Mivacurium Chloride

Trade Names:
Mivacron
- Injection 0.5 mg/mL
- Injection 2 mg/mL

Mechanism of Action

Pharmacology

Binds competitively to cholinergic receptors on motor end-plate to antagonize action of acetylcholine, resulting in block of neuromuscular transmission.

Pharmacokinetics

Distribution

Mean Vd's are 0.15 (trans-trans isomer), 0.27 (cis-trans isomer), and 0.31 min (cis-cis isomer).

Metabolism

Rapid hydrolysis by plasma cholinesterase.

Elimination

Mean t _½ is 2.3 min (trans-trans isomer), 2.1 min (cis-trans isomer), and 55 min (cis-cis isomer). Mean plasma clearance is 53 (trans-trans isomer), 99 (cis-trans isomer), and 4.2 mL/nim/kg (cis-cis isomer).

Peak

Time to peak effect is 2.3 to 4.9 min (dose dependent).

Duration

95% recovery; 21 to 34 min (dose dependent).

Special Populations

Increased duration of action and decreased clearance.

Increased duration of action and decreased clearance.

Increased duration of action and decreased clearance.

Indications and Usage

Adjunct to general anesthesia; facilitation of tracheal intubation.

Contraindications

Hypersensitivity to mivacurium or similar agents; use of multidose vials in benzyl alcohol-sensitive patients.

Dosage and Administration

IV 0.15 mg/kg over 5 to 15 sec.

IV 0.1 mg/kg q 15 min prn or 9 to 10 mcg/kg/min infusion initially followed by titration (range 1 to 15 mg/kg/min).

IV 0.2 mg/kg over 5 to 15 sec.

IV 14 mcg/kg/min infusion initially followed by titration (range 5 to 31 mcg/kg/min).

Storage/Stability

Store injection and premixed injection at controlled room temperature (59° to 86°F). Protect from freezing and direct UV light.

Drug Interactions

Action of mivacurium potentiated.

Action of mivacurium may be decreased or reversed.

Shortened action of mivacurium and decreased effectiveness.

Dose-dependent reversal of neuromuscular blockade.

Prolonged apnea.

Enhanced action of mivacurium (eg, respiratory depression).

Incompatibility

Alkaline solutions (pH more than 8.5).

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Flushing; hypotension; tachycardia; bradycardia; arrhythmia; phlebitis.

Dermatologic

Rash; urticaria; erythema; injection site reaction.

Respiratory

Bronchospasm; wheezing; hypoxemia.

Miscellaneous

Dizziness; muscle spasms.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy in children younger than 2 yr not established.

Elderly

Neuromuscular blockade may be longer.

Renal Function

Duration of action is longer; use lower maintenance doses.

Hepatic Function

Duration of action is longer; use lower maintenance doses.

Cachectic or debilitated patients, patients with neuromuscular disease, burns

Use test dose of no more than 0.015 to 0.02 mg/kg.

CV disease or allergy/sensitivity (eg, asthma)

Administer initial dose of no more than 0.15 mg/kg over 60 sec.

Obese patients

Use ideal body weight to determine initial dose.

Reduced plasma cholinesterase activity

Use drug with great caution, if at all.

Overdosage

Symptoms

Flaccid paralysis, apnea, hypotension.

Patient Information

• Explain that drug will be administered while patient is unconscious.
• Advise patient that dizziness or muscle spasms sometimes occur during recovery.

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