Ropivacaine

NAROPIN

Open Ropivacaine in the interactive console ↗

Ropivacaine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Ropivacaine ballicule

What it isLong-acting amide local anesthetic that blocks voltage-gated sodium channels; used for epidural, peripheral nerve, and local infiltration anesthesia.

Why this oneProvides prolonged sensory block with less motor block and less cardiotoxicity than comparable bupivacaine concentrations.

What limits itIntravascular injection or excessive dose causes local-anesthetic systemic toxicity; inject incrementally with aspiration and cardiorespiratory monitoring.

Ropivacaine molecular structure (skeletal formula) — Molecular structure: Ropivacaine

FDA-approved for

local/regional anesthesia (1996)

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
Surgical anesthesia (epidural, major nerve block, field block)	Adults	0.5–1% (5–10 mg/mL) per block	—	Per block; e.g. epidural up to ~200 mg
Labor analgesia / acute postoperative pain (epidural infusion)	Adults	0.2% (2 mg/mL)	—	Continuous epidural up to 28 mg/hr

Renal Undefined

Hepatic Undefined

Dose varies by block type, site, and patient status; consult the block-specific dosage table.

Instructions

Use the smallest effective dose and concentration; use fractional/incremental dosing
Give an epinephrine-containing test dose before inducing complete block
Single-dose, preservative-free; discard unused solution
Not approved for intra-articular infusion (risk of chondrolysis)

Available strengths

inj 2, 5, 7.5, 10 mg/mL

Cautions

CNS and cardiovascular toxicity from excessive plasma levels or inadvertent intravascular injection (arrhythmia, cardiac arrest)
Chondrolysis with intra-articular infusion
Methemoglobinemia
Caution in debilitated, elderly, or hepatic/renal impairment

Adverse reactions

Hypotension
Nausea
Vomiting
Bradycardia
Back pain
Fever
Headache

Pregnancy No human data; crosses the placenta and can cause fetal/neonatal toxicity when used in labor.

Lactation Present in human milk at low levels; no adverse reactions reported in breastfed infants.

Cost

Ropivacaine (NAROPIN)

Strength		#/mo	CostPlus
2 mg/mL	inj	per unit	not offered
5 mg/mL	inj	per unit	not offered
7.5 mg/mL	inj	per unit	not offered
10 mg/mL	inj	per unit	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Ropivacaine is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal risklocal-anesthetic systemic toxicity from inadvertent intravascular injection

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability1 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk1 / 4

Legacy pregnancy categoryB

Defining liabilitySystemic local-anesthetic toxicity and cardiovascular collapse

Open Ropivacaine in the interactive console ↗