Mivacurium chloride


Full Generic Medicine Info
Dosage/Direction for Use

Intravenous
Adjunct to general anaesthesia
Adult: Initially, 70-250 mcg/kg. Doses of up to 150 mcg/kg may be given over 5-15 seconds; higher doses must be administered over 30 seconds. Maintenance: 100 mcg/kg at approx 15-minute intervals. Dosage is individualised according to response.
Child: 2-6 months Initially, 150 mcg/kg over 5-15 seconds; 7 months to 12 years Initially, 200 mcg/kg. Maintenance: 2 months to 12 years 100 mcg/kg given every 6-9 minutes. >12 years Same as adult dose. Dosage is individualised according to response.
Elderly: Dose reduction may be necessary.
Max Dosage: 150 mg/kg given over 5-15 sec IV injection, or over 30 sec if higher doses, or 60 sec for asthma and CV patients.
Renal impairment: Dose adjustment may be necessary.
Hepatic impairment: Dose adjustment may be necessary.
Reconstitution: Infusion: May dilute in 5% dextrose for inj, 0.9% NaCl solution or Lactated Ringer's solution to a max concentration of 500 mcg/mL. Doses may also be given undiluted. Dilute immediately before use then administer thereafter.
Incompatibility: Incompatible with highly alkaline solutions having a pH of >8.5 (e.g. barbiturates).

Intravenous
Endotracheal intubation
Adult: Initially, 150 mcg/kg, then 100 mcg/kg given 30 seconds after. Maintenance: 100 mcg/kg at approx 15-minute intervals. Dosage is individualised according to response.
Child: 2-6 months Initially, 150 mcg/kg over 5-15 seconds; 7 months to 12 years Initially, 200 mcg/kg. Maintenance: 2 months to 12 years 100 mcg/kg given every 6-9 minutes. >12 years Same as adult dose. Dosage is individualised according to response.
Elderly: Dose reduction may be necessary.
Renal impairment: Dose adjustment may be necessary.
Hepatic impairment: Dose adjustment may be necessary.
Reconstitution: Infusion: May dilute in 5% dextrose for inj, 0.9% NaCl solution or Lactated Ringer's solution to a max concentration of 500 mcg/mL. Doses may also be given undiluted. Dilute immediately before use then administer thereafter.
Incompatibility: Incompatible with highly alkaline solutions having a pH of >8.5 (e.g. barbiturates).

Intravenous
Maintenance of neuromuscular block
Adult: Infuse at an initial rate of 8-10 mcg/kg/min, adjusted every 3 minutes if needed by increments of 1 mcg/kg/min to a usual rate of 6-7 mcg/kg/min. Dosage is individualised according to response.
Child: 2 months to 12 years Usual rate: 11-14 mcg/kg/min via IV infusion. >12 years Same as adult dose. Dosage is individualised according to response.
Elderly: Dose reduction may be necessary.
Renal impairment: Dose adjustment may be necessary.
Hepatic impairment: Dose adjustment may be necessary.
Reconstitution: Infusion: May dilute in 5% dextrose for inj, 0.9% NaCl solution or Lactated Ringer's solution to a max concentration of 500 mcg/mL. Doses may also be given undiluted. Dilute immediately before use then administer thereafter.
Incompatibility: Incompatible with highly alkaline solutions having a pH of >8.5 (e.g. barbiturates).

