Acute Porphyria Drug Database

Monograph

N01BB01 - Bupivacaine
Not porphyrinogenic
NP

Rationale
Used uneventfully in 56 patients with latent or active acute porphyria. By clinical criteria the local anaesthetic bupivacaine is not porphyrinogenic. One report of increased porphyrinogenic activity following an operation where bupivacaine was used in epidural anaesthesia, but causality was not established.
Chemical description
Bupivacaine hydrochloride is a local anesthetic of the amide type. Bupivacaine occurs as a 50:50 racemic mixture of the R- and S-enantiomers, but the S(-)-isomer levobupivacaine is also used.
Therapeutic characteristics
Local anaesthetic. Administration in combination with vasoconstrictor such as epinephrine (adrenaline) (not porphyrinogenic) prolongs the effect of bupivacaine, and reduces hepatic exposure and the risk of systemic reactions.
Hepatic exposure
Volume required to obtain uM concentrations when injected intravenously: approximately 5 ml (of bupivacaine 5 mg/ml).
Metabolism and pharmacokinetics
Bupivacaine is principally metabolized to pipecolylxylidine (PPX) by N-dealkylation, probably in the liver. Bupivacaine is excreted in urine as small amounts of PPX, unchanged drug (5%), and other metabolites as yet unidentified. Rendic (2002) reports that bupivacaine is a substrate of CYP3A4 (major reaction), CYP1A2, CYP2C19 and 2D6 (minor reaction).
Personal communication
Thunell, S., study to be published: 48 patients exposed without porphyric adverse reaction reported. Peters: According to our experience not porphyrinogenic.
Published experience
Used uneventfully in AIP woman during delivery (Aggarwal, N., Bagga, R. et al, 2002). Used uneventfully for epidural anaesthesia during delivery by woman with latent VP (Consolo, D., Ouardirhi, Y. et al, 2005). Used uneventfully twice over two years in the same patient (one epidural and one spinal injection), an AIP woman (McNeill, M.J. & Bennet, A., 1990). Used uneventfully in epidural anaesthesia to relieve postoperative pain in AIP patient presenting with elevated PBG (Messmer, M., Gerheuser, F. et al, 2004). Used uneventfully as epidural, during surgery and post operativly in VP woman (Minoda,Y., Yoshimine, K. et al, 1997). Used uneventfully as spinal epidural in AIP woman (Sahu, M.T., Rajaram, S. et al, 2006). Used uneventfully as epidural, during surgery and post operativly, in HCP man (Yamamori, Y., Sumi, M. et al, 1996). Used uneventfully as spinal anesthesia in VP man (Bohrer, H. & Schmidt, H., 1992). Listed as safe in review by James and Hift (James, M.F. & Hift, R.J., 2000). One report of increased porphyrinogenic activity following an operation where bupivacaine was used in epidural anaesthesia, but causality was not established (Ii, C., Tanaka, N. et al, 1993).
IPNet drug reports
Uneventful use reported in 5 patients with acute porphyria.

