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.
1Infiltrate 7 mL of EXPAREL into the tissues surrounding the osteotomy and 1 mL into the subcutaneous tissue.
2Dilute 20 mL of EXPAREL with 10 mL of saline, for a total of 30 mL, and divide the mixture into six 5 mL aliquots. Perform the anal block by visualizing the anal sphincter as a clock face and slowly infiltrating one aliquot to each of the even numbers.
Surgery
Dose of EXPAREL
Volume of EXPAREL
Bunionectomy1
106 mg
8 mL
Hemorrhoidectomy2
266 mg
20 mL
2.1 Injection Instructions
EXPAREL should be injected slowly into soft tissues of the surgical site with frequent aspiration to check for blood and minimize the risk of intravascular injection.
EXPAREL is intended for single-dose infiltration only.
EXPAREL should be administered with a 25 gauge or larger bore needle.
The maximum dosage of EXPAREL should not exceed 266 mg (20 mL, 1.3% of undiluted drug).
Do not administer EXPAREL if the product is discolored.
Do not administer EXPAREL if it is suspected that the vial has been frozen or exposed to high temperature (greater than 40°C or 104°F) for an extended period.
EXPAREL can be administered undiluted or diluted up to 0.89 mg/mL (i.e. 1:14 dilution by volume) with normal (0.9%) sterile saline for injection or lactated Ringer’s solution.
Vials of EXPAREL should be inverted multiple times to re-suspend the particles immediately prior to withdrawal from the vial.
Diluted suspensions of EXPAREL should be used within 4 hours of preparation in a syringe.
2.2 Administration Precautions
Some physicochemical incompatibilities exist between EXPAREL and certain other drugs. Direct contact of EXPAREL with these drugs results in a rapid increase in free (unencapsulated) bupivacaine, altering EXPAREL characteristics and potentially affecting the safety and efficacy of EXPAREL. Therefore, admixing EXPAREL with other drugs prior to administration is not recommended [See Drug Interactions (7)].
Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more.
Bupivacaine HCl, when injected immediately before EXPAREL, may impact the pharmacokinetic and/or physicochemical properties of the drugs if the milligram dose of bupivacaine HCl solution exceeds 50% of the EXPAREL dose. The toxic effects of these drugs are additive and their administration should be used with caution including monitoring for neurologic and cardiovascular effects related to toxicity [See Warnings and Precautions (5.1) and Overdosage (10)].
When a topical antiseptic such as povidone iodine (e.g., Betadine®) is applied, the site should be allowed to dry before EXPAREL is administered into the surgical site. EXPAREL should not be allowed to come into contact with antiseptics such as povidone iodine in solution.
Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL.
When administered in recommended doses and concentrations, bupivacaine HCl does not ordinarily produce irritation or tissue damage and does not cause methemoglobinemia.
2.3 Non-Interchangeability with Other Formulations of Bupivacaine
Different formulations of bupivacaine are not bioequivalent even if the milligram dosage is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL and vice versa.
Liposomal encapsulation or incorporation in a lipid complex can substantially affect a drug's functional properties relative to those of the unencapsulated or nonlipid-associated drug. In addition, different liposomal or lipid-complexed products with a common active ingredient may vary from one another in the chemical composition and physical form of the lipid component. Such differences may affect functional properties of these drug products. Do not substitute.
2.4 Dosing in Special Populations
EXPAREL has not been studied in patients younger than 18 years of age, pregnant patients or patients who are nursing.