mivacurium chloride: