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Brand Name :
Marcaine, Sensorcaine 
Synonyms :
bupivacaine, bupivacaina 
Class :
Local Anesthetics, Amides 
Brand Name :
Marcaine, Sensorcaine 
Synonyms :
bupivacaine, bupivacaina 
Class :
Local Anesthetics, Amides 
Dosage Forms & Strengths 
Injectable Solution 
0.25%
0.5%
Injectable Solution, Preservative-free
0.25%
vaginal hysterectomy:
7.5 mg or 1
ml
appendectomy :12 mg or 1.6 mL
Local anesthesia:
0.25
%
is given and may increase up to 175 mg
Regional anesthesia
Sympathetic block
0.25%; 50-125 mg (20-50 mL)
Retrobulbar block
0.75%; 15-30 mg (2-4 mL)
Peripheral nerve block
0.25%; 12.5 -175 mg (5-70 mL)
Caudal block
0.25%; 15-30 mL (37.5-75 mg)
Lumbar epidural block
0.25%; 10-20 mL (25-50 mg)
Dosage Forms & Strengths 
Injectable Solution 
0.25%
0.5%
Injectable Solution, Preservative-free
0.25%
<12 years: Not recommended
Dose should be decreased by 30% in infants <6 months
≥12 years
Local infiltration: 0.25% and may increase up to 2.5 mg/kg
Refer to adult dosing.
It may enhance toxicity when combined with chloroprocaine
bupivacaine: it may increase the risk of methemoglobinemia agents
bupivacaine: it may increase the risk of methemoglobinemia agents
bupivacaine: it may increase the risk of methemoglobinemia agents
bupivacaine: it may increase the risk of methemoglobinemia agents
bupivacaine: it may increase the risk of methemoglobinemia agents
may increase the risk or severity of methemoglobinemia when miltefosine is combined
may increase the QTc prolonging effect of QT-prolonging agents
may increase the adverse effect of lidocaine
may increase the toxic effect of Methemoglobinemia Associated Agents
may have an increasingly adverse effect when combined with bupivacaine
may have an increasingly adverse effect when combined with bupivacaine
may have an increasingly adverse effect when combined with bupivacaine
may have an increasingly adverse effect when combined with bupivacaine
may have an increasingly adverse effect when combined with bupivacaine
when both drugs are combined, there may be an increased risk or severity of methemoglobinemia    
may have an increasingly adverse effect when combined with bupivacaine
may increase the toxic effect of local anesthetics
it increases the toxicity of bupivacaine
may have an increased CNS depression when combined with bupivacaine
valproate increases the toxicity of bupivacaine
they increase the effect of neuromuscular blockage of neuromuscular-blocking agents
they increase the effect of neuromuscular blockage of neuromuscular-blocking agents
they increase the effect of neuromuscular blockage of neuromuscular-blocking agents
they increase the effect of neuromuscular blockage of neuromuscular-blocking agents
they increase the effect of neuromuscular blockage of neuromuscular-blocking agents
Beta-blockers increase the concentration of bupivacaine in the serum
Beta-blockers increase the concentration of bupivacaine in the serum
Beta-blockers increase the concentration of bupivacaine in the serum
Beta-blockers increase the concentration of bupivacaine in the serum
Beta-blockers increase the concentration of bupivacaine in the serum
may enhance the serum concentration of Beta-Blockers
may enhance the serum concentration of Beta-Blockers
may enhance the serum concentration of Beta-Blockers
may enhance the serum concentration of Beta-Blockers
may enhance the serum concentration of Beta-Blockers
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
Local Anesthetics can intensify the adverse/toxic effect of bupivacaine
inhalational anesthetics increase the effect of hypotension of calcium channel blockers
inhalational anesthetics increase the effect of hypotension of calcium channel blockers
inhalational anesthetics increase the effect of hypotension of calcium channel blockers
inhalational anesthetics increase the effect of hypotension of calcium channel blockers
inhalational anesthetics increase the effect of hypotension of calcium channel blockers
The potential for increased CNS depression risk or seriousness occurs when bupivacaine is used together with pinazepam
The potential for increased CNS depression risk or seriousness occurs when bupivacaine is used together with pipecuronium
When bupivacaine is used together with bromisoval, the risk or seriousness of CNS depression is enhanced
When captodiame is used together with bupivacaine, There is a risk or seriousness of CNS depression is enhanced
The potential for CNS depression may enhanced when bupivacaine is used together with fencamfamin
The potential for methemoglobinemia to occur or its seriousness may be enhanced when mepartricin is used together with bupivacaine
When bupivacaine is used together with niaprazine, the risk or seriousness of CNS depression is enhanced
When bupivacaine is used together with levosulpiride, the risk or seriousness of CNS depression is enhanced
When domeperidone and bupivacaine is used together, this leads to reduction in the domeperidone’s metabolism
When bupivacaine is used together with fluconazole, this leads to reduction in the bupivacaine metabolism
When chlordiazepoxide is used together with bupivacaine, this leads to enhanced risk or seriousness of CNS depression
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
When bupivacaine is used together with capsaicin, this leads to enhanced risk or seriousness of methemoglobinemia
When cyclacillin is used together with bupivacaine, this leads to increased risk or seriousness of methemoglobinemia
When temocillin is used together with bupivacaine, this leads to increased risk or seriousness of methemoglobinemia
When encainide is used together with bupivacaine, this leads to a reduction in the encainide’s metabolism
When bupivacaine is used together with melitracen, this leads to enhanced risk or seriousness of CNS depression
When artemotil is used together with bupivacaine this leads to enhanced risk or seriousness of methemoglobinemia
When emylcamate is used together with bupivacaine, this leads to enhanced risk or seriousness of CNS depression
When bupivacaine is used together with etizolam, this leads to enhanced risk or seriousness of CNS depression
When acepromazine is used together with bupivacaine, this leads to enhanced risk or seriousness of CNS depression
combining roquinimex with bupivacaine may raise the chances of methemoglobinemia
when protionamide is combined with bupivacaine, the chances of methemoglobinemia may be increased
the metabolism of bupivacaine may be reduced when combined with cholecalciferol
When clomocycline is used together with bupivacaine, this leads to enhanced risk or seriousness of methemoglobinemia.
