Drug reference

Levobupivacaine

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1443, 1444

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Acute postoperative pain ▶BY CONTINUOUS EPIDURAL INFUSION ▶Adult: 12.5–18.75 mg/hour, dose administered using a 1.25 mg/mL (0.125%) or 2.5 mg/mL (0.25%) solution; maximum 400 mg per day Acute labour pain ▶BY LUMBAR EPIDURAL ▶Adult: 15–25 mg, repeated at intervals of at least 15 minutes, dose administered using a 2.5 mg/mL (0.25%) solution; maximum 400 mg per day ▶BY CONTINUOUS EPIDURAL INFUSION ▶Adult: 5–12.5 mg/hour, dose administered using a 1.25 mg/mL (0.125%) solution; maximum 400 mg per continued → day Surgical anaesthesia, peripheral nerve block ▶BY REGIONAL ADMINISTRATION ▶Adult: 2.5–150 mg, dose administered using a 2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution Surgical anaesthesia, peribulbular nerve block ▶BY REGIONAL ADMINISTRATION ▶Adult: 37.5–112.5 mg, dose administered using a 7.5 mg/mL (0.75%) solution Surgical anaesthesia for caesarean section ▶BY LUMBAR EPIDURAL ▶Adult: 75–150 mg, to be given over 15 –20 minutes, dose administered using a 5 mg/mL (0.5%) solution Surgical anaesthesia ▶BY LUMBAR EPIDURAL ▶Adult: 50–150 mg, to be given over 5 minutes, dose administered using a 5 mg/mL (0.5%) or 7.5 mg/mL (0.75%) solution ▶BY INTRATHECAL INJECTION ▶Adult: 15 mg, dose administered using a 5 mg/mL (0.5%) solution ▶BY LOCAL INFILTRATION ▶Adult: 2.5–150 mg, dose administered using a Anaesthesia 2.5 mg/mL (0.25%) solution DOSES AT EXTREMES OF BODY-WEIGHT ▶To avoid excessive dosage in obese patients, dose should be calculated on the basis of ideal body-weight.

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Contra Indications

Avoid injection into infected tissues . avoid injection into inﬂamed tissues. intravenous regional anaesthesia (Bier’s block). preparations containing preservatives should not be used for caudal, epidural, or spinal block CONTRA-INDICATIONS, FURTHER INFORMATION ▶Injection site Manufacturer advises local anaesthetics should not be injected into inﬂamed or infected tissues. Increased absorption into the blood increases the possibility of systemic side-effects, and the local anaesthetic effect may also be reduced by altered local pH.

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Cautions

Cardiovascular disease. complete heart block. debilitated patients (consider dose reduction). elderly (consider dose reduction). epilepsy. hypovolaemia. impaired cardiac conduction. impaired respiratory function. myasthenia gravis. shock

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Allergy And Cross Sensitivity

▶Hypersensitivity and cross-sensitivity Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.

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Prescribing And Dispensing Information

Levobupivacaine is an isomer of bupivacaine.

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Safety

Important Safety Information

The licensed doses stated may not be appropriate in some settings and expert advice should be sought. Should only be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and should not be administered parenterally unless adequate resuscitation equipment is available.

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Interactions

→Appendix 1: anaesthetics, local

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Side Effects

▶Common or very common Anaemia. back pain. dizziness. fever. headache. hypotension. nausea. procedural pain. vomiting ▶Frequency not known Angioedema. apnoea. arrhythmias. asthenia. atrioventricular block. bladder disorder. cardiac arrest. drowsiness. eye disorders. faecal incontinence. ﬂushing. loss of consciousness. muscle twitching. muscle weakness. nerve disorders. neurological injury. oral hypoaesthesia. paralysis. priapism. respiratory disorders. seizure. sensation abnormal. skin reactions. sneezing. sweat changes. syncope. vision blurred SIDE-EFFECTS, FURTHER INFORMATION The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. Systemic toxicity can occur due to inadvertent intravascular injection. The onset of toxicity can be unpredictable and delayed. Monitor as per local protocol for at least 30 minutes after administration.

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Pregnancy

Large doses during delivery can cause neonatal respiratory depression, hypotonia, and bradycardia after epidural block. Avoid if possible in the ﬁrst trimester—toxicity in animal studies. May cause fetal distress syndrome. Do not use for paracervical block in obstetrics. Do not use 7.5 mg/mL strength in obstetrics.

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Breast Feeding

Amount too small to be harmful.

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Hepatic Impairment

Manufacturer advises caution in impairment or patients with reduced hepatic blood ﬂow (no information available).

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Dose and formulations

Directions For Administration

For 1.25 mg/mL concentration dilute standard solutions with sodium chloride 0.9%.

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Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Solution for injection ▶Levobupivacaine (Non-proprietary) Levobupivacaine (as Levobupivacaine hydrochloride) 2.5 mg per 1 ml Levobupivacaine 25mg/10ml solution for injection ampoules | 5 ampoule P £9.45 (Hospital only) Levobupivacaine (as Levobupivacaine hydrochloride) 5 mg per 1 ml Levobupivacaine 50mg/10ml solution for injection ampoules | 5 ampoule P £10.85 (Hospital only) Levobupivacaine (as Levobupivacaine hydrochloride) 7.5 mg per 1 ml Levobupivacaine 75mg/10ml solution for injection ampoules | 5 ampoule P £16.20 (Hospital only) ▶Chirocaine (AbbVie Ltd) Levobupivacaine (as Levobupivacaine hydrochloride) 2.5 mg per 1 ml Chirocaine 25mg/10ml solution for injection ampoules | 10 ampoule P £14.11 (Hospital only) Levobupivacaine (as Levobupivacaine hydrochloride) 5 mg per 1 ml Chirocaine 50mg/10ml solution for injection ampoules | 10 ampoule P £16.15 (Hospital only) Levobupivacaine (as Levobupivacaine hydrochloride) 7.5 mg per 1 ml Chirocaine 75mg/10ml solution for injection ampoules | 10 ampoule P £24.23 (Hospital only) Infusion ▶Levobupivacaine (Non-proprietary) Levobupivacaine (as Levobupivacaine hydrochloride).625 mg per 1 ml Levobupivacaine 62.5mg/100ml infusion bags | 5 bag P s Levobupivacaine 125mg/200ml infusion bags | 5 bag P s Levobupivacaine (as Levobupivacaine hydrochloride) 1.25 mg per 1 ml Levobupivacaine 125mg/100ml infusion bags | 5 bag P s ▶Chirocaine (AbbVie Ltd) Levobupivacaine (as Levobupivacaine hydrochloride) 1.25 mg per 1 ml Chirocaine 125mg/100ml infusion bags | 24 bag P £174.22 Chirocaine 250mg/200ml infusion bags | 12 bag P £124.44

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Dose text by age group

Adult

12.5–18.75 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

15–25 mg, repeated at intervals of at least

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1443

Adult

5–12.5 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

2.5–150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

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Adult

37.5–112.5 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Adult

75–150 mg, to be given over 15 –20 minutes,

First-line fragment. Read the complete Indications and Dose section above.

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Adult

50–150 mg, to be given over 5 minutes, dose

First-line fragment. Read the complete Indications and Dose section above.

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Adult

15 mg, dose administered using a 5 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

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Adult

2.5–150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Levobupivacaine

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1443, 1444

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF pages 1443, 1444

Contra Indications

PDF page 1444

Cautions

PDF page 1444

Allergy And Cross Sensitivity

PDF page 1444

Prescribing And Dispensing Information

Levobupivacaine is an isomer of bupivacaine.

PDF page 1444

Safety

Important Safety Information

PDF page 1444

Interactions

→Appendix 1: anaesthetics, local

PDF page 1444

Side Effects

PDF page 1444

Pregnancy

PDF page 1444

Breast Feeding

Amount too small to be harmful.

PDF page 1444

Hepatic Impairment

Manufacturer advises caution in impairment or patients with reduced hepatic blood ﬂow (no information available).

PDF page 1444

Dose and formulations

Directions For Administration

For 1.25 mg/mL concentration dilute standard solutions with sodium chloride 0.9%.

PDF page 1444

Medicinal Forms

PDF page 1444

Dose text by age group

Adult

12.5–18.75 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1443

Adult

15–25 mg, repeated at intervals of at least

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1443

Adult

5–12.5 mg/hour, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1443

Adult

2.5–150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Adult

37.5–112.5 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Adult

75–150 mg, to be given over 15 –20 minutes,

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Adult

50–150 mg, to be given over 5 minutes, dose

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Adult

15 mg, dose administered using a 5 mg/mL

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Adult

2.5–150 mg, dose administered using a

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1444

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.