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Interactions between Exparel and Sensorcaine with Epinephrine

1 drug interaction and 18 additional warnings found for the following 2 drugs:

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Drug interactions

Major drug interactions

Major:

BUPivacaine BUPivacaine liposome

Applies to: Sensorcaine with Epinephrine (bupivacaine / epinephrine) and Exparel (bupivacaine liposome)
Adjust dosing interval

Administration of bupivacaine liposome suspension together with other bupivacaine (hydrochloride) formulations, either simultaneously in the same syringe or sequentially to the same site, may impact the pharmacokinetic and/or physicochemical properties of bupivacaine liposome in a concentration-dependent manner. Specifically, when the milligram dose of bupivacaine HCl exceeds 50% of the bupivacaine liposome dose, substantial displacement and rapid release of free bupivacaine from liposomes may occur, which may affect the safety and efficacy of the medication.

Monitor closely

Additive toxicities may occur when bupivacaine liposome suspension is coadministered with other local anesthetics, including bupivacaine HCl. Moreover, injection of multiple doses of bupivacaine or other amide-containing anesthetics may cause significant increases in plasma concentrations with each repeated dose due to slow accumulation of the drug or its metabolites, or to slow metabolic degradation. Tolerance to elevated concentrations will vary with patient status, but the potential for increased risk of systemic toxicities such as methemoglobinemia and central nervous system and cardiovascular adverse reactions should be recognized.

Management

Additional use of local anesthetics, including bupivacaine HCl, should generally be avoided within 96 hours following administration of bupivacaine liposome suspension. If necessary, bupivacaine HCl and bupivacaine liposome may be administered simultaneously in the same syringe, or bupivacaine HCl may be injected immediately before bupivacaine liposome, as long as the ratio of the milligram dose of bupivacaine HCl to bupivacaine liposome does not exceed 1:2. Some authorities recommend that the total amount of co-administered bupivacaine HCl and bupivacaine liposomal should not exceed 400 mg equivalents of bupivacaine HCl (UK). However, because the toxic effects of these medications are additive, caution and close observation for development of methemoglobinemia as well as central nervous system and cardiovascular adverse reactions are advised. Early warning signs of central nervous system toxicity may include restlessness, anxiety, incoherent speech, dizziness, lightheadedness, numbness and tingling of the mouth and lips, metallic taste, tinnitus, blurred vision, tremors, twitching, depression, and drowsiness. Cardiovascular toxicity include atrioventricular block, ventricular arrhythmias, cardiac arrest, and decreased cardiac output and arterial blood pressure due to depressed cardiac conductivity, excitability, and myocardial contractility. Patients should have cardiovascular and respiratory vital signs and state of consciousness constantly monitored while under treatment.

References (3)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. (2011) "Product Information. Exparel (BUPivacaine liposome)." Pacira Pharmaceuticals Inc
  3. Kharitonov V (2014) "A review of the compatibility of liposome bupivacaine with other drug products and commonly used implant materials." Postgrad Med, 126, p. 129-38

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition.

It can be intentional, when combining drugs with similar actions adds demonstrated therapeutic benefit — or unintentional, such as when a patient sees multiple prescribers or fills prescriptions at more than one pharmacy, which can lead to adverse effects.

Duplication:

Local injectable anesthetics

The recommended maximum number of medicines in the 'local injectable anesthetics' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'local injectable anesthetics' category:

  • Exparel (bupivacaine liposome)
  • Sensorcaine with Epinephrine (bupivacaine/epinephrine)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

EPINEPHrine Caffeine

Applies to: Sensorcaine with Epinephrine (bupivacaine / epinephrine)
Monitor

Coadministration of two or more sympathomimetic or noradrenergic agents may increase the risk of nervousness, irritability, tachycardia, and/or increased blood pressure. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic and/or noradrenergic agents, including norepinephrine transporter inhibitors. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

Management

Caution is advised if two or more sympathomimetic or noradrenergic agents are coadministered. Pulse and blood pressure should be closely monitored. Consultation with individual product labeling, as well as relevant institutional protocols, may be advisable for further guidance.

