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Exparel Side Effects

Generic Name: bupivacaine liposome

Note: This page contains information about the side effects of bupivacaine liposome. Some of the dosage forms included on this document may not apply to the brand name Exparel.

For the Consumer

Applies to bupivacaine liposome: injection suspension

In addition to its needed effects, some unwanted effects may be caused by bupivacaine liposome (the active ingredient contained in Exparel). In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking bupivacaine liposome, check with your doctor or nurse immediately:

More common:
  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • blurred vision
  • confusion
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fast, pounding, or irregular heartbeat or pulse
  • fever
  • pale skin
  • rapid weight gain
  • sweating
  • tingling of the hands or feet
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • unusual weight gain or loss
Less common:
  • Bleeding from the anus
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain or discomfort
  • fainting
  • lightheadedness, dizziness, or fainting
  • painful defecation
  • shortness of breath
  • slow or irregular heartbeat
  • swelling at the surgical site
Less common or rare:
  • Chills
  • decrease in the frequency of urination
  • decrease in the urine volume
  • difficult or troubled breathing
  • difficulty in passing urine (dribbling)
  • extra heart beat
  • headache
  • hives
  • hoarseness
  • irregular, fast or slow, or shallow breathing
  • irritation
  • itching
  • joint pain, stiffness, or swelling
  • nervousness
  • not breathing
  • painful urination
  • pale or blue lips, fingernails, or skin
  • pounding in the ears
  • rash
  • redness of the skin
  • shakiness in the legs, arms, hands, or feet
  • shortness of breath
  • swelling at the incision site
  • tightness in the chest
  • troubled breathing or swallowing
  • weakness
  • wheezing

Minor Side Effects

Some of the side effects that can occur with bupivacaine liposome may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:
  • Back pain
  • muscle spasm
  • nausea
  • sleepiness or unusual drowsiness
  • sleeplessness
  • trouble sleeping
  • unable to sleep
  • vomiting
Less common:
  • Decreased appetite
  • itching in the genital or other skin areas
  • scaling
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
Less common or rare:
  • Agitation
  • cold sweats
  • hives or welts
  • increased sweating
  • muscle weakness
  • pain in the neck
  • paleness of the skin
  • restlessness

For Healthcare Professionals

Applies to bupivacaine liposome: injectable suspension


The most common adverse reactions were nausea, vomiting, and dizziness.[Ref]


Very common (10% or more): Nausea (up to 40.2%), vomiting (up to 27.8%)
Common (1% to 10%): Constipation, anal hemorrhage, painful defecation, rectal discharge
Frequency not reported: Procedural nausea[Ref]

Nervous system

Very common (10% or more): Dizziness (up to 11.3%)
Common (1% to 10%): Headache, somnolence, hypoesthesia, syncope
Frequency not reported: Tremor, dizziness postural, paresthesia, syncope, tinnitus[Ref]


Common (1% to 10%): Pyrexia, edema peripheral, procedural pain, lethargy, body temperature increased, feeling hot, post-procedural swelling
Frequency not reported: Chills, pain, edema[Ref]


Common (1% to 10%): Hypotension, tachycardia, bradycardia
Frequency not reported: Bradycardia, procedural hypertension, procedural hypotension, palpitations, sinus bradycardia, supraventricular extrasystoles, ventricular extrasystoles, ventricular tachycardia, hypertension, blood pressure increased, blood pressure decreased, pallor[Ref]


Common (1% to 10%): Anemia, anemia postoperative, hemorrhagic anemia[Ref]


Common (1% to 10%): Pruritus generalized, pruritus
Frequency not reported: Erythema, rash pruritic, hyperhidrosis, cold sweat, urticaria[Ref]


Common (1% to 10%): Alanine aminotransferase increased, aspartate aminotransferase increased


Common (1% to 10%): Muscle spasms, back pain
Frequency not reported: Muscular weakness, neck pain[Ref]


Common (1% to 10%): Fungal infection
Frequency not reported: Drug hypersensitivity, hypersensitivity[Ref]


Common (1% to 10%): Appetite decreased
Frequency not reported: Oxygen saturation decreased[Ref]


Common (1% to 10%): Insomnia
Frequency not reported: Anxiety, confusional state, depression, agitation, restlessness[Ref]


Common (1% to 10%): Blood creatinine increased


Frequency not reported: Hypoxia, laryngospasm, apnea, respiratory depression, respiratory failure[Ref]


Frequency not reported: Urinary retention, urinary incontinence[Ref]


Frequency not reported: Incision site edema[Ref]


Frequency not reported: Vision blurred[Ref]


1. "Product Information. Exparel (bupivacaine liposome)." Pacira Pharmaceuticals Inc, San Diego, CA.

Not all side effects for Exparel may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.