bupivacaine (Marcaine; Sensorcaine)

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GENERIC NAME: bupivacaine

BRAND NAMES: Marcaine; Sensorcaine

DRUG CLASS AND MECHANISM: Bupivacaine is a local anesthetic that is similar to lidocaine and mepivacaine (amide type). Bupivacaine, like other local anesthetics reduces the flow of sodium in and out of nerves. This decreases the initiation and transfer of nerve signals in the area in which the drug is applied. This blockage leads first to a loss of sensation of pain, then temperature, touch, deep pressure, and muscle control. The concentration of the drug will determine how quickly it starts working. The FDA approved bupivacaine in October 1972.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Intrathecal solution and injection solution with or without methylparaben and or preservatives: 0.25%, 0.5%, 0.75% in 2, 10, 30, 50 mL. Preservative free formulations should be used in caudal or epidural block.

STORAGE: Bupivacaine should be stored at room temperature, between 20 C to 25 C (68 F to 77 F).

PRESCRIBED FOR: Bupivacaine is prescribed for local or regional anesthesia (loss of sensation) or analgesia (decreased pain) for surgical, dental, diagnostic, and obstetrical procedures.

DOSING: The initial dose for adults depends on the procedure, necessary depth of anesthesia, blood flow to the region, desired duration of anesthesia, and the condition of the patient. For example, in surgical procedures requiring a high degree of muscle relaxation and prolonged effects, 10-20 mL of 0.75% bupivacaine should be administered. Smaller procedures will require smaller doses.

DRUG INTERACTIONS: Therapy should be monitored when used with beta-blockers, such as atenolol (Tenormin), as they may increase the concentration of bupivacaine.

Monitor therapy with peginterferon Alfa-2b as it may decrease the concentration of bupivacaine and lead to diminished effects.

Hyaluronidase may increase how quickly bupivacaine starts to work as well as increase how much bupivacaine is absorbed into the blood stream. Monitor for toxic reactions such as low blood pressure, decreased heart rate, irregular heart rhythm, or cardiac arrest.

Technetium Tc 99m tilmanocept should not be simultaneously injected with the bupivacaine as it interferes with how well the technetium Tc 99m tilmanocept is able to spread and be used for diagnostic purposes.

PREGNANCY: There are not adequate studies in pregnant women. It may be used for obstetrical anesthesia or analgesia if benefits outweigh the risks.

NURSING MOTHERS: Bupivacaine is excreted in breast milk and should not be used by nursing mothers.

SIDE EFFECTS: Side effects are related to higher doses, as well as unintentional injection into alternative sites. Absorption into the blood stream may lead to low blood pressure, slow heart rate, strong or irregular heartbeat, and cardiac arrest. Additional side effects include nausea, vomiting, fecal and urinary incontinence, loss of sexual function, blurred vision, ringing in the ears, and loss of joint cartilage.

Rare, but serious complications include decreased function of the nervous system, activation of the nervous system (resulting in seizures), paraplegia, nerve disorder, total block of spinal nerves, and respiratory arrest. Specific warnings exist about using the 0.75 % dose in obstetrical anesthesia as there have been reports of cardiac arrest.

REFERENCE: FDA Prescribing Information.


Medically Reviewed by a Doctor on 6/27/2014



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