Bupivacaine; Meloxicam Extended-Release Solution for Instillation

What is this medication?

BUPIVACAINE; MELOXICAM (bue PIV a kane; mel OX i cam) relieves pain after procedures. It numbs the area where it is applied, which blocks your nerves from sending pain signals to your brain. It also works by decreasing inflammation. It is a combination of a local anesthetic and an NSAID.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): ZYNRELEF

What should I tell my care team before I take this medication?

They need to know if you have any of these conditions:

• Asthma (lung or breathing disease)
• Bleeding disorder
• Coronary artery bypass graft (CABG) within the past 2 weeks
• Drink more than 3 alcoholic drinks every day
• G6PD deficiency
• Heart disease
• High blood pressure
• History of stomach bleeding
• Kidney disease
• Liver disease
• Low blood pressure
• Smoke tobacco cigarettes
• Stomach or intestine problems
• An unusual or allergic reaction to bupivacaine, meloxicam, aspirin, other NSAIDs, other medications, foods, dyes, or preservatives
• Pregnant or trying to get pregnant
• Breast-feeding

How should I use this medication?

This medication is for insertion into a surgery site. This medication is given in a hospital or clinic setting.

Talk to your care team about the use of this medication in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

This does not apply. This medication is not for regular use.

What may interact with this medication?

Do not take this medication with any of the following:

• Cidofovir
• Ketorolac

This medication may interact with the following:

• Acetaminophen
• Aspirin and aspirin-like medications
• Certain antibiotics like dapsone, nitrofurantoin, aminosalicylic acid, sulfonamides
• Certain medications for blood pressure, heart disease, irregular heart beat
• Certain medications for seizures like phenobarbital, phenytoin, valproic acid
• Certain medications that treat or prevent blood clots like warfarin
• Chloroquine
• Cyclophosphamide
• Cyclosporine
• Diuretics
• Flutamide
• Hydroxyurea
• Ifosfamide
• Lithium
• Methotrexate
• Metoclopramide
• Nitric oxide
• Nitroglycerin
• Nitroprusside
• Nitrous oxide
• Other local anesthetics like lidocaine, pramoxine, tetracaine
• Other NSAIDs, medications for pain and inflammation, like ibuprofen and naproxen
• Pemetrexed
• Primaquine
• Quinine
• Rasburicase
• SNRIs, medications for depression, like desvenlafaxine, duloxetine, levomilnacipran, venlafaxine
• SSRIs, medications for depression, like citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
• Sulfasalazine

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medication?

Your condition will be monitored carefully while you are receiving this medication.

Be careful to avoid injury while the area is numb, and you are not aware of pain.

If you have a procedure in the next 4 days, tell your care team you had this medication.

This medication can cause serious ulcers and bleeding in the stomach. It can happen with no warning. Smoking, drinking alcohol, older age, and poor health can also increase risks. Call your care team right away if you have stomach pain or blood in your vomit or stool.

What side effects may I notice from receiving this medication?

Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
• CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
• Headache, unusual weakness or fatigue, shortness of breath, nausea, vomiting, rapid heartbeat, blue skin or lips, which may be signs of methemoglobinemia
• Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
• Heart failure—shortness of breath, swelling of the ankles, feet, or hands, sudden weight gain, unusual weakness or fatigue
• Increase in blood pressure
• Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
• Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
• Rash, fever, and swollen lymph nodes
• Redness, blistering, peeling, or loosening of the skin, including inside the mouth
• Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision

Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):

• Constipation
• Headache
• Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medication?

This medication is given in a hospital or clinic. It will not be stored at home.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.