bupivacaine: it may increase the risk of methemoglobinemia with pheneticillin
methemoglobinemia associated agents may enhance the adverse/toxic effect of local anesthetics
methemoglobinemia associated agents may enhance the adverse/toxic effect of local anesthetics
methemoglobinemia associated agents may enhance the adverse/toxic effect of local anesthetics
methemoglobinemia associated agents may enhance the adverse/toxic effect of local anesthetics
methemoglobinemia associated agents may enhance the adverse/toxic effect of local anesthetics
may increase the toxic effect
may increase the arrhythmogenic effect of inhalational anesthetics
may increase the serum concentration of beta blockers
may increase the toxic effect of methemoglobinemia associated agents
may have an increasingly adverse effect when combined with local anesthetics
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increased neuromuscular-blocking effect when combined with neuromuscular-blocking agents
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may have an increasingly adverse effect when combined with local anesthetics
may increase the adverse effect of Methemoglobinemia Associated Agents
may increase the adverse effect of Methemoglobinemia Associated Agents
may increase the toxic effect of Methemoglobinemia Associated Agents
may increase the hypotensive effect of QT-Prolonging Inhalational Anesthetics
may increase the adverse effect of Methemoglobinemia Associated Agents
may increase the toxic effect of Methemoglobinemia Associated Agents
may increase the adverse effect of Methemoglobinemia Associated Agents
acetaminophen/doxylamine/dextromethorphanÂ
may enhance the toxic effect of Methemoglobinemia Associated Agents
may decrease the therapeutic effect of anesthetics
may enhance the QTc-prolonging effect of each other when combined
using brexucabtagene autoleucel alongside bupivacaine may heighten the risk or severity of methemoglobinemia
the risk of CNS depression may be increased
the risk of methemoglobinemia may be increased
the risk of methemoglobinemia may be increased
the risk of methemoglobinemia can be increased
combining beloranib with bupivacaine may raise the risk or extent of methemoglobinemia
the risk of methemoglobinemia may be increased
the risk of methemoglobinemia may be increased
CNS depressants increases the toxicity of bupivacaine
CNS depressants increases the toxicity of bupivacaine
CNS depressants increases the toxicity of bupivacaine
CNS depressants increases the toxicity of bupivacaine
CNS depressants increases the toxicity of bupivacaine
Actions and spectrum: 
bupivacaine is a local anesthetic commonly used for pain management during surgeries, dental procedures, and childbirth.
Action:  
bupivacaine blocks nerve impulses that transmit pain signals to the brain. This results in a loss of sensation in the affected area and numbing the pain.
Spectrum:  
bupivacaine has a broad spectrum of action, which can numb many areas, including the spinal cord, peripheral nerves, and sympathetic nerve fibers. Its effects can last for a few hours, making it useful for surgical procedures that require a longer duration of anesthesia.
