Bupivacaine and Adrenaline (Epinephrine)Injection 0.5% w/v, 1 in 200,000

READ ALL OF THIS LEAFLET CAREFULLY BEFORE YOU START USING THIS MEDICINE.

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4.

The product is known by the above name but will be referred to as Bupivacaine & Adrenaline Injection throughout the rest of this leaflet.

What is in this leaflet:

1. What Bupivacaine & Adrenaline Injection is and what it is used for
2. What you need to know before you are given Bupivacaine & Adrenaline Injection
3. How Bupivacaine & Adrenaline Injection is given to you
4. Possible side effects
5. How to store Bupivacaine & Adrenaline Injection
6. Contents of the pack and other information

Do not use

Adrenaline containing Bupivacaine & Adrenaline injection for special techniques (e.g. penile block, Oberst block) to numb parts of the body where areas with end arteries are affected.

You should not be given this medicine if:

• you are allergic to bupivacaine or to any other amide-type of local anaesthetic, or to adrenaline, or to any of the other ingredients of this medicine (listed in section 6)
• you are to be injected in a vein of the hands or legs (Bier's block)
• you suffer from the condition known as thyrotoxicosis (when your body produces too much of the hormone thyroxine)
• you have severe heart disease particularly if it is associated with an increased heart rate.

Because the solution contains adrenaline, which narrows the blood vessels, this injection should not be used in areas such as fingers, toes, ears, nose or penis, as the blood supply to these areas might become inadequate.

You should not be given this injection as an epidural if:

• you have problems with the clotting of your blood or are taking any anticoagulant drugs (e.g. warfarin) that thin the blood
• you have an infection of the skin with pus at or near the site to be injected
• you have inadequate circulation of blood to the heart, sudden loss of blood or weakness of the heart that causes low blood pressure, a weak rapid pulse, sweating and confusion
• you are suffering from any infection, disease or tumour of the brain or spinal cord
• you have bleeding inside the head (intracranial haemorrhage)
• you have increased pressure within the brain.

Speak to your doctor or midwife if one of these applies to you before you are given this medicine.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before you are given Bupivacaine & Adrenaline injection

• you suffer from any liver, severe kidney problems
• you suffer from any heart problem, particularly if it affects the heart rate
• you have breathlessness or restriction to breathing from fluid or a large tumour in the abdomen
• you have high blood pressure or problems with the circulation of blood to the brain
• you have diabetes
• you have a decrease in the amount of fluid circulating in your body causing symptoms such as sweating, mental confusion, dizziness or fainting (for example, due to dehydration or severe bloodloss)
• you suffer from severe shock or low blood pressure
• you have accumulation of fluid around the lungs
• you are elderly (senile)
• you have accumulation of excess fat in your body
• you have excess fluid in the womb during pregnancy (hydraminos)
• you have a tumour of the ovary or the womb
• you suffer from blood poisoning (septicaemia)
• you have an overactive thyroid gland
• you have a tumour of the adrenal glands called a phaeochromocytoma
• you suffer from increased pressure in the eye (glaucoma)
• you have low potassium concentration in the blood
• you have excess calcium in the blood
• you suffer from cancer of the prostate
• you suffer from disorders/damage of the brain.

Other medicines and Bupivacaine & Adrenaline injection:

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

A large number of drugs can interact with Bupivacaine & Adrenaline Injection which can significantly alter their effects.

These drugs include:

• lidocaine, mexiletine, amiodarone (or any other medicine with local anaesthetic effect) for controlling the heart’s rhythm
• medicines to lower your blood pressure including beta-blockers e.g. atenolol, bisoprolol, alpha blockers e.g. phentolamine, adrenergic neurone blockers e.g. guanethidine, potassium depleting diuretics
• medicines which enhance the effects of the sympathetic system such as dopamine
• medicines used to treat allergies such as antihistamines e.g. diphenhydramine
• medicines used to treat heart failure such as cardiac glycosides e.g. digoxin
• medicines used for pain and inflammation such as corticosteroids
• medicines which help you to breathe e.g. aminophylline, theophylline
• medicines used to treat increased blood sugar levels e.g. insulin, oral hypoglycemic agents
• monoamine oxidase inhibitors (MAOI) or tricyclic antidepressants e.g. imipramine both used for depression
• phenothiazines (e.g.chlorpromazine) which are used to treat mental illness
• medicines for Parkinson’s disease (such as entacapone)
• doxapram (a medicine which stimulates your breathing)
• oxytocin (a drug which causes the womb to contract and may be used in labour)
• inhaled general anaesthetics, such as halothane
• medicines used to treat thyroid insufficiency such as thyroid hormones. e.g. thyroxine.

