Drug Interaction Report

BUPivacaine liposome is a specially formulated anesthetic that releases the medication into the surrounding tissue at a controlled rate. When exposed to other local anesthetic solutions, the release rate can be altered. Therefore, BUPivacaine liposome and prilocaine should not be mixed together or injected into the same area at the same time, as it may cause rapid release of the active medication and alter the safety and efficacy of BUPivacaine liposome. Additional use of local anesthetics including prilocaine should generally be avoided within 96 hours following administration of BUPivacaine liposome. If necessary, BUPivacaine liposome may be locally administered after at least 20 minutes following the local administration of lidocaine. However, there are currently no data to support administration of other local, non-bupivacaine based anesthetics prior to administration of BUPivacaine liposome. Because the toxic effects of these medications are additive, using them together requires caution and constant monitoring of vital signs and state of consciousness to prevent serious and potentially life-threatening side effects such as methemoglobinemia (a condition that can deprive tissues and organs of oxygen), central nervous system reactions (e.G., convulsions, unconsciousness, coma, respiratory arrest), and cardiovascular disorders (e.G., low blood pressure, heart block, irregular heart rhythm, cardiac arrest). Patients require immediate medical attention if they develop signs and symptoms of methemoglobinemia such as pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue.

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)
• prilocaine

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.