References

# Citation details PMID
*Scientific articles
1. Aggarwal, N., Bagga, R. et al. Pregnancy with acute intermittent porphyria: A case report and review of literature. J Obstet Gynaecol Res 2002; 28(3): 160-2.
2. Bohrer, H., Schmidt, H. Regional Anesthesia as Anesthetic Technique of Choice in Acute Hepatic Porphyria. J Clin Anesth 1992; 4: 259.
1610588
3. Consolo, D.,Ouardirhi, Y. et al.[Obstetrical anaesthesia and porphyrias].Annales Françaises d’Anesthésie et de Réanimation 2005;24: 428-431.
4. de Verneuil,H., Deybach,J.C. et al. Study of anaesthetic agents for their ability to elicit porphyrin biosynthesis in chick embryo liver. Biochem Pharmacol 1982; 32: 1011-18.
5. Ii, C., Tanaka, N. et al. [Anesthetic management of a patient with acute intermittent porphyria]. Masui 1993; 42: 1849-52.
6. James,M.F., Hift,R.J. Porphyrias.Br J Anaesth 2000; 85, 143-53.
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7. McNeill, MJ, Bennet, A. Use of regional anaesthesia in a patient with acute porphyria. Br J Anaesth 1990;64: 371-3.
8. Messmer, M., Gerheuser, F. et al.[Desflurane in acute intermittent porphyria.] Anaesthesist 2004; 53:244-8. DOI 10.1007/s00101-003-0615-7
9. Minoda, Y., Yoshimine, K. et al. Anesthetic management of a patient with variegate porphyria. Anesth 1997;11:307-8.
10. Parikh, RK, Moore, MR. Effect of certain anaesthetic agents on the activity of rat hepatic delta-aminolaevulinate synthase. Br J Anaesth 1978; 50:1099-1103.
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11. Rendic, S. Summery of information on human CYP enzymes: human P450 metabolism. Drug metabolism reviews 2002; 34(1&2), 83-448.
12. Thunell, S. Evidence-based porphyrogenicity assessment of seven local anasthetics (2009, to be published).
13. Yamamori,Y., Sumi, M. et al. Safety of isoflurane and epidural anesthesia in a patient with hereditary coproporphyria. J Anesth 1996;10:80-2.
*Drug reference publications
14. McEvoy GK, editor. Bupivacaine Hydrochloride. The AHFS Drug Information 2008. Bethesda, MD: American Society of Health-System Pharmacists; 2009. Electronic version (January 2009).
15. Sweetman SC, editor. Martindale: The complete drug reference. Bupivacaine Hydrochloride. Pharmaceutical Press 2009.
*Summary of Product Characteristics
16. Norwegian medicines agency. Summary of Product Characteristics (SPC). Marcain-adrenalin.

