Skip to Content

Marcaine HCl with Epinephrine Side Effects

Generic Name: bupivacaine / epinephrine

Note: This page contains information about the side effects of bupivacaine / epinephrine. Some of the dosage forms included on this document may not apply to the brand name Marcaine HCl with Epinephrine.

Applies to bupivacaine / epinephrine: injectable solution


In general, reactions to bupivacaine are typical of those associated with other amide-type local anesthetics. A major cause of adverse reactions to these drugs is high plasma levels, which may be due to overdosage, rapid absorption from injection site, diminished tolerance, accidental intravascular injection, or slow metabolic degradation.

The most common side effects that require immediate countermeasures are related to the central nervous system and the cardiovascular system. These reactions are generally dose related and due to excessive plasma levels. Accidental subarachnoid injection may result in underventilation or apnea. Hypotension caused by loss of sympathetic tone and respiratory paralysis or underventilation caused by cephalad extension of the motor level of anesthesia may occur and may lead to cardiac arrest if untreated. Elderly patients over 65 years of age, especially those with hypertension, may be at higher risk of hypotensive effects. Factors influencing plasma protein binding, such as acidosis, altered protein production due to systemic diseases, or competition with other drugs for protein binding sites, may decrease tolerance.[Ref]

Nervous system

Nervous system side effects following epidural or caudal anesthesia have included spinal block (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control all of which may have slow, incomplete, or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; and cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid. Neurologic effects following other procedures or routes of administration may include persistent anesthesia, paresthesia, weakness, paralysis, all of which may have slow, incomplete, or no recovery. Central nervous system side effects have included excitation and/or depression, restlessness, anxiety, dizziness, tinnitus, blurred vision, tremors, convulsions, drowsiness, unconsciousness, respiratory arrest, nausea, vomiting, chills, and pupil constriction.[Ref]


Cardiovascular side effects have included myocardial depression, decreased cardiac output, heart block, hypotension, bradycardia, ventricular arrhythmias (including ventricular tachycardia and ventricular fibrillation), and cardiac arrest.[Ref]


Other side effects have included a high spinal (characterized by paralysis of the legs, loss of consciousness, respiratory paralysis, and bradycardia) following accidental subarachnoid injection.[Ref]


Hypersensitivity side effects have included allergic-type reactions including signs such as urticaria, pruritus, erythema, angioneurotic edema (including laryngeal edema), tachycardia, sneezing, nausea, vomiting, dizziness, syncope, excessive sweating, elevated temperature, and possibly, anaphylactoid-like symptomatology (including severe hypotension).[Ref]


1. "Product Information. Sensorcaine-MPF with Epinephrine (bupivacaine-epinephrine)." Astra-Zeneca Pharmaceuticals, Wilmington, DE.

2. "Product Information. Marcaine HCl with Epinephrine (bupivacaine-epinephrine)." Hospira Inc, Lake Forest, IL.

Not all side effects for Marcaine HCl with Epinephrine 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.