Medication Pearl of the Day: Bupivacaine and Meloxicam (Zynrelef)
Indication: Zynrelef contains bupivacaine, an amide local anesthetic, and meloxicam, a nonsteroidal anti-inflammatory drug (NSAID). It is indicated in adults for soft tissue or periarticular instillation to produce postsurgical analgesia for up to 72 hours after foot and ankle, small-to-medium open abdominal, and lower extremity total joint arthroplasty surgical procedures.
- Dosing: The recommended dose of Zynrelef is up to a maximum dose of 400 mg/12 mg (14 mL).
- Dosage forms: Zynrelef extended-release solution is available in 4 dosage strengths as single-dose glass vials—400 mg bupivacaine and 12 mg meloxicam; 300 mg bupivacaine and 9 mg meloxicam; 200 mg bupivacaine and 6 mg meloxicam; 60 mg bupivacaine and 1.8 mg meloxicam.
- Adverse events: Most common adverse reactions (incidence ≥10%) are constipation, vomiting, and headache.
- Mechanism of action: Local anesthetics block the generation and the conduction of nerve impulses presumably by increasing the threshold for electrical excitation in the nerve, by slowing the propagation of the nerve impulse, and by reducing the rate of rise of the action potential. Meloxicam is a potent inhibitor of prostaglandin synthesis in vitro. Prostaglandins sensitize afferent nerves and potentiate the action of bradykinin in inducing pain in animal models.
Source: prescribing-information.pdf (zynrelef.com)