MIVACURIUM CHLORIDE

MIVACURIUM CHLORIDE
(miv-a-cur'i-um)
Mivacron
Classifications: skeletal muscle relaxant, nondepolarizing; Therpeutic: skeletal muscle relaxant, nondepolarizing
Prototype: Atracurium
Pregnancy Category: C

Availability

2 mg/mL injection

Action

Short-acting, skeletal muscle relaxant that combines competitively to cholinergic receptors on the motor neuron end-plate. Antagonizes action of acetylcholine, and blocks neuromuscular transmission. Neuromuscular blocking action is readily reversible with an anticholinesterase agent.

Therapeutic Effect

Blocks nerve impulse transmission, which results in skeletal muscle relaxation and paralysis.

Uses

Adjunct to general anesthesia, to facilitate tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Contraindications

Allergic reactions to mivacurium or its ingredients; neonates; pregancy (category C).

Cautious Use

Kidney function impairment, liver function impairment; older adult patients; pulmonary disease, COPD; lactation.

Route & Dosage

Tracheal Intubation and Mechanical Ventilation
Adult: IV Loading Dose 0.15–0.25 mg/kg given over 5–15 sec (over 60 sec in patients with cardiovascular disease) IV Maintenance Dose 0.1 mg/kg generally q15min IV Continuous Infusion Initial infusion of 9–10 mcg/kg/min, then 6–7 mcg/kg/min
Child: IV Loading Dose 2–12 y, 0.2 mg/kg given over 5–15 sec (range: 0.09–0.2 mg/kg) then 14 mcg/kg/min

Obesity
Use IBW.

Renal Impairment
Decrease infusion rates by up to 50%.

Hepatic Impairment
May decrease infusing rate up to 50%.

Administration

Intravenous

PREPARE: Direct/Continuous: Add 3 mL of D5W, NS, D5/NS, RL, or D5/RL to each 1 mL mivacurium to yield 0.5 mg/mL.  

ADMINISTER: Direct Loading Dose: Give over 5–15 sec (60 sec for those with CV disease).  Continuous: Give at the rate determined by weight. Refer to manufacturer's infusion rate tables.  

  • Store diluted solution at 5°–25° C (41°–77° F) for up to 24 h.

Adverse Effects (≥1%)

CV: Transient decrease in arterial BP, hypotension, increases and decreases in heart rate. Skin: Transient flushing about the face, neck, and/or chest (especially with rapid administration).

Interactions

Drug: general anesthetics may enhance the degree of neuromuscular blockade produced by mivacurium. aminoglycosides, tetracyclines, bacitracin, polymyxins, lincomycin, clindamycin, colistin, magnesium salts, lithium, local anesthetics, procainamide, and quinidine may enhance the neuromuscular blockade.

Pharmacokinetics

Peak: 2–6 min. Duration: 25–30 min in adults, 8–16 min in children. Distribution: Limited tissue distribution. Metabolism: Rapidly hydrolyzed by plasma cholinesterase.

Nursing Implications

Assessment & Drug Effects

  • Assess patients with neuromuscular disease carefully and adjust drug dosage using a peripheral nerve stimulator when they experience prolonged neuromuscular blocks.
  • Monitor hemodynamic status carefully in patients with significant cardiovascular disease or those with potentially greater sensitivity to release of histamine-type mediators (e.g., asthma).
  • Monitor for significant drop in BP because overdose may increase the risk of hemodynamic adverse effects.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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