Formulary
Mivacurium: Indications, Dosing, Side Effects and Interactions
Mivacurium clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Mivacurium: Indications, Dosing, Side Effects and Interactions
Mivacurium clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Neuromuscular blockade (short duration) during surgery for mivacurium**
- **Child 2-5 months** (Initially by intravenous injection): Initially 150 micrograms/kg, then (by intravenous injection) 100 micrograms/kg every 6-9 minutes as required, alternatively (by intravenous infusion) 8-10 micrograms/kg/minute, (by intravenous infusion) adjusted in steps of 1 microgram/kg/minute every 3 minutes if required; (by intravenous infusion) usual dose 11-14 micrograms/kg/minute.
- **Child 6 months-11 years** (Initially by intravenous injection): Initially 200 micrograms/kg, then (by intravenous injection) 100 micrograms/kg every 6-9 minutes as required, alternatively (by intravenous infusion) 8-10 micrograms/kg/minute, (by intravenous infusion) adjusted in steps of 1 microgram/kg/minute every 3 minutes if required; (by intravenous infusion) usual dose 11-14 micrograms/kg/minute.
- **Child 12-17 years** (Initially by intravenous injection): Initially 70-250 micrograms/kg, then (by intravenous injection) 100 micrograms/kg every 15 minutes as required, alternatively (by intravenous infusion) 8-10 micrograms/kg/minute, (by intravenous infusion) adjusted in steps of 1 microgram/kg/minute every 3 minutes if required; (by intravenous infusion) usual dose 6-7 micrograms/kg/minute.
Cautions
For all non-depolarising neuromuscular blocking drugs Burns (resistance can develop, increased doses may be required); cardiovascular disease (reduce rate of administration); electrolyte disturbances (response unpredictable); fluid disturbances (response unpredictable); hypothermia (activity prolonged, lower doses required); myasthenia gravis (activity prolonged, lower doses required); neuromuscular disorders (response unpredictable) Cautions For mivacurium Burns (low plasma cholinesterase activity; dose titration required); elderly
Side effects
For all non-depolarising neuromuscular blocking drugs Common or very common Flushing; hypotension Uncommon Bronchospasm; hypersensitivity; skin reactions; tachycardia Rare or very rare Circulatory collapse; muscle weakness (after prolonged use in intensive care); myopathy (after prolonged use in intensive care); shock
Interactions
**Severe interactions:**
- Neuromuscular Blockers SSRIs may reduce plasma cholinesterase activity resulting in a prolongation of the neuromuscular blocking action of mivacurium and suxamethonium Fosamprenavir/ritonavir:...
**Other interactions (4):**
- Mivacurium and suxamethonium Metoclopramide injection may prolong the duration of neuromuscular block (through inhibition of plasma cholinesterase).
- Brevibloc moderately prolonged the clinical duration (18.6%) and recovery index (6.7%) of mivacurium.
- Although the interactions observed in studies of warfarin, digoxin, morphine, suxamethonium chloride or mivacurium are not of major clinical importance, Brevibloc should be titrated with caution in...
- Neuromuscular Blockers SSRIs may reduce plasma cholinesterase activity resulting in a prolongation of the neuromuscular blocking action of mivacurium or other neuromuscular blockers.
Pregnancy
For all non-depolarising neuromuscular blocking drugs Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts.
Breast feeding
For all non-depolarising neuromuscular blocking drugs Non-depolarising neuromuscular blocking drugs are ionised at physiological pH and are unlikely to be present in milk in significant amounts. Breast-feeding may be resumed once the mother has recovered from neuromuscular block.
Hepatic impairment
Manufacturer advises caution in hepatic failure (increased duration of action). Dose adjustments Manufacturer advises dose reduction in hepatic failure.
Renal impairment
Use with caution. M Dose adjustments Reduce dose according to response in end-stage renal disease (clinical effect prolonged). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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