Bupivacaine Hydrochloride and XaQuil XR

• Generic Name: bupivacaine
• Dosage Forms: n.a.
• Other Brand Names: Marcaine HCl, Marcaine Spinal, Sensorcaine, Sensorcaine-MPF, Sensorcaine-MPF Spinal, Bupivacaine Fisiopharma, Bupivacaine Spinal, Marcaine, Marcaine Preservative Free, P-Care M, ReadySharp Bupivacaine

Local or regional anesthesia or analgesia in surgical, obstetrical, dental, diagnostic, and therapeutic procedures.

Available as conventional bupivacaine hydrochloride preparations with or without epinephrine or as a liposomal injection containing bupivacaine in an aqueous suspension of multivesicular liposomes (Exparel).

Conventional preparations are used for local infiltration and nerve block techniques including peripheral, sympathetic, epidural (including caudal), retrobulbar, and dental block. Do not use 0.75% concentration for obstetrical anesthesia. (See Boxed Warning.) A hyperbaric solution containing 0.75% bupivacaine hydrochloride in 8.25% dextrose is used for spinal anesthesia.

Liposomal bupivacaine (Exparel) is used for local infiltration or interscalene brachial plexus nerve block to provide postsurgical analgesia; safety and efficacy not established for other nerve blocks. Because of possible differences in physiochemical and functional properties, do not use liposomal bupivacaine interchangeably with other bupivacaine-containing preparations.

Local anesthetics should be used as a component of multimodal analgesia (i.e., simultaneous use of a combination of analgesic drugs and techniques that target different mechanisms) in the management of postoperative pain.

Studies comparing relative efficacy of liposomal bupivacaine and conventional bupivacaine hydrochloride for postsurgical analgesia have shown variable results.

Do not use for obstetric paracervical block.

• Generic Name: l-methylfolate
• Dosage Forms: n.a.
• Other Brand Names: Deplin, L-Methylfolate Formula, XaQuil XR, L-Methylfolate Formula 75

Folate is a form of B vitamin that occurs naturally in many foods. Folic acid is the man-made form of folate that is added to processed foods or vitamin and mineral supplements. Folate is needed in the human body for production of red blood cells.

A lack (deficiency) of folate in the human body can be caused by certain diseases, by taking certain medications, or by not getting enough folate in your diet. Folate deficiency can lead to decreased red blood cells, or anemia. Folate deficiency can also cause high levels of a certain amino acid in the blood, a condition called hyperhomocysteinemia (HYE-per-HOE-moe-sis-tin-EE-mee-a).

XaQuil XR is a medical food for use in people who have conditions related to folate deficiency. This medicine is also used in people with major depressive disorder who have folate deficiency, or in people with schizophrenia who have hyperhomocysteinemia related to folate deficiency.

XaQuil XR is not an antidepressant or anti-psychotic medication. However, this medicine may enhance the effects of antidepressant medications.

XaQuil XR may also be used for purposes not listed in this medication guide.