Pregnancy and breast-feeding:

If you are pregnant or breast feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

As with all drugs Bupivacaine & Adrenaline Injection should only be given in pregnancy if absolutely necessary.

The safety and efficacy of Bupivacaine & Adrenaline injection 0.5%w/v, 1 in 200,000 in children aged < 12 years of age have not been established.. Other strengths may be more appropriate.

The safety and efficacy of Bupivacaine & Adrenaline injection 0.25%w/v, 1 in 200,000 in children aged < 1 year of age have not been established.

Driving and using machines:

Certain areas of your body will be numb for about 2-4 hours after having this medicine. If this is likely to affect your ability to drive or use machinery you should wait for the effect to wear off. In general, it is wise to ask your doctor whether it is safe to drive.

Bupivacaine & Adrenaline Injection contains sodium:

This medicine contains sodium metabisulphite, a preservative. This may rarely cause severe allergic (hypersensitivity) reactions and wheezing.

This medicinal product contains less than 1mmol sodium (23mg) per dose (essentially ‘sodium-free’).

Use in children and adolescents

Depending on the type of required analgesia Bupivacaine & Adrenaline injection is injected slowly either into the epidural space (part of the spine) or other parts of the body by an anaesthesiologist experienced in paediatric anaesthetic techniques. Dosage depends on the age and weight of the patient and will be determined by the anaesthesiologist.

Tell your doctor straight away if you notice any of the following side effects:

Very common: may affect more than 1 in 10 people

• low blood pressure
• feeling sick (nausea).

Common: may affect up to 1 in 10 people

• being sick (vomiting)
• dizziness
• pins and needles
• drooping of the upper eyelid, sunk in eye or flushing on the affected side of the face (Horner’s syndrome) are most commonly experienced in pregnant women
• slow heart beat
• high blood pressure
• problems passing water.

Uncommon: may affect up to 1 in 100 people

• fits (convulsions)
• numbness of the tongue
• being sensitive to sound
• loss of consciousness
• light headedness
• difficulty in speaking.
• abnormal sensation of the skin
• ringing in the ears (tinnitus)
• blurred vision (visual disturbances)
• uncontrollable involuntary muscle movement (tremor)
• muscle twitching

Rare: may affect up to 1 in 1,000 people

• Double vision
• Nerve damage that may cause changes in sensation or muscle weakness. This may include peripheral nerve damage
• A condition called arachnoiditis (inflammation of the membrane that surrounds the spinal cord). The signs include a stinging or burning pain in the lower back or legs and tingling, numbness or weakness in legs
• Spinal cord injury (paraplegia)
• Partial loss of movement (paresis)
• Uneven heart beat or stopped heart beat. This could be life threatening
• Slowed or stopped breathing.

Other possible side effects include:

• problems with your liver enzymes. This may happen if you have long-term treatment with this medicine
• cessation of breathing (apnoea)
• deficiency in the amount of oxygen reaching body tissues (hypoxia)
• more than normal level of carbon dioxide in blood (hypercarbia)
• increased acidity in the blood (acidosis)
• increased potassium levels in the blood (hyperkalemia).

Additional side effects in children and adolescents

Adverse drug reactions in children are similar to those in adults.

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store By reporting side effects you can help provide more information on the safety of this medicine.

What Bupivacaine & Adrenaline Injection looks like and contents of pack

Bupivacaine & Adrenaline Injection is a colourless or almost colourless, aqueous, sterile solution for injection and is available in two strengths:

1. Bupivacaine & Adrenaline Injection 0.25% w/v, 1 in 200,000. Each 10ml of this solution contains 25mg of anhydrous bupivacaine hydrochloride and 50 micrograms of adrenaline.
2. Bupivacaine & Adrenaline Injection 0.5% w/v, 1 in 200,000. Each 10ml of this solution contains 50mg of anhydrous bupivacaine hydrochloride and 50 micrograms of adrenaline.

Both product strengths are available as 10ml glass ampoules in boxes of 10 or individually sterile wrapped in packs of 10.

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