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Zynrelef
bupivacaine/ meloxicam
Black Box Warnings .
Cardiovascular Thrombotic Event
NSAIDs incr. risk of serious and potentially fatal cardiovascular thrombotic events, incl. MI and stroke; risk may occur early in tx and may incr. w/ duration of use; contraindicated in CABG periop setting
GI Bleeding, Ulceration, and Perforation
NSAIDs incr. risk of serious and potentially fatal GI adverse events incl. bleeding, ulcer, and stomach or intestine perforation; GI events may occur at any time during use and w/o warning sx; elderly pts and pts w/ hx of PUD or GI bleeding at greater risk for serious GI events
Adult Dosing .
Dosage forms: ER SOL: 60 mg/1.8 mg per 2.3 mL, 200 mg/6 mg per 7 mL, 300 mg/9 mg per 10.5 mL, 400 mg/12 mg per 14 mL
pain, postop
- [foot or ankle procedures]
- Dose: instill up to 2.3 mL into surgical site x1; Info: use lowest effective dose; consider lower dose in CYP2C9 poor metabolizers
- [total joint arthroplasty procedures]
- Dose: instill up to 14 mL into surgical site x1; Info: use lowest effective dose; consider lower dose in CYP2C9 poor metabolizers
- [spinal procedures, 1- to 3-level]
- Dose: instill up to 7 mL into surgical site x1; Info: use lowest effective dose; consider lower dose in CYP2C9 poor metabolizers
- [soft tissue procedures]
- Dose: instill up to 10.5-14 mL into surgical site x1; Info: use lowest effective dose; consider lower dose in CYP2C9 poor metabolizers
renal dosing
- [see below]
- mild-moderate impairment: consider decr. usual dose; severe impairment: avoid use; advanced renal dz: avoid use
- HD/PD: avoid use
hepatic dosing
- [see below]
- mild-moderate impairment: no adjustment; severe impairment: not defined, caution advised
Peds Dosing .
Peds dosing is currently unavailable or not applicable for this drug.