Exparel
Exparel (bupivacaine liposome) is a long-acting local anesthetic. It's used to control pain after surgery in people 6 years and older. In adults, it's also used as a nerve block to help manage pain in certain situations. Exparel (bupivacaine liposome) is given as a one-time injection at the surgical area or near specific nerves. A trained healthcare professional will give the injection during the procedure. It works to numb the area and block pain signals to the brain. Common side effects include nausea, vomiting, and constipation.
What is Exparel (bupivacaine liposome)?
What is Exparel (bupivacaine liposome) used for?
- Numbing a small area of the body for after-surgery care in people ages 6 years and older
- Numbing the shoulder area for after-surgery care in adults
- Numbing the lower leg and foot for after-surgery care in adults
- Numbing the knee, lower leg, and ankle for after-surgery care in adults
How Exparel (bupivacaine liposome) works
Exparel (bupivacaine liposome) is a local anesthetic. It slowly releases bupivacaine from tiny lipid (fat) spheres called liposomes. This medication works by blocking your nerves from sending pain signals to your brain.
Drug facts
| Common Brands | Exparel |
|---|---|
| Drug Class | Local anesthetic |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Exparel (bupivacaine liposome)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Nausea
- Vomiting
- Constipation
- Dizziness
Less Common Side Effects
- Headache
- Sleepiness
- Fever
- Itching
- Muscle twitching
- Blurry vision
- Changes in blood pressure
- Fast or slow heartbeat
Exparel (bupivacaine liposome) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reaction: rash, itching, flushing, heavy sweating, dizziness, swelling of the face, trouble breathing, trouble speaking, throat tightening up, fast heartbeat
- Too much bupivacaine in your body: restlessness, anxiety, dizziness, confusion, ringing in the ears, numb or tingly mouth, metallic taste, blurry vision, tremors, twitching, seizures, chest pain, slow or irregular heartbeat
- Blood problem called methemoglobinemia: pale, gray, or blue skin or lips; headache; feeling dizzy or faint; feeling tired; trouble breathing; fast heart beat; seizures; loss of consciousness
The following Exparel (bupivacaine liposome) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
- Headache, unusual weakness or fatigue, shortness of breath, nausea, vomiting, rapid heartbeat, blue skin or lips, which may be signs of methemoglobinemia
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Increase in blood pressure
- Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
- Seizures
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Exparel (bupivacaine liposome)
Pros
- Given as a one-time dose
- Provides long-lasting numbness to help control pain after surgery for up to several days
- Non‑opioid option that could reduce opioid use after surgery
- Can be used in children as young as 6 years old for numbing areas of the body for after-surgery care
Cons
- Numbness or weakness can linger and raise the risk of getting hurt
- Must avoid using other local anesthetics for 4 days
- Not recommended for epidural or use inside a joint
- Not recommended for people who are pregnant
Pharmacist tips for Exparel (bupivacaine liposome)
- Before your procedure, tell your care team about all your health conditions. Liver, kidney, or heart problems can raise risks with Exparel (bupivacaine liposome). Your care team can decide if they need to change your treatment plan and watch you more closely to keep you safe.
- After your procedure, be sure someone can drive you home. The area where you got Exparel (bupivacaine liposome) injected can be numb or weak. This can make driving dangerous, especially if it affects your arm or leg.
- Exparel (bupivacaine liposome) can keep an area numb for up to 5 days. Protect the numb area from heat, cold, and getting hurt. If your leg is numb from the medication, use help when walking to prevent falls.
- Nerve blocks with Exparel (bupivacaine liposome) can cause muscle weakness or a strange feeling in the area. Use handrails and avoid uneven ground to keep your balance. Don’t drive until feeling and your strength fully come back. This helps prevent falls and accidents.
- Don't use other local anesthetics for 4 days after receiving Exparel (bupivacaine liposome). This includes lidocaine cream or patches, benzocaine, and pramoxine. Using other local anesthetics too soon can raise your risk of side effects. Talk to your care team about other options if you need more pain relief after surgery.
- Tell every clinician that you’ve received Exparel (bupivacaine liposome). This is very important if you need dental work, urgent care, or another procedure within 4 days. You should generally avoid other local anesthetics for 4 days after getting Exparel (bupivacaine liposome).
- If you suddenly notice a metallic taste in your mouth, ringing in your ears, numb lips, dizziness, or confusion, tell your care team right away. These can be early signs that there's too much Exparel (bupivacaine liposome) in your body.
- Rarely, Exparel (bupivacaine liposome) can cause a blood condition that lowers oxygen in your blood. If your lips look blue or gray, you feel very short of breath, you feel unusually tired, get urgent help.
