Drug reference

Mivacurium

Neuromuscular Blocker · Muscle relaxant for anaesthesia

Neuromuscular BlockerMuscle relaxant for anaesthesia

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Mildly prolonged maternal neuromuscular

FDA category + note

Top interactionssee all 12 →

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Mechanism

Mivacurium is a non-depolarizing neuromuscular blocking drug of the benzylisoquinolinium group. It competitively antagonizes acetylcholine for receptor sites at the neuromuscular junction, specifically at the motor end plate of skeletal muscle fibers. This blockade prevents muscle contraction, leading to muscle relaxation.

Indications

Muscle relaxation for surgery in conjunction with general anaestheticsRelaxation of muscles of the abdomen and diaphragmRelaxation of vocal cords to allow passage of a tracheal tubeFacilitation of mechanical ventilationAdjuvant in surgical anesthesia to obtain relaxation of skeletal muscleelectroconvulsive therapy (alternative to succinylcholine)

Dosing

Adult: although duration of action is dose-dependent. Drugs with a shorter or intermediate duration of action, such as atracurium besilate and vecuronium bromide p. 1409, are more widely used than those with a longer duration of action, such as pancuronium bromide.…
Pediatric: Commonly administered for short procedures where only a single intubating dose is required

Pharmacokinetics

Onset

2–3 min

Duration

Short-acting (15 – 30 minutes), dose-dependent

Bioavailability

Poorly absorbed from the GI tract

Metabolism

Ester hydrolysis by Butyrylcholinesterase (BCHE)

Excretion

Hydrolysis by plasma cholinesterases

Contraindications

Use with caution in patients with renal or hepatic insufficiency

Side effects

Common

dose and speed of injection related transient cutaneous flushing (due to histamine release)fall in BP (possible)minimal change in HR

Serious

Prolonged muscle paralysis (in individuals with Butyrylcholinesterase (BCHE) polymorphism who are poor metabolizers)
Can cause histamine release
Prolonged apnea in patients with atypical plasma cholinesterase
prolonged paralysis in pseudocholinesterase deficiency