Special Populations: Patient with clinically significant CV disease, asthma or those unusually sensitive to falls in arterial blood pressure (e.g. hypovolaemic): Initial doses must be administered over 60 seconds. Burn injury patients (≥20% of total BSA): Dose adjustment may be necessary. Administer a test dose of 15-20 mcg/kg, followed by appropriate dosing guided by monitoring of block with a nerve stimulator. Obese patients (weighing ≥30% of their ideal body weight): Dose must be based on the ideal body weight. Pharmacogenomics: Mivacurium chloride is metabolised by plasma cholinesterase. Patients with genetic variation of plasma cholinesterase may have reduced plasma cholinesterase activity. Individuals who are known or suspected of being homozygous for the atypical plasma cholinesterase gene (BCHE) are extremely sensitive to the neuromuscular blocking effect of mivacurium chloride. FDA drug label recommends great caution during the administration of mivacurium chloride due to risk of prolonged neuromuscular block.
Contraindications
Patients known or suspected to be homozygous for the atypical plasma cholinesterase gene.
Special Precautions
Patient with previous anaphylactic reaction to other neuromuscular blockers; clinically significant CV disease; conditions that may antagonise neuromuscular blockade (e.g. hypercalcaemia, respiratory alkalosis, peripheral neuropathies, demyelinating lesions, denervation, muscle trauma); conditions that may diminish plasma cholinesterase activity (e.g. anaemia, myxoedema, collagen diseases, peptic ulcer); conditions that may potentiate neuromuscular blockade (e.g. myasthenia gravis, neuromuscular disease, metabolic or respiratory acidosis, electrolyte abnormalities, Eaton-Lambert syndrome); asthma, hypovolaemia. Burn injury, obese or immobilised patients. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation. Monitoring Parameters Monitor vital signs (e.g. blood pressure, heart and respiratory rate); degree of muscle paralysis (e.g. ventilator asynchrony, shivering, presence of spontaneous movement).
Adverse Reactions
Significant: Bradycardia, neuromuscular cross-sensitivity. Cardiac disorders: Transient tachycardia. General disorders and administration site conditions: Inj site reactions. Musculoskeletal and connective tissue disorders: Muscle spasms. Nervous system disorders: Dizziness. Respiratory, thoracic and mediastinal disorders: Bronchospasm, wheezing. Skin and subcutaneous tissue disorders: Erythema, urticaria, rash. Vascular disorders: Flushing, hypotension.
Potentially Fatal: Severe anaphylactic reactions.
Overdosage
Symptoms: Prolonged muscle paralysis, and hypotension. Treatment: Maintain a patent airway and assisted positive ventilation until spontaneous respiration is adequate. Provide full sedation since consciousness is not impaired. Once evidence of spontaneous respiration is present, administer anticholinesterase agents (e.g. neostigmine) with an anticholinergic agent (e.g. atropine, glycopyrrolate) to hasten recovery. Provide CV support by proper positioning and administration of fluids or vasopressors as needed.
Drug Interactions
Increased neuromuscular blocking effects with inhalational anaesthetics (e.g. enflurane, isoflurane, sevoflurane, halothane), antibiotics (e.g. aminoglycosides, polymyxin, tetracyclines, clindamycin), antiarrhythmics (e.g. quinidine, lidocaine, Ca channel blockers), diuretics (e.g. furosemide, acetazolamide), ganglion blocking agents (e.g. hexamethonium, trimetaphan), Mg salts, ketamine, and lithium salts. Prolonged neuromuscular blocking effects with antimitotic drugs, MAOIs, organophosphates, anticholinesterases, bambuterol, SSRIs. May result in a prolonged and complex block with depolarising relaxant (e.g. suxamethonium chloride).
Action
Mivacurium chloride is a short-acting non-depolarising neuromuscular blocker which inhibits skeletal muscle contractile activity by antagonising acetylcholine. It competitively binds to cholinergic receptors on motor endplates in skeletal muscles leading to muscle paralysis.
Onset: Neuromuscular blockade (dose-dependent): 1.5-3 minutes (adults); 1.5 minutes slower (elderly); child (faster than adults).
Duration: 15-20 minutes (dose-dependent).
Absorption: Time to peak plasma concentration: 2.3-4.9 minutes.
Distribution: Volume of distribution: 147-274 mL/kg.
Metabolism: Undergoes enzymatic hydrolysis by plasma cholinesterase to form inactive metabolites.
Excretion: Via urine (approx 7% as unchanged drug); bile. Elimination half-life: Approx 2 minutes.
Storage
Intravenous: Store below 25°C. Do not freeze. Protect from light. Storage requirement may vary between individual products (refer to detailed product guideline).
CIMS Class
Neuromuscular Disorder Drugs
ATC Classification
M03AC10 - mivacurium chloride ; Belongs to the class of other quaternary ammonium-containing agents used as peripherally-acting muscle relaxants.
Disclaimer: This information is independently developed by CIMS based on mivacurium chloride from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2023 CIMS. All rights reserved. Powered by CIMSAsia.com
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