Gore-tex, and polyester
  • Silicone membranes
  • Bone cement
  • Metal alloys used in surgical implants

Further information

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