What the FDA labels say about taking them together
Bupivacaine and epinephrine
Bupivacaine's FDA label of April 14, 2026 names epinephrine in its contraindications section; the epinephrine labels PlainMeds reads (4) do not name bupivacaine. The bupivacaine label: “… consciousness should be performed after injection of MARCAINE / MARCAINE WITH EPINEPHRINE solutions.”
Check it at the source: the bupivacaine FDA label on DailyMed (effective April 14, 2026, Hospira, Inc.); the epinephrine FDA label on DailyMed (effective July 13, 2026, A-S Medication Solutions).
What does the bupivacaine label say about epinephrine?
Bupivacaine label, contraindicationsCONTRAINDICATIONS Bupivacaine Hydrochloride Injection/Bupivacaine Hydrochloride and Epinephrine Injection is contraindicated in:
Bupivacaine label, drug interactionsMonoamine Oxidase Inhibitors and Tricyclic Antidepressants: Administration of Bupivacaine Hydrochloride and Epinephrine Injection to patients receiving monoamine oxidase inhibitors or tricyclic antidepressants may produce severe, prolonged hypertension.
Bupivacaine label, warnings and precautionsDose-Related Toxicity: Monitor cardiovascular and respiratory vital signs and patient’s state of consciousness after injection of Bupivacaine Hydrochloride Injection/Bupivacaine Hydrochloride and Epinephrine Injection.
Marcaine Spinal label (Hospira, Inc., June 23, 2026), warnings and precautionsThe majority of reported cases of chondrolysis have involved the shoulder joint; cases of gleno-humeral chondrolysis have been described in pediatric and adult patients following intra-articular infusions of local anesthetics with and without epinephrine for periods of 48 to 72 hours.
Marcaine label (Henry Schein, Inc., June 30, 2026), contraindicationsContraindications MARCAINE / MARCAINE WITH EPINEPHRINE is contraindicated in: •obstetrical paracervical block anesthesia.
Marcaine label (Henry Schein, Inc., June 30, 2026), drug interactionsIf coadministration of other local anesthetics with MARCAINE / MARCAINE WITH EPINEPHRINE cannot be avoided, monitor patients for neurologic and cardiovascular effects related to local anesthetic systemic toxicity [see Dosage and Administration (2.1), Warnings and Precautions (5.2)].
Source: FDA drug label (Marcaine Spinal, NDA018692), Hospira, Inc., effective June 23, 2026 (SPL set 9679cc05-2f8a-4e88-53b5-6e9122c8b8c0), via openFDA
Source: FDA drug label (BUPIVACAINE HYDROCHLORIDE), Hospira, Inc., effective April 14, 2026 (SPL set bb44c7e1-d911-4788-908f-09b7b271969b), via openFDA; the full label on DailyMed
What does the epinephrine label say about bupivacaine?
Epinephrine's label (effective July 13, 2026) and its 3 other brand-application labels do not name bupivacaine in these sections. A label lists what its studies and reports found; it is not a complete list.
Source: FDA drug label (Epinephrine), A-S Medication Solutions, effective July 13, 2026 (SPL set 6e811e28-0199-4df7-a916-5940c632401d), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Bupivacaine | Epinephrine | |
|---|---|---|
| Labeled for | n/a | Asthma |
| Boxed warning | Yes | No |
| Pharmacy cost (NADAC) | $0.086 per mL 0.5% vial | $123.51 per unit 0.15 mg auto-injct |
| Shortage now | In shortage | A presentation being discontinued |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once