Mivacurium Chloride

Registered South African indications:

• Muscle relaxant

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Patients known or suspected of being homozygous for the atypical plasma cholinesterase gene

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Severe hepatic impairment
• Elderly
• Puerperium 
• Genetically determined abnormalities of plasma cholinesterase
• Tetanus
• Tuberculosis 
• Severe or chronic infections
• Chronic debilitating disease
• Malignancy
• Chronic anaemia 
• Malnutrition
• Myxoedema 
• Collagen diseases
• Decompensated cardiac disease
• Peptic ulcer
• Burns 
• Heterozygous for the atypical plasma cholinesterase gene
• Following plasma exchange, plasmapheresis or cardiopulmonary bypass
• Neonates and infants < 2 months 
• Myasthenia gravis
• Asthma
• Hypovolaemia
• Neuromuscular disease
• Cachectic patients
• Severe acid-base or electrolyte abnormalities
• Malignant hyperthermia-susceptible patients
• Mechanical ventilation in the intensive care unit

Forms avail. in SA and covered in this monograph: inj

Endotracheal intubation

• IV: 0.07-0.25mg/kg, bolus given over 5-15sec

Takes effect in 2.5min

Maintenance of muscle relaxation for surgical procedures

• IV: 0.1mg/kg, bolus given over 5-15sec, will last 15min
  OR
• IV: 8-10μg/kg/min as a continuous infusion; Adjust by 1μg/kg/min increments at 3min intervals

Do not mix in the same syringe or administer simultaneously through the same needle as highly alkaline solutions

Paed. forms avail. in SA and covered in this monograph: inj

Endotracheal intubation

Younger than 2 years

• Not established for use

Between 2-12 years

• IV: 0.1-0.2mg/kg, bolus given over 5-15sec

Older than 12 years

• See adult dosage

Takes effect in 2.5min

Maintenance of muscle relaxation for surgical procedures

Younger than 2 years

• Not established for use

Between 2-12 years

• IV: Initial: 0.1mg/kg, bolus given over 5-15sec, will last 6-7min
  OR
• IV: 10-15μg/kg/min as continuous infusion

Older than 12 years

• See adult dosage

Do not mix in the same syringe or administer simultaneously through the same needle as highly alkaline solutions

Pregnancy

• FDA Pregnancy Category C

Breastfeeding

• Caution

Renal Impairment

• Caution; dose adjustment recommended

Hepatic Impairment

• Severe: Caution; dose adjustment recommended

Elderly            

• Caution; dose adjustment recommended

Cardiovascular Disorders

• Transient tachycardia
• Flushing
• Hypotension

Respiratory Disorders

• Bronchospasm

Skin and Subcutaneous Tissue Disorders

• Erythema
• Urticaria
• Skin flushing

Immune, Blood and Lymphatic System Disorders

• Severe anaphylactic reaction

• Inhalational anaesthetics 
• Antibiotics
• Antiarrhythmic agents
• Diuretics
• Magnesium salts
• Ketamine
• Lithium salts
• Ganglion blocking agents
• Anti-mitotic agents
• Monoamine oxidase inhibitors
• Ecothiophate iodine
• Pancuronium
• Organophosphates
• Anticholinesterases
• Hormones
• Bambuterol 
• Selective serotonin reuptake inhibitors
• Beta blockers 
• Antirheumatic agents
• Trimetaphan
• Chlorpromazine
• Steroids
• Phenytoin
• Suxamethonium chloride 

None routine

Mivacurium is a short-acting, non-depolarising, neuromuscular blocking agent. The termination of the neuromuscular blocking action of mivacurium is mainly dependent on hydrolysis by plasma pseudocholinesterase.

Injection (per ml) 2mg

• Mivacron (Pharmacare) originator