References (20)
  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2024) "Product Information. Ephedrine (ephedrine)." Hameln Pharma Ltd
  8. (2023) "Product Information. Ephedrine Hydrochloride (ephedrine)." Wockhardt UK Ltd
  9. (2026) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
  10. (2025) "Product Information. Atomoxetine (atomoxetine)." Zentiva Pharma UK Ltd
  11. (2026) "Product Information. Atomoxetine (Apo) (atomoxetine)." Arrotex Pharmaceuticals Pty Ltd
  12. Angita Pharma, Inc (2026) AG-ATOMOXETINE Product Monograph (Health Canada) https://pdf.hres.ca/dpd_pm/00059014.PDF
  13. (2026) "Product Information. Boots Decongestant (Pseudoephedrine) (pseudoephedrine)." The Boots Company Plc
  14. (2023) "Product Information. Sinus and Nasal Decongestant (Trust) (pseudoephedrine)." Noumed Pharmaceuticals Pty Ltd
  15. (2019) "Product Information. Ephedrine (ephedrine)." Pfizer Australia Pty Ltd
  16. (2024) "Product Information. EPHEDrine Sulfate (ePHEDrine)." Amneal Pharmaceuticals LLC
  17. (2024) "Product Information. Lemsip Cough Max for Mucus Cough and Cold (guaifenesin/paracetamol/phenylephrine)." Reckitt Benckiser Healthcare (UK) Ltd
  18. emc (2026) Product information: sudafed plus blocked nose 1mg/50mg/ml nasal spray. https://www.medicines.org.uk/emc/product/14256/smpc?utm_source=chatgpt.com
  19. (2023) "Product Information. EPHEDrine Sulfate (ePHEDrine)." Baxter Corporation
  20. Neo Health (OTC) Pty Ltd (2026) Product information: pseudoephedrine hydrochloride-paracetamol capsules. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2024-PI-02603-1&d=20260804172310101&d=20260827172310101

Disease interactions

16 potential interactions Applies to: 11 conditions, including Arrhythmia, Hyperthyroidism, Diabetes Mellitus, Liver Disease, and Dehydration.

Acidosis

Moderate:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a moderate potential interaction with Acidosis.

Acidosis, hypoxia, and hypercapnia may reduce the effectiveness of sympathomimetic amines in raising blood pressure. These conditions should be corrected before initiating therapy with sympathomimetic amines, if possible. Monitoring the patients acid-base balance, carbon dioxide levels, and oxygen saturation is recommended.

Arrhythmia

Moderate:

Exparel

The BUPivacaine liposome in Exparel has a moderate potential interaction with Arrhythmia.

Bupivacaine and other amide- containing products should be used with caution in patients with impaired cardiovascular function, as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs. Toxic blood concentrations can depress cardiac conductivity and excitability, which can lead to atrioventricular block, ventricular arrhythmias, and cardiac arrest. In addition, myocardial contractility is depressed and peripheral vasodilation occurs, leading to decreased cardiac output and arterial blood pressure.

Moderate:

Sensorcaine with Epinephrine

The BUPivacaine in Sensorcaine with Epinephrine has a moderate potential interaction with Arrhythmia.

Bupivacaine and other amide- containing products should be used with caution in patients with impaired cardiovascular function, as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs. Toxic blood concentrations can depress cardiac conductivity and excitability, which can lead to atrioventricular block, ventricular arrhythmias, and cardiac arrest. In addition, myocardial contractility is depressed and peripheral vasodilation occurs, leading to decreased cardiac output and arterial blood pressure.

Cardiovascular Conditions and Disorders

Major:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a major potential interaction with Cardiovascular Conditions and Disorders.

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

Moderate:

Exparel

The BUPivacaine liposome in Exparel has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Bupivacaine and other amide- containing products should be used with caution in patients with impaired cardiovascular function, as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs. Toxic blood concentrations can depress cardiac conductivity and excitability, which can lead to atrioventricular block, ventricular arrhythmias, and cardiac arrest. In addition, myocardial contractility is depressed and peripheral vasodilation occurs, leading to decreased cardiac output and arterial blood pressure.

Moderate:

Sensorcaine with Epinephrine

The BUPivacaine in Sensorcaine with Epinephrine has a moderate potential interaction with Cardiovascular Conditions and Disorders.

