Mivacurium chloride


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Adjunct to general anesth Initial: 70-250 mcg/kg via inj. Maintenance: 100 mcg/kg at 15-min intervals. Patients w/ asthma/CV disease: ≤150 mcg/kg. Endotracheal intubation Initial: 150 mcg/kg, then 100 mcg/kg 30 sec later. Maintenance of neuromuscular block Infuse 8-10 mcg/kg/min, adjusted every 3 mins, if needed, up to a usual rate of 6-7 mcg/kg/min.
Dosage Details
Intravenous
Adjunct to general anaesthesia
Adult: Initially, 70-250 mcg/kg by IV inj. Up to 150 mcg/kg may be given over 5-15 sec; give higher doses over 30 sec. Maintenance: 100 mcg/kg at 15-min intervals. Patients with asthma/CV disease: ≤150 mcg/kg over 60 sec.
Child: 2-6 mth: Initially, 150 mcg/kg; 7 mth-12 yr: Initially, 200 mcg/kg. Maintenance: 2 mth-12 yr: 100 mcg/kg every 6-9 min.
Elderly: Dose reduction may be required.

Intravenous
Maintenance of neuromuscular block
Adult: Infuse at a 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.
Child: 2 mth-12 yr: 11-14 mcg/kg/min by IV infusion.
Elderly: Dose reduction may be required.

Intravenous
Endotracheal intubation
Adult: Initially, 150 mcg/kg, then 100 mcg/kg 30 sec after.
Child: 2-12 yr: 200 mcg/kg over 5-15 sec.
Elderly: Dose reduction may be required.
Special Patient Group
Obese patients: Determine initial dose using patient's ideal wt. Burn patients: Give a test dose of 15-20 mcg/kg; adjust dose guided by a neuromuscular block monitor.
Renal Impairment
Dose reduction may be required.
Hepatic Impairment
Dose reduction may be required.
Reconstitution
Intravenous:
Maintenance of neuromuscular block: Dilute in 5% dextrose for inj to a max concentration of 0.5 mg/ml.
Incompatibility
Intravenous:
Maintenance of neuromuscular block: May be incompatible with alkaline solutions with pH >8.5 (e.g. barbiturate solutions).
Contraindications
Patients known or suspected to be homozygous for the atypical plasma cholinesterase gene.
Special Precautions
Clinically significant CV disease. Any history of greater sensitivity to the release of histamine or related mediators (e.g. asthma); assure adequate hydration and carefully monitor haemodynamic status. Obese patients. Neuromuscular diseases (e.g. myasthenia gravis and the myasthenic syndrome). Burn patients. Fluid and electrolyte abnormalities. Renal or hepatic impairment. Reduced plasma cholinesterase activity. Pregnancy and lactation.
Adverse Reactions
Cutaneous flushing, mild hypotension, moderate wheezing; tachycardia, bradycardia, phlebitis; bronchospasm, hypoxaemia; rash, inj site reaction; dizziness; prolonged drug effect; muscle spasms.
Potentially Fatal: Anaphylactoid reactions, cardiac arrhythmias.
Overdosage
Symptoms: Prolonged neuromuscular block. Hypotension may occur. Treatment: Maintain a patent airway and control ventilation until recovery of normal neuromuscular function. Further recovery may be facilitated by use of an anticholinesterase agent (e.g. neostigmine, edrophonium) in combination with an appropriate anticholinergic agent. Provide CV support by proper positioning of the patient, fluid and/or vasopressor agent admin.
Drug Interactions
Effects may be increasead by aminoglycosides, clindamycin, calcium-channel blockers, colistin, enflurane, halothane, isoflurane, potassium-depleting diuretics, ketamine, lidocaine, sodium colistimethate, magnesium salts, polymyxin B, procainamide, quinidine, tetracyclines, opioid analgesics, suxamethonium, vancomycin. Effect may be reduced by carbamazepine, phenytoin (chronic use), corticosteroids, calcium and theophylline.
Action
Description: Mivacurium chloride, a short-acting non-depolarising neuromuscular blocker, inhibits muscle's contractile activity by antagonising acetylcholine. It binds competitively to cholinergic sites on motor endplates in skeletal muscles leading to muscle paralysis.
Onset: 1.5-2.5 min (IV inj).
Duration: 10-20 min (IV inj).
Pharmacokinetics:
Metabolism: Enzymatic hydrolysis by plasma cholinesterase.
Excretion: Via urine and bile.
Storage
Store at room temperature.
Disclaimer: This information is independently developed by MIMS 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 MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS 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 © 2020 MIMS. All rights reserved. Powered by MIMS.com
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