Frequency defined:  
>10% 
Visible bruising (91.1%)
Nausea (20-55.8%)
Surgical site bleeding (8.7-48.9%)
Somnolence (8.3-40%)
Vomiting (4.4-29%)
Bradycardia (22.9%)
Constipation (30.4%)
Headache (11.1-27.2%)
Paresthesia (7.5-18.4%)
Hypoesthesia (17.3%)
Tinnitus (13.2%)
Dizziness (15-40.3%)
Postprocedural contusion (14-71.2%)
Dysgeusia (13-17.6%)
C-reactive protein increased (11.7%)
Procedural pain (<11.4%)
Dysuria (10.1%)
Pyrexia (6-11.7%)
Anemia (4.5-16.7%)
Pruritus generalized (2.2-21.6%)
1-10% 
Diarrhea (9.8%)
Incision site erythema (4.1-8.1%)
Abdominal distension (8.2%)
Postprocedural discharge (7.5%)
Blood potassium decreased (6.7%)
Insomnia (3.9-7.1%)
Hypertension (6.7%)
Headache (5.7%)
Hypokalemia (5.9%)
Confusion (5.7%)
Incision site hematoma (5-5.2%)
Dyspepsia (3.8-5.7%)
Oropharyngeal pain (3.5-4.6%)
Flatulence (4.6%)
Tachycardia (4.6%)
Hypertension (2.8-4.6%)
Drainage from surgical incision (4.4%)
Incision site infection (4.5%)
Abdominal pain (4.4%)
Musculoskeletal pain (4.2%)
Viral infection (4.1%)
Back pain (4.1%)
ECG T wave inversion (3.8%)
Hypoesthesia (3.8%)
Dyspnea (3.8%)
Wound dehiscence (3.6%)
Muscle twitching (3.8%)
Cough (3.6%)
ECG change (3.3%)
Peripheral swelling (3.9%)
Procedural hemorrhage (3.3%)
Dry throat (3.2%)
Vaginal hematoma (3.3%)
Testicular swelling (3.2%)
Local swelling (3%)
Hyperhidrosis (3%)
Upper respiratory tract infection (3%)
Ileus (2.7%)
Chest pain (2.9%)
Dysmenorrhea (2.7%)
Urinary retention (2.7-2.8%)
Incision site pruritus (2.7%)
Nasal congestion (2.5%)
Abdominal pain upper (2.5%)
Pruritus generalized (2.5%)
Body temperature increased (2.4%)
Contusion (2.5%)
Dry mouth (2.2%)
Pain in extremities (2.1%)
Rash (2.1%)
Angina pectoris (<2%)
Nasopharyngitis (2.1%)
Blepharospasm (<2%)
Fatigue (<2%)
Osteoarthritis (<2%)
ECG T-wave amplitude decreased (<2%)
Procedural nausea (<2%)
Pulmonary arterial hypertension (<2%)
Frequency Not Defined 
Cardiovascular
Neurologic
Labor and delivery
immune system disorders
Nausea
vomiting
Black box warning: 
The black box warning for Marcaine (bupivacaine) regarding obstetrical anesthesia highlights the risk of cardiac arrest and difficulty in resuscitation.
Contraindications/cautions: 
Caution 
Pregnancy consideration: USFDA pregnancy category A
Lactation: safety and efficacy not mentioned.
Pregnancy category: 
Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester.
Category B: There is no evidence of risk to the fetus found in animal reproduction studies and there are not enough studies on pregnant women.
Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for an effect in humans, care must be taken for potential risks in pregnant women
Category D: There is adequate data available with sufficient evidence of human fetal risk from various platforms, but despite potential risks may be used only in emergency cases for potential benefits.
Category X: Drugs listed in this category outweigh risks over benefits These category drugs should be prohibited for pregnant women.
Category N: There is no data available for the drug under this category.
Pharmacology: 
bupivacaine acts by inhibiting the movement of sodium ions into the nerve fibers, which interferes with the ability of the nerve to generate an action potential. This leads to a block of the transmission of nerve impulses and a loss of sensation in the affected area.
Pharmacodynamics: 
bupivacaine works by inhibiting the movement of sodium ions into the nerve fibers, which interferes with the ability of the nerve to generate an action potential. This leads to a block of the transmission of nerve impulses and a loss of sensation in the affected area.
Pharmacokinetics: 
bupivacaine is rapidly absorbed after administration and rapidly distributed to the peripheral tissues. It is metabolized through the liver and eliminated from the body primarily through the kidneys. The half-life of bupivacaine is approximately 2 hours, but its duration of action may be longer due to its slow release from peripheral tissues.
Absorption 
bupivacaine is rapidly absorbed after administration, with peak plasma levels occurring within 30 to 60 minutes of injection. The rate of absorption depends on the route of administration and the dose.
Distribution 
bupivacaine is rapidly distributed to the peripheral tissues, where it produces its anesthetic effects. The volume of distribution of bupivacaine is approximately 90 litres in healthy adults.
Metabolism 
bupivacaine is metabolized in the liver by the cytochrome P450 system. The major metabolites of bupivacaine are 2,6-pipecoloxylidide and hippuric acid.
Elimination 
bupivacaine is eliminated from the body primarily through the kidneys, with approximately 75% of an administered dose being eliminated within 24 hours. The elimination half-life of bupivacaine is approximately 2 hours, but its duration of action may be longer due to its slow release from peripheral tissues.
Administration: 
bupivacaine is a local anesthetic that is commonly used for various surgical procedures and to provide pain relief during labor and delivery. It is usually administered by injection into the tissue surrounding the area that requires pain relief.
The administration of bupivacaine requires careful attention to dosing, as well as consideration of the patient’s age, weight, and medical history. It is important to titrate the dose of bupivacaine carefully in order to achieve effective pain relief while minimizing the risk of side effects.
bupivacaine is available in both a plain form, as well as in a formulation combined with epinephrine, which helps to prolong the duration of action of the anesthetic.
Patient information leaflet 
Generic Name: bupivacaine
Pronounciation: (bue-PIV-a-kane)
Why do we use bupivacaine? 
bupivacaine is a local anesthetic that is used to produce local or regional anesthesia. It is commonly used for a variety of medical procedures, including:
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