Risks and warnings for Exparel (bupivacaine liposome)
Exparel (bupivacaine liposome) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Central nervous system reactions
- Risk factors: Higher doses | Accidental injection into a blood vessel | Older adults | Young children | History of liver problems | Use with other local anesthetics
Exparel (bupivacaine liposome) can affect your central nervous system. This can cause drowsiness, dizziness, breathing problems, restlessness, or anxiety. Other reactions can include ringing in the ears, blurry vision, or tremors. Some people might also have nausea, vomiting, a metallic taste in the mouth, or chills.
Your care team will give Exparel (bupivacaine liposome) in a medical setting. This is so they can watch you closely and treat any problems quickly. Tell your care team right away if you notice any of these symptoms.
Heart problems
- Risk factors: High levels of Exparel (bupivacaine liposome) in the body | History of heart problems | Using together with other local anesthetics
Too much Exparel (bupivacaine liposome) in the body can slow down your heart's electric system. This can lead to abnormal heart beats or even cardiac arrest. It can also cause low blood pressure.
Let your care team know if you have a history of heart disease. They can make sure Exparel (bupivacaine liposome) is safe for you. In general, your care team will watch carefully for any changes in your vital signs after the injection. Get urgent medical care if you notice chest pain, fainting, shortness of breath, a racing heart, or a very slow heartbeat.
Serious allergic reaction
- Risk factors: Allergy to bupivacaine or similar medications
Rarely, Exparel (bupivacaine liposome) can cause a serious allergic reaction. It can sometimes be life-threatening.
Tell your care team about any allergies before your procedure. The risk of an allergic reaction might be higher if you've had one to other bupivacaine medications before. It also might be higher if you've had an allergic reaction to similar local anesthetics. If this is the case, your care team might choose a different local anesthetic to keep you safe.
Your care team will watch you during and after your Exparel (bupivacaine liposome) injection. Let them know right away if you have itching, rash, flushing, heavy sweating, or swelling. Also get medical help right away if you experience wheezing, trouble breathing, or throat tightness. These can be signs of a serious allergic reaction.
Blood problem called methemoglobinemia
- Risk factors: History of methemoglobinemia | History of glucose-6-phosphate dehydrogenase (G6PD) deficiency | Heart or lung problems | Exposure to other oxidizing agents, such as chlorine and hydrogen peroxide
Some people who received local anesthetics like Exparel (bupivacaine liposome) have had a serious blood problem called methemoglobinemia. This happens when red blood cells can't carry enough oxygen through the body.
The risk is higher if you have glucose-6-phosphate dehydrogenase (G6PD) deficiency. You also might be at risk if you've been around chemicals, like chlorine or hydrogen peroxide. These are found in some household cleaning products and hair dye. Be extra aware of this risk if you've recently used products with these oxidizing chemicals.
Signs of the blood problem can happen right away or within hours of the Exparel (bupivacaine liposome) injection. Early signs include headache, tiredness, and skin that looks bluish. Tell your care team right away if you notice these symptoms. Getting help quickly can help prevent serious problems, like seizures, heart rhythm problems, or coma.
Exparel (bupivacaine liposome) dosage
Vial| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 10ml of 1.3% | 2 vials | $492.69 | $246.35 |
| 20ml of 1.3% | 1 vial | $372.40 | $372.40 |
Typical dosage for Exparel (bupivacaine liposome)
A trained healthcare professional will inject the medication into a specific area of your body during your surgery. It's given as a one-time injection to help control pain after surgery.
-
Numbing a small area of the body
- Adults: The exact dose will depend on the size of the surgery area and other factors to make sure it's safe for you. The typical dose is up to 266 mg injected into the area near the surgical site.
- Children ages 6 to less than 17 years old: The typical dose is 4 mg/kg of body weight injected into the area near the surgical site. The maximum dose is 266 mg.
-
Numbing the shoulder area
- Adults: The typical dose is 133 mg injected near a group of nerves in the neck.
-
Numbing the lower leg and foot
- Adults: The typical dose is 133 mg injected near a group of nerves behind the knee.
-
Numbing the knee, lower leg, and ankle
- Adults: The typical dose is 133 mg injected near a group of nerves in the thigh. The healthcare professional will mix it with another form of bupivacaine before giving it.
How much does Exparel (bupivacaine liposome) cost?
$372.40
Exparel (bupivacaine liposome) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Exparel (bupivacaine liposome) will not be safe for you to take.
- Use for paracervical block to numb pain from the first stage of labor (contractions and dilation)
