Bupivacaine: uses, dosing, side effects & brands
Bupivacaine is an amide local anesthetic sold in the U.S. under 5 brand and generic names, for postoperative pain. Below: what the FDA label says, every product that contains it, what the pills look like, and its recall record.
Key facts
- Drug class
- Amide Local Anesthetic
- Treats (across its forms)
- Postoperative Pain
- Available as
- Injectable · Liposomal · Solution · Implant
- Sold as
- 5 products — Exparel, Marcaine and Bupivacaine Hydrochloride, and others
- Prescription?
- Prescription only
- Generic available?
- Yes
- What the pharmacy pays
- about $0.06 per ml — not your price
- Boxed warning
- Boxed warning
How Exparel is dosed
From the FDA label for Exparel (application NDA022496). Other bupivacaine products — different forms, different strengths — are dosed differently. Follow the label for the one you were prescribed.
EXPAREL is for single administration only ( 2.1 ). EXPAREL is not substitutable with other bupivacaine products even if the strength is the same. Therefore, it is not possible to convert a dose from other bupivacaine products to an EXPAREL dose and vice versa ( 2.1 , 2.5 ). Do not dilute EXPAREL with water or other hypotonic solutions ( 2.1 ). The recommended dose of EXPAREL for: Local infiltration in adults is up to a maximum dose of 266 mg. See Full Prescribing Information for guidance on dose selection ( 2.2 ). Local infiltration in pediatric patients aged 6 to less than 17 years is 4 mg/kg, up to a maximum of 266 mg ( 2.2 ). Interscalene brachial plexus nerve block in adults is 133 mg ( 2.3 ). Sciatic nerve block in the popliteal fossa in adults is 133 mg ( 2.3 ). Adductor canal block in adults is 133 mg (10 mL) admixed with 50 mg (10 mL) 0.5% bupivacaine HCl, for a total volume of 20 mL ( 2.3 ). For all these nerve blocks, administer additional analgesics, which may include other immediate-release local anesthetics, as appropriate ( 2.3 ). See Full Prescribing Information for important preparation and administration instructions and compatibility considerations ( 2.4 , 2.5 ). 2.1 Important Dose, Preparation, and Administration Instructions EXPAREL is for single administration only. EXPAREL is not substitutable with other bupivacaine products even if the strength is the…
Everything below is the FDA label for Exparel (injectable, liposomal). Bupivacaine is also sold as solution and implant, and those are different medicines to take — follow the label for the one you were prescribed.
Exparel side effects
The following serious adverse reactions have been associated with bupivacaine hydrochloride in clinical trials and are described in greater detail in other sections of the labeling: Central Nervous System Reactions [see Warnings and Precautions (5.1) ] Cardiovascular System Reactions [see Warnings and Precautions (5.1) ] Allergic Reactions [see Warnings and Precautions (5.1) ] Chondrolysis [see Warnings and Precautions (5.1) ] Methemoglobinemia [see Warnings and Precautions (5.1) ] Accidental intravascular injection [see Warnings and Precautions (5.2) ] Adverse reactions reported with an incidence greater than or equal to 10% following EXPAREL administration via: Infiltration in adults were nausea, constipation, and vomiting ( 6.1 ). Nerve block in adults were nausea, pyrexia, headache, and constipation ( 6.1 ). Infiltration in pediatric patients six to less than 17 years of age were nausea, vomiting, constipation, hypotension, anemia, muscle twitching, blurred vision, pruritus, and tachycardia ( 6.1 ). To report SUSPECTED ADVERSE REACTIONS, contact Pacira Pharmaceuticals, Inc. at 1-855-RX-EXPAREL (1-855-793-9727) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the…
Who shouldn’t take Exparel
EXPAREL is contraindicated in obstetrical paracervical block anesthesia [see Use in Specific Populations (8.1) ]. While EXPAREL has not been tested with this technique, the use of bupivacaine HCl with this technique has resulted in fetal bradycardia and death. EXPAREL is contraindicated in obstetrical paracervical block anesthesia ( 4 ).
Exparel drug interactions
The toxic effects of local anesthetics are additive and concomitant use should be used with caution including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity [see Dosage and Administration (2.2) , Warnings and Precautions (5.1) , and Overdosage (10) ] . Avoid additional use of local anesthetics within 96 hours following administration of EXPAREL. Patients who are administered local anesthetics, including EXPAREL, may be at increased risk of developing methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics dapsone, nitrofurantoin, para-aminosalicylic acid, sulfonamides Antimalarials chloroquine, primaquine Anticonvulsants Phenobarbital, phenytoin, sodium valproate Other drugs acetaminophen, metoclopramide, quinine, sulfasalazine Lidocaine or other non-bupivacaine local anesthetics : Do not admix with EXPAREL. EXPAREL may be administered at least 20 minutes or more following local administration of lidocaine ( 7 ). Bupivacaine HCl : Do not exceed a milligram dose of bupivacaine HCl solution to EXPAREL of 1:2 when admixing, as this may impact the pharmacokinetics and/or physicochemical properties of the drugs ( 7 ). Bupivacaine Bupivacaine HCl administered together with EXPAREL may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. Therefore, bupivacaine HCl and EXPAREL may be administered simultaneously in the same syringe, and bupivacaine HCl may be injected immediately before EXPAREL as long as the ratio of the milligram dose of bupivacaine HCl solution to EXPAREL does not exceed 1:2. Non-Bupivacaine Local Anesthetics EXPAREL should not be admixed with local anesthetics other than bupivacaine. Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. There are no data to support administration of other local anesthetics prior to administration of EXPAREL. Other than bupivacaine as noted above, EXPAREL should not be admixed with other drugs prior to administration. Water and Hypotonic Agents Do not dilute EXPAREL with water or other hypotonic agents, as it will result in disruption of the liposomal particles.
