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Exparel Side Effects Center

Medical Editor: Charles Patrick Davis, MD, PhD

Last reviewed on RxList 6/5/2015

Exparel (bupivacaine liposome) is a non-opioid postsurgical analgesic used in the management of postsurgical pain. Exparel provides prolonged postsurgical analgesia for up to 72 hours with a single-dose local administration at the surgical site. Side effects of Exparel include dizziness, drowsiness, nausea, constipation, vomiting, itching, headache, back pain, or swelling in your hands or feet.

Exparel is available in two sizes: 10 mL and 20 mL single use vials in a strength of 1.3% (1.33 mg/ml). Exparel is intended for single-dose administration only. The recommended dose of Exparel is based on the surgical site and the volume required to cover the area. Exparel should not be mixed with lidocaine or other nonbupivacaine-based local anesthetics. Exparel may be administered after at least 20 minutes or more have elapsed following local administration of lidocaine. Serious side effects may include prolonged AV conduction; the drug should not be used in obstetrical paracervical block due to possible fetal harm. Exparel has not been studied in pediatric patients younger than 18 years of age, pregnant patients or patients who are nursing.

Our Exparel Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is Patient Information in Detail?

Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.

Exparel in Detail - Patient Information: Side Effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives, red rash, itching; sneezing, difficulty breathing; severe dizziness, vomiting; swelling of your face, lips, tongue, or throat.

You will be watched closely after receiving bupivacaine liposome, to make sure you do not have a reaction to the medication. Tell your caregivers at once if you have any of these signs of a serious side effect:

  • ringing in your ears;
  • feeling restless or anxious;
  • feeling like you might pass out;
  • speech or vision problems, a metallic taste in your mouth;
  • numbness or tingling around your mouth;
  • tremors, twitching, mood changes;
  • fast heart rate, feeling short of breath, feeling unusually hot or cold;
  • numbness, weakness, or loss of movement where the injection was given; or
  • if you still feel numb several hours after your surgery.

Less serious side effects include:

  • mild dizziness or drowsiness;
  • nausea, vomiting;
  • constipation;
  • itching;
  • headache, back pain; or
  • swelling in your hands or feet.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Read the entire detailed patient monograph for Exparel (Bupivacaine Liposome Injectable Suspension)

What is Prescribing information?

The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.

Exparel FDA Prescribing Information: Side Effects
(Adverse Reactions)



The most commonly encountered acute adverse experiences to bupivacaine and all amide-type local anesthetics that demand immediate counter-measures are related to the central nervous and cardiovascular systems.

High plasma concentrations of bupivacaine can occur from overdosage, unintended intravascular injection, or accumulation of bupivacaine in plasma secondary to decreased hepatic metabolic degradation of the drug or diminished plasma protein binding capacity due to acidosis, pathologically lowered plasma protein production, or competition with other drugs for protein binding sites. Although rare, some individuals have a lower tolerance to and are supersensitive to bupivacaine and other amide-type local anesthetics and may rapidly develop signs of toxicity at low doses [See OVERDOSAGE].

Adverse Reactions Reported In All Wound Infiltration Clinical Studies

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 clinical studies of another drug and may not reflect the rates observed in practice.

The safety of EXPAREL was evaluated in 10 randomized, double-blind, local administration into the surgical site clinical studies involving 823 patients undergoing various surgical procedures. Patients were administered a dose ranging from 66 to 532 mg of EXPAREL. In these studies, the most common adverse reactions (incidence greater than or equal to 10%) following EXPAREL administration were nausea, constipation, and vomiting.

The common adverse reactions (incidence greater than or equal to 2% to less than 10%) following EXPAREL administration were pyrexia, dizziness, edema peripheral, anemia, hypotension, pruritus, tachycardia, headache, insomnia, anemia postoperative, muscle spasms, hemorrhagic anemia, back pain, somnolence, and procedural pain.

The less common/rare adverse reactions (incidence less than 2%) following EXPAREL administration were chills, erythema, bradycardia, anxiety, urinary retention, pain, edema, tremor, dizziness postural, paresthesia, syncope, incision site edema, procedural hypertension, procedural hypotension, procedural nausea, muscular weakness, neck pain, pruritus generalized, rash pruritic, hyperhidrosis, cold sweat, urticaria, bradycardia, palpitations, sinus bradycardia, supraventricular extrasystoles, ventricular extrasystoles, ventricular tachycardia, hypertension, pallor, anxiety, confusional state, depression, agitation, restlessness, hypoxia, laryngospasm, apnea, respiratory depression, respiratory failure, body temperature increased, blood pressure increased, blood pressure decreased, oxygen saturation decreased, urinary incontinence, vision blurred, tinnitus, drug hypersensitivity, and hypersensitivity.