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Tradenames and packages
From some sources, we get a list of packages (United Kingdom, Ireland, Estonia). Other sources contain more or less "clean" versions of the trade name (Denmark, Finland, Iceland, Lithuania, Norway). What you see here is the raw data we get from each country, so there will appear to be duplicates. The bold names are the searchable terms. The gray names that follow are all mapped to the bolded term.
Note: The cleaning is done automatically by a proprietary algorithm, and it may produce errors. We strive to improve it continuously.
Netherlands
Bupivacaïne · Bupivacaïne Accord 2,5 mg/ml oplossing voor injectie · Bupivacaïne Accord 5 mg/ml oplossing voor injectie · Bupivacaïne Eugia 2,5 mg/ml, oplossing voor injectie · Bupivacaïne Eugia 5 mg/ml, oplossing voor injectie · Bupivacaïne Eugia 7,5 mg/ml epiduraal, oplossing voor injectie · Bupivacaïne HCl Eureco-Pharma 5 mg/ml Glucose, oplossing voor injectie voor intrathecale toediening · Bupivacaïne HCl Grindeks Spinaal 5 mg/ml oplossing voor injectie · Bupivacaine Glucose · Bupivacaine Grindeks Glucose 5mg/ml oplossing voor injectie · EXPAREL · EXPAREL liposomal 133 mg/10 ml dispersie voor injectie met verlengde afgifte · EXPAREL liposomal 266 mg/20 ml dispersie voor injectie met verlengde afgifte · Marcaine · Marcaine 2,5 mg/ml oplossing voor injectie · Marcaine 5 mg/ml Glucose, oplossing voor injectie voor intrathecale toediening 20 mg/4 ml · Marcaine 5 mg/ml Spinaal, oplossing voor injectie voor intrathecale toediening · Marcaine 5,0 mg/ml oplossing voor injectie · Pankaine Glucose · Pankaine Glucose 5 mg/ml, oplossing voor injectie
Belgium
Exparel · Exparel Liposomal 133 mg/10 ml disp. inj. lib. prol. flac. · Exparel Liposomal 266 mg/20 ml disp. inj. lib. prol. flac. · Marcaine · Marcaine 0,5 % Hyperbare sol. inj. i.théc. amp. · Marcaine 0.5 % sol. inj. p.dural flac.
United Kingdom
Bupivacain · Bupivacain Sintetica 40mg/ml (4%) solution for injection ampoules · Bupivacaine · Bupivacaine 0.25% solution for injection 10ml Sure-Amp ampoules · Bupivacaine 0.5% solution for injection 10ml Sure-Amp ampoules · Bupivacaine 0.75% solution for injection 10ml Sure-Amp ampoules · Bupivacaine 1.25g/500ml (0.25%) infusion bags · Bupivacaine 1.25g/500ml (0.25%) solution for infusion bottles · Bupivacaine 100mg/100ml (0.1%) infusion bags · Bupivacaine 100mg/20ml (0.5%) solution for injection vials · Bupivacaine 156.25mg/250ml (0.0625%) solution for infusion bottles · Bupivacaine 2.4g/960ml (0.25%) solution for infusion bottles · Bupivacaine 2.5g/500ml (0.5%) solution for infusion bottles · Bupivacaine 200mg/250ml (0.08%) infusion bags · Bupivacaine 250mg/250ml (0.1%) infusion bags · Bupivacaine 25mg/10ml (0.25%) solution for injection ampoules · Bupivacaine 300mg/10ml (3%) solution for injection ampoules · Bupivacaine 312.5mg/250ml (0.125%) infusion bags · Bupivacaine 312.5mg/500ml (0.0625%) solution for infusion bottles · Bupivacaine 400mg/500ml (0.08%) infusion bags · Bupivacaine 500mg/500ml (0.1%) solution for infusion bottles · Bupivacaine 50mg/10ml (0.5%) solution for injection ampoules · Bupivacaine 50mg/10ml (0.5%) solution for injection vials · Bupivacaine 50mg/20ml (0.25%) solution for injection vials · Bupivacaine 625mg/250ml (0.25%) infusion bags · Bupivacaine 625mg/250ml (0.25%) solution for infusion bottles · Bupivacaine 625mg/500ml (0.125%) infusion bags · Bupivacaine 750mg/500ml (0.15%) infusion bags · Bupivacaine 835mg/500ml (0.167%) solution for infusion bottles · Exparel · Exparel liposomal 133mg/10ml prolonged-release dispersion for injection vials · Exparel liposomal 266mg/20ml prolonged-release dispersion for injection vials · Marcain · Marcain 0.25% solution for injection 10ml Polyamp Steripack ampoules · Marcain 0.5% solution for injection 10ml Polyamp Steripack ampoules
Denmark
Bupivacain · Bupivacain "SAD" · Bupivacaine · Bupivacaine "Baxter" · Bupivacaine "Noridem" · Bupivacainhydrochlorid · Bupivacainhydrochlorid ”Carefarm” · EXPAREL · EXPAREL liposomal · Hevicain · Hevicain Spinal Tung · Marcain · Marcain Spinal · Marcain Spinal Tung · Marcaine · Pankaine · Pankaine Spinal tung
Norway
Bupivacaine Baxter · Marcain · Marcain Spinal · Marcain Spinal Tung
Poland
Bupivacaine Baxter · Bupivacaine Grindeks · Bupivacaine Spinal Grindeks · Bupivacaine WZF Spinal 0,5% Heavy · Bupivacaini Noridem · Exparel liposomal · Marcaine Spinal 0,5% Heavy · Pankaine Spinal Heavy · Sanergy Heavy
Luxembourg
MARCAINE · MARCAINE 0,5 PC HYPERBARE
Iceland
Exparel · Exparel liposomal · Marcain · Marcain spinal · Marcain spinal tung
Finland
Bicain Pond Spinal · Bicain Spinal · EXPAREL liposomal · Hevicain Spinal Tung · Pankaine Spinal Tung
Latvia
Bupivacaine · Bupivacaine Baxter · Bupivacaine Grindeks · Bupivacaine-Grindeks · Bupivacaine-Grindeks Spinal · EXPAREL · EXPAREL liposomal · Marcaine · Marcaine Spinal · Marcaine Spinal Heavy
Serbia
Bupivakain · Bupivakain Grindeks · Bupivakain Grindeks Spinal · Marcaine · Marcaine® 0.5% · Marcaine® Spinal 0.5% · Marcaine® Spinal 0.5% Heavy
 
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