Bupivacaine and other amide- containing products should be used with caution in patients with impaired cardiovascular function, as they may be less able to compensate for functional changes associated with the prolongation of AV conduction produced by these drugs. Toxic blood concentrations can depress cardiac conductivity and excitability, which can lead to atrioventricular block, ventricular arrhythmias, and cardiac arrest. In addition, myocardial contractility is depressed and peripheral vasodilation occurs, leading to decreased cardiac output and arterial blood pressure.

Dehydration

Major:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a major potential interaction with Dehydration.

The use of sympathomimetic amines has been infrequently associated with significant hypotension especially in dehydrated patients secondary to the drug's beta-2 mediated vasodilation. Hypovolemia should be corrected, if possible, before administering sympathomimetic amines. Blood pressure and ECG should be monitored at regular intervals. Monitoring of cardiac output and pulmonary wedge pressure may also be desired.

Diabetes Mellitus

Moderate:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a moderate potential interaction with Diabetes Mellitus.

Sympathomimetic agents may cause increases in blood glucose concentrations. These effects are usually transient and slight but may be significant with dosages higher than those normally recommended. Therapy with sympathomimetic agents should be administered cautiously in patients with diabetes mellitus. Closer monitoring of blood glucose concentrations may be appropriate.

Hyperthyroidism

Major:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a major potential interaction with Hyperthyroidism.

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

Liver Disease

Moderate:

Exparel

The BUPivacaine liposome in Exparel has a moderate potential interaction with Liver Disease.

Amide-type local anesthetics, such as bupivacaine, are metabolized by the liver. Bupivacaine should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations.

Moderate:

Sensorcaine with Epinephrine

The BUPivacaine in Sensorcaine with Epinephrine has a moderate potential interaction with Liver Disease.

Amide-type local anesthetics, such as bupivacaine, are metabolized by the liver. Bupivacaine should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease, because of their inability to metabolize local anesthetics normally, are at a greater risk of developing toxic plasma concentrations.

Neurological Disorders

Moderate:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a moderate potential interaction with Neurological Disorders.

Epinephrine should be administered with caution to patients with Parkinson's disease as these patients may experience psychomotor agitation or notice a temporary worsening of symptoms.

Parkinsonism

Moderate:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a moderate potential interaction with Parkinsonism.

Epinephrine should be administered with caution to patients with Parkinson's disease as these patients may experience psychomotor agitation or notice a temporary worsening of symptoms.

Pheochromocytoma

Major:

Sensorcaine with Epinephrine

The EPINEPHrine in Sensorcaine with Epinephrine has a major potential interaction with Pheochromocytoma.

Sympathomimetic agents may cause adverse cardiovascular effects, particularly when used in high dosages and/or in susceptible patients. In cardiac tissues, these agents may produce positive chronotropic and inotropic effects via stimulation of beta- 1 adrenergic receptors. Cardiac output, oxygen consumption, and the work of the heart may be increased. In the peripheral vasculature, vasoconstriction may occur via stimulation of alpha-1 adrenergic receptors. Palpitations, tachycardia, arrhythmia, hypertension, reflex bradycardia, coronary occlusion, cerebral vasculitis, myocardial infarction, cardiac arrest, and death have been reported. Some of these agents, particularly ephedra alkaloids (ephedrine, ma huang, phenylpropanolamine), may also predispose patients to hemorrhagic and ischemic stroke. Therapy with sympathomimetic agents should generally be avoided or administered cautiously in patients with sensitivity to sympathomimetic amines, hyperthyroidism, or underlying cardiovascular or cerebrovascular disorders. These agents should not be used in patients with severe coronary artery disease or severe/uncontrolled hypertension.

Renal Dysfunction

Moderate:

Exparel

The BUPivacaine liposome in Exparel has a moderate potential interaction with Renal Dysfunction.

Bupivacaine is substantially excreted by the kidney, and the risk of toxic reactions may be greater in patients with impaired renal function. Care should be taken in dose selection in patients with renal impairment.

Moderate:

Sensorcaine with Epinephrine

The BUPivacaine in Sensorcaine with Epinephrine has a moderate potential interaction with Renal Dysfunction.

Bupivacaine is substantially excreted by the kidney, and the risk of toxic reactions may be greater in patients with impaired renal function. Care should be taken in dose selection in patients with renal impairment.

More resources

Exparel

A total of 131 drugs are known to interact with Exparel.

Sensorcaine with Epinephrine

A total of 355 drugs are known to interact with Sensorcaine with Epinephrine.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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