Mivacurium Brand Name– Mivacron
What is Mivacurium
Mivacurium is a parenteral, short-acting, nondepolarizing, neuromuscular blocking agent (NMBA) indicated as an adjunct to general anesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.
Mivacurium undergoes hydrolysis via plasma cholinesterase similar to succinylcholine but at only 88% the rate; this results in a clinical duration of approximately twice as long as succinylcholine.
Conditions associated with altered plasma cholinesterase activity (e.g., cholinesterase deficiency) will prolong the effects of mivacurium.
Like several other benzylisoquinolinium NMBAs, large bolus doses of mivacurium have been reported to cause histamine release and transient decreases in blood pressure.
Indications
- endotracheal intubation
- neuromuscular blockade during mechanical ventilation
- neuromuscular blockade during surgery
Side Effects
- acute quadriplegic myopathy syndrome
- anaphylactoid reactions
- angioedema
- anxiety
- apnea
- bradycardia
- bronchospasm
- conjunctivitis
- dizziness
- dyspnea
- erythema
- flushing
- hypotension
- hypoxia
- injection site reaction
- keratitis
- malignant hyperthermia
- muscle cramps
- muscle paralysis
- myopathy
- phlebitis
- pruritus
- rash
- respiratory depression
- sinus tachycardia
- skin erosion
- skin ulcer
- thrombosis
- tolerance
- urticaria
- weakness
- wheezing
- xerophthalmia
Monitoring Parameters
- peripheral nerve stimulation
Contraindications
- accidental exposure
- acid/base imbalance
- adrenal insufficiency
- anemia
- asthma
- breast-feeding
- burns
- cardiac disease
- cholinesterase inhibitor toxicity
- chronic lung disease (CLD)
- chronic obstructive pulmonary disease (COPD)
- corticosteroid therapy
- dehydration
- electrolyte imbalance
- geriatric
- hepatic disease
- hypercalcemia
- hypermagnesemia
- hypocalcemia
- hypokalemia
- hypothermia
- infection
- labor
- malignant hyperthermia
- metabolic acidosis
- metabolic alkalosis
- myasthenia gravis
- myxedema
- neuromuscular blocking agent hypersensitivity
- neuromuscular disease
- obesity
- obstetric delivery
- peptic ulcer disease
- pregnancy
- pseudocholinesterase deficiency
- pulmonary disease
- renal disease
- renal failure
- renal impairment
- requires a specialized care setting
- requires an experienced clinician
- respiratory acidosis
- respiratory alkalosis
Interactions
- Acebutolol
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Amide local anesthetics
- Aminoglycosides
- Amlodipine
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amphotericin B
- Amphotericin B cholesteryl sulfate complex (ABCD)
- Amphotericin B lipid complex (ABLC)
- Amphotericin B liposomal (LAmB)
- Atenolol
- Atenolol; Chlorthalidone
- Bacitracin
- Bendroflumethiazide; Nadolol
- Beta-blockers
- Betaxolol
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Botulinum Toxins
- Brimonidine; Timolol
- Calcium
- Calcium Acetate
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Calcium Chloride
- Calcium Gluconate
- Calcium-channel blockers
- Calcium; Vitamin D
- Capreomycin
- Carbonic anhydrase inhibitors
- Carteolol
- Carvedilol
- Chromium
- Clevidipine
- Colistimethate, Colistin, Polymyxin E
- Corticosteroids
- Cyclophosphamide
- Cyclosporine
- Demeclocycline
- Desflurane
- Dextromethorphan; Quinidine
- Diltiazem
- Donepezil
- Donepezil; Memantine
- Dorzolamide; Timolol
- Doxycycline
- Enalapril; Felodipine
- Enflurane
- Esmolol
- Ester local anesthetics
- Felodipine
- Fosphenytoin
- Galantamine
- Hetastarch; Dextrose; Electrolytes
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Indapamide
- Irinotecan
- Irinotecan Liposomal
- Isoflurane
- Isradipine
- Ketorolac
- Labetalol
- Levobetaxolol
- Levobunolol
- Lincosamides
- Lithium
- Loop diuretics
- Magnesium
- Metoclopramide
- Metoprolol
- Minocycline
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Neostigmine
- Nicardipine
- Nifedipine
- Nimodipine
- Nisoldipine
- Omadacycline
- Oral Contraceptives
- Penbutolol
- Perindopril; Amlodipine
- Phenelzine
- Phenytoin
- Physostigmine
- Pindolol
- Piperacillin
- Piperacillin; Tazobactam
- Polymyxin B
- Polymyxins
- Procainamide
- Propranolol
- Pyridostigmine
- Quinidine
- Quinine
- Ranitidine
- Rivastigmine
- Sarecycline
- Sevoflurane
- Sotalol
- Succinylcholine
- Tetracycline
- Tetracyclines
- Theophylline, Aminophylline
- Thiazide diuretics
- Thiotepa
- Timolol
- Trandolapril; Verapamil
- Vancomycin
- Verapamil