Neurological and Cardiac Adverse Reactions Reported in All Wound Infiltration Clinical Studies

In the EXPAREL wound infiltration studies, adverse reactions with an incidence greater than or equal to 1% in the Nervous System Disorders system organ class following EXPAREL administration were dizziness (6.2%), headache (3.8%), somnolence (2.1%), hypoesthesia (1.5%), and lethargy (1.3%). The adverse reactions with an incidence greater than or equal to 1% in the Cardiac Disorders system organ class following EXPAREL administration were tachycardia (3.9%) and bradycardia (1.6%).

Adverse Reactions Reported in Placebo-Controlled Wound Infiltration Clinical Studies

Adverse reactions with an incidence greater than or equal to 2% reported by patients in clinical studies comparing 8 mL EXPAREL 1.3% (106 mg) to placebo and 20 mL EXPAREL 1.3% (266 mg) to placebo are shown in Table 1.

Table 1: Treatment-Emergent Adverse Reactions (TEAE) with an Incidence Greater than or Equal to 2%: Placebo-Controlled Studies

System Organ Class Preferred Term STUDY 1a STUDY 2b
EXPAREL 8 mL/1.3% (106 mg)
(N=97) n (%)
(N=96) n (%)
EXPAREL 20 mL/1.3% (266 mg)
(N=95) n (%)
(N=94) n (%)
Any TEAE 53 (54.6) 59 (61.5) 10 (10.5) 17 (18.1)
Gastrointestinal Disorders 41 (42.3) 38 (39.6) 7 (7.4) 13 (13.8)
  Nausea 39 (40.2) 36 (37.5) 2 (2.1) 1 (11)
  Vomiting 27 (27.8) 17 (17.7) 2 (2.1) 4 (4.3)
  Constipation 2 (2.1) 1 (1.0) 2 (2.1) 2 (2.1)
  Anal Hemorrhage 0 (0.0) 0 (0.0) 3 (3.2) 4 (4.3)
  Painful Defecation 0 (0.0) 0 (0.0) 2 (2.1) 5 (5.3)
  Rectal Discharge 0 (0.0) 0 (0.0) 1 (11) 3 (3.2)
Nervous System Disorders 20 (20.6) 30 (31.3) 0 (0.0) 0 (0.0)
  Dizziness 11 (11.3) 25 (26.0) 0 (0.0) 0 (0.0)
  Headache 5 (5.2) 8 (8.3) 0 (0.0) 0 (0.0)
  Somnolence 5 (5.2) 1 (1.0) 0 (0.0) 0 (0.0)
  Syncope 2 (2.1) 0 (0.0) 0 (0.0) 0 (0.0)
  Skin And Subcutaneous Tissue Disorders 8 (8.2) 7 (7.3) 0 (0.0) 0 (0.0)
  Pruritus Generalized 5 (5.2) 6 (6.3) 0 (0.0) 0 (0.0)
  Pruritus 3 (3.1) 1 (1.0) 0 (0.0) 0 (0.0)
Investigations 5 (5.2) 3 (3.1) 4 (4.2) 3 (3.2)
  Alanine Aminotransferase Increased 3 (3.1) 3 (3.1) 1 (11) 0 (0.0)
  Aspartate Aminotransferase Increased 3 (3.1) 2 (2.1) 0 (0.0) 0 (0.0)
  Blood Creatinine Increased 2 (2.1) 0 (0.0) 0 (0.0) 0 (0.0)
  Body Temperature Increased 0 (0.0) 0 (0.0) 3 (3.2) 3 (3.2)
General Disorders And Administration Site Conditions 4 (4.1) 0 (0.0) 1 (11) 1 (11)
  Feeling Hot 2 (2.1) 0 (0.0) 0 (0.0) 0 (0.0)
  Pyrexia 2 (2.1) 0 (0.0) 1 (1.1) 1 (1.1)
Infections And Infestations 2 (2.1) 1 (1.0) 0 (0.0) 0 (0.0)
  Fungal Infection 2 (2.1) 1 (1.0) 0 (0.0) 0 (0.0)
Injury, Poisoning And Procedural Complications 2 (2.1) 0 (0.0) 0 (0.0) 0 (0.0)
  Post Procedural Swelling 2 (2.1) 0 (0.0) 0 (0.0) 0 (0.0)
Metabolism And Nutrition Disorders 2 (2.1) 2 (2.1) 0 (0.0) 0 (0.0)
  Decreased Appetite 2 (2.1) 2 (2.1) 0 (0.0) 0 (0.0)
aStudy 1: Bunionectomy
bStudy 2: Hemorrhoidectomy At each level of summation (overall, system organ class, preferred term), patients are only counted once. Preferred terms are included where at least 2% of patients reported the event in any treatment group. TEAE = treatment-emergent adverse event.

Read the entire FDA prescribing information for Exparel (Bupivacaine Liposome Injectable Suspension)

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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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