Every bupivacaine product we track (5)
Same active ingredient — different manufacturer, form, price and FDA recall record. That last one is what our independent score measures.
| # | Drug | Rating | Type | Form | Generic? | Pharmacy pays | |
|---|---|---|---|---|---|---|---|
| 1 | 70/100 | Prescription | Injectable | Generic | $0 | View → | |
| 2 | 60/100 | Prescription | Injectable | Generic | $0 | View → | |
| 3 | Not yet rated | Prescription | Injectable | Generic | $0 | View → | |
| 4 | Not yet rated | Prescription | Solution | Generic | $0 | View → | |
| 5 | Not yet rated | Prescription | Implant | Generic | $0 | View → |
Combination products containing bupivacaine
A combination is a different drug — different dosing, different warnings. It is listed here so you can find it, not so you can substitute it.
Bupivacaine recalls
From the FDA Enforcement database. A recall covers specific lots — not the drug as a whole.
How long bupivacaine keeps
No bupivacaine label we read sets a separate limit for after opening, but they do specify how it must be stored — and the stability behind any date assumes those conditions.
Does bupivacaine expire? The in-use limits and storage rules from its labelsBupivacaine and breastfeeding
From LactMed, the US National Library of Medicine’s Drugs and Lactation Database — quoted, not rewritten.
Full LactMed record for bupivacaine: levels in milk, effects in breastfed infants, and the drugs it would consider insteadBecause of the low levels of bupivacaine in breastmilk, and it is not orally absorbed, amounts received by the infant are small and it has not caused any adverse effects in breastfed infants.
National Institute of Child Health and Human Development, record revised October 15, 2024. LactMed states its information is not a substitute for professional judgement.
What people report to the FDA about bupivacaine
The FDA Adverse Event Reporting System (FAERS) collects reports from patients and clinicians. It holds 13,908 reports naming bupivacaine, and the FDA flagged 74% of those reports as serious. The effects reported most often — leaving out reports about overdose, misuse or the condition being treated, which dominate the raw list for common medicines:
- hypotension833 reports
- anaesthetic complication818 reports
- maternal exposure during pregnancy668 reports
- nausea550 reports
- exposure during pregnancy514 reports
- hypoaesthesia491 reports
- vomiting410 reports
- dyspnoea377 reports
Read these as a signal, not a rate. A report does not mean bupivacaine caused the effect — anyone can file one, and many describe people taking several medicines for several conditions. Crucially there is no denominator: FAERS does not record how many people took the drug, so these counts cannot be turned into “X% of patients” — a bigger number often just means a more widely used or more talked-about drug. Duplicates exist, and publicity drives reporting. For what is actually established, read the FDA label section above.
Source: openFDA drug/event (FAERS), retrieved August 25, 2026.
Related calculators
Frequently asked questions
What is Exparel?
EXPAREL (bupivacaine liposome injectable suspension) is a sterile, non-pyrogenic white to off-white preservative-free aqueous suspension consisting of multivesicular liposomes containing bupivacaine. Bupivacaine is present at a concentration of 13.3 mg/mL. After injection of EXPAREL, bupivacaine is released from the multivesicular liposomes. EXPAREL is for infiltration or perineural use.
What kind of drug is bupivacaine?
The FDA classifies bupivacaine as an amide local anesthetic. Amide local anesthetics temporarily block the sodium channels that nerves use to fire, so the treated nerves can't send signals. This numbs pain in the area, and because the block reverses as the drug wears off, sensation returns afterward. If you are checking whether it is safe to combine with something else, the class is what matters — two drugs from the same class usually should not be stacked.
Can you take bupivacaine with other medicines?
It depends on the medicine. We check it against the FDA labels rather than guessing: our interaction checker searches each drug's own label for the other and quotes what it says, naming the section it came from. Run bupivacaine against whatever else you take — and remember that a label not naming a drug is not the same as that combination being safe.
What brand names is bupivacaine sold under?
We track 5 bupivacaine-containing products in the U.S.: Exparel, Marcaine, Bupivacaine Hydrochloride, Posimir and Xaracoll. They are the same active ingredient; they differ in form, manufacturer, price and FDA recall record.
What forms does bupivacaine come in?
Across the brands we track, bupivacaine is currently marketed as injectable, liposomal, solution and implant, per the FDA's National Drug Code Directory. Each form is dosed differently — follow the label for the exact product you were prescribed.
Is there a generic bupivacaine?
Yes. Our catalog lists 1 generic bupivacaine product alongside the brand versions. A generic has the same active ingredient and must meet the FDA's bioequivalence standard; it usually costs less. Ask your pharmacist which one your plan covers.
Has bupivacaine been recalled?
The FDA's Enforcement database lists 2 recall records whose product description mentions bupivacaine. The most recent: Bupivacaine Hydrochloride 0.75% in 8.25% Dextrose Injection (Apr 2, 2026). A recall applies to specific lots, not to the drug as a whole — check the record for the affected lot numbers.
Cite this page
- APA
- pharmaranks. (2026, July 24). Bupivacaine: uses, dosing, side effects & brands. https://pharmaranks.com/drugs/bupivacaine
- MLA
- “Bupivacaine: uses, dosing, side effects & brands.” pharmaranks, 24 July 2026, https://pharmaranks.com/drugs/bupivacaine.
We summarise public FDA and NIH sources — for a clinical claim, cite the primary source we link to as well.
Sources: FDA openFDA drug label, National Drug Code Directory, and Enforcement (recall) database. This page reproduces public FDA data and is not medical advice. Dosing is set by your prescriber.
Read the full FDA label for bupivacaine on DailyMed (NIH) ↗ — including its boxed warning in full.