When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to bupivacaine or other types of local anesthetic.

How to Use This Medicine:
Injectable

• Your doctor will prescribe your exact dose and tell you how the medicine will be given. This medicine is sometimes given through a catheter placed in your lower back for an epidural or a spinal block. You may also receive the injection into your rib cage, chest, or other body area. This medicine is injected directly into your gums for dental work.
• A nurse or other health provider will give you this medicine.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how bupivacaine works. Tell your doctor if you are taking any of the following:
  
  • An MAO inhibitor
  • A tricyclic antidepressant
  • Blood pressure medicine, such as atenolol, doxazosin, lisinopril, terazosin, metoprolol
  • Depression medicine, such as amitriptyline, nortriptyline
  • Ergot medicine or other medicines for headaches or migraines
  • Phenothiazine medicine, such as promethazine, chlorpromazine
• Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.

Warnings While Using This Medicine:

• If you are not receiving this medicine for childbirth, tell your doctor if you are pregnant or breastfeeding. Tell your doctor if you have asthma, diabetes, liver, kidney, or heart disease, seizures, myasthenia gravis, thyroid problems, circulation problems, high blood pressure, low blood pressure, or methemoglobinemia.
• This medicine may make you dizzy or drowsy. Do not drive or do anything that could be dangerous until you know how this medicine affects you.
• This medicine should cause numbness only to the area where it is injected. It is not meant to cause you to fall asleep or become unconscious.
• It may be easier to hurt yourself while your treated body area is still numb. Be careful to avoid injury until you have regained all the feeling and are no longer numb.
• If you are receiving this medicine as an epidural to ease labor pains, it may take longer than normal for you to push your baby out. It is also possible that the baby may have unwanted effects after birth (sleepiness, slow responses). Talk to your doctor if you have questions about how this medicine might affect your baby.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Anxiety, depression, restlessness, drowsiness, ringing in your ears, blurred vision
• Chest pain, fast, pounding, slow, or uneven heartbeat, trouble breathing
• Lightheadedness or fainting
• Nausea, vomiting, chills, metallic taste in your mouth
• Seizures, shivering, shaking, or tremors

If you notice these less serious side effects, talk with your doctor:

• Headache, back pain
• Pain, redness, or swelling where the needle was placed

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088