Bupivacaine
Bupivacaine is a long-acting local anesthetic used to provide regional anesthesia and pain relief during and after surgical procedures. It works by blocking nerve impulses in a specific area of the body, making it useful for epidurals, nerve blocks, and local infiltration. This medication is commonly used in obstetrics, surgery, and chronic pain management.
Bupivacaine is a long-acting local anesthetic that blocks nerve signals to provide surgical anesthesia and pain relief.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- N01BB01
- RxNorm
- 1815
- Generic
- Bupivacaine
- Class
- atc-n01
- Brands
- Marcaine, Exparel, Marcaine with Epinephrine, Sensorcaine, Nocita, Sensorcaine with Epinephrine, Xaracoll, Zynrelef, Posimir, Vivacaine
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- injection, solution
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 50-150mg
- Maximum
- consult physician
- Frequency
- single dose or continuous infusion
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 0.5-2mg/kg
- Maximum
- consult physician
- Frequency
- single dose or continuous infusion
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 25-75mg
- Maximum
- consult physician
- Frequency
- single dose or continuous infusion
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
10 groupspregnancy
first trimesteravoid if possible
use only when benefits clearly outweigh risks; avoid routine use
regular fetal monitoring
Use with caution and monitor for adverse effects.
pregnancy
second trimesteruse lowest effective dose
use only when benefits outweigh potential risks
fetal heart rate monitoring
Use with caution and monitor for adverse effects.
pregnancy
third trimesteravoid high doses
use with extreme caution; avoid prolonged use
continuous fetal monitoring
Use with caution and monitor for adverse effects.
lactation
breastfeedingno specific adjustment
generally considered compatible; monitor infant for unusual sedation or feeding problems
observe infant for signs of toxicity
Use with caution and monitor for adverse effects.
geriatric
elderlyreduce dose by 25-50%
use lower doses; increased risk of cardiac and CNS toxicity; monitor closely
continuous cardiac monitoring, vital sign monitoring
Use with caution and monitor for adverse effects.
pediatric_age
neonates infantsweight-based dosing, reduce dose
use with extreme caution in neonates and infants under 6 months; avoid high concentrations
continuous cardiac and respiratory monitoring
Use with caution and monitor for adverse effects.
pediatric_age
childrenweight-based dosing
use appropriate weight-based dosing; avoid caudal block with high doses
cardiac and respiratory monitoring
Use with caution and monitor for adverse effects.
renal_impairment
moderate to severeno major adjustment needed
use with caution; monitor for accumulation
monitor for signs of toxicity
Use with caution and monitor for adverse effects.
hepatic_impairment
mildno major adjustment
use standard dosing with monitoring
monitor for signs of toxicity
Use with caution and monitor for adverse effects.
hepatic_impairment
moderate to severereduce dose, extended interval between doses
use reduced doses and extended dosing intervals; avoid continuous infusions if possible
close monitoring for signs of toxicity, cardiac monitoring recommended
Use with caution and monitor for adverse effects.
Statistics and clinical data
Drug class
Drug classification information
FDA approval year
Original FDA approval date for bupivacaine
Common uses
Primary therapeutic applications
Mechanism of action
Primary pharmacodynamic mechanism
Used for surgical anesthesia (epidural, spinal, nerve blocks, infiltrations), postoperative pain management, labor analgesia, and chronic pain conditions requiring regional anesthesia techniques.
Blocks the generation and conduction of nerve impulses by increasing the threshold for electrical excitation in nerves, slowing nerve impulse propagation, and reducing the rate of rise of the action potential.
Long-acting local anesthetic with potential cardiotoxicity; must not be administered intravenously without epinephrine for certain procedures; dosing varies by procedure and patient factors; use with caution in patients with cardiovascular disease, liver impairment, or elderly patients.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed July 26, 2026. · Read our editorial policy