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Zynrelef Side Effects

Generic name: bupivacaine / meloxicam

Medically reviewed by Last updated on Sep 12, 2022.

Note: This document contains side effect information about bupivacaine / meloxicam. Some dosage forms listed on this page may not apply to the brand name Zynrelef.

Applies to bupivacaine / meloxicam: injection solution extended release.


Injection route (Solution, Extended Release)

Risk of Serious Cardiovascular and Gastrointestinal EventsCardiovascular Thrombotic EventsNonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.Bupivacaine/meloxicam is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.Gastrointestinal Bleeding, Ulceration, and PerforationNSAIDs cause an increased risk of serious gastrointestinal (GI) adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients and patients with a prior history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.

Serious side effects of Zynrelef

Along with its needed effects, bupivacaine / meloxicam may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur while taking bupivacaine / meloxicam:

More common

Incidence not known

  • Agitation
  • blistering, peeling, loosening of the skin
  • blood in the urine
  • bloody or black, tarry stools
  • bluish-colored lips, fingernails, or palms
  • chest tightness
  • coma
  • confusion
  • constipation
  • dark urine
  • decrease in amount of urine
  • depression
  • diarrhea
  • difficulty in speaking
  • difficulty swallowing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • double vision
  • heartburn
  • hives, itching
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • indigestion
  • irritability
  • joint or muscle pain
  • lethargy
  • loss of appetite
  • noisy, rattling breathing
  • numbness or tingling in the hands, feet, or lips
  • pain or discomfort in the arms, jaw, back, or neck
  • painful or difficult urination
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red irritated eyes
  • red skin lesions, often with a purple center
  • seizures
  • shoulder discomfort, pain, or stiffness
  • stomach pain, cramping, or burning
  • stupor
  • sweating
  • swelling of the face, fingers, hands, feet, ankles, or lower legs
  • swollen glands
  • vomiting of blood or material that looks like coffee grounds
  • weakness or heaviness of the legs
  • weight gain
  • yellow eyes or skin

Other side effects of Zynrelef

Some side effects of bupivacaine / meloxicam may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Change in taste
  • increased sweating
  • loss of taste
  • pain, redness, or swelling at the injection site
  • slow wound healing
  • unusual skin odor

For Healthcare Professionals

Applies to bupivacaine / meloxicam: injectable solution extended release.


The most common adverse reactions were constipation, vomiting, and headache.[Ref]


Very common (10% or more): Nausea (up to 50%), vomiting (up to 26%), constipation (up to 24%)

Common (1% to 10%): Dysgeusia[Ref]

Nervous system

Very common (10% or more): Dizziness (22%), headache (14%)[Ref]


Very common (10% or more): Incision site edema (17%), incision site erythema (13%)

Common (1% to 10%): Incision site cellulitis, wound dehiscence, incision site infection[Ref]


Very common (10% or more): Hypertension (up to 19%)

Common (1% to 10%): Bradycardia, hypotension[Ref]


Very common (10% or more): Pyrexia (up to 14%)[Ref]


Common (1% to 10%): Leukocytosis, anemia[Ref]


Common (1% to 10%): Skin odor abnormal, pruritus, hyperhidrosis[Ref]


Common (1% to 10%): Muscle twitching


Common (1% to 10%): Impaired healing[Ref]


1. "Product Information. Zynrelef (bupivacaine-meloxicam)." Heron Therapeutics (2021):

Further information

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

Some side effects may not be reported. You may report them to the FDA.