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Anti-arrhythmic drugs: Local anaesthetics of the amide type, such as bupivacaine, should be used with caution in patients receiving other local anaesthetics or agents structurally related to amide-type local anaesthetics e.g. certain antiarrhythmic drugs such as mexiletine and lignocaine, since potentiation of cardiac effects may occur. Specific interaction studies with bupivacaine and anti-arrhythmic drugs class III (e.g. amiodarone) have not been performed, but caution should be advised (see Precautions).
Alkaline solutions: The solubility of bupivacaine is limited at pH >6.5. This must be taken into consideration when alkaline solutions, i.e., carbonates, are added since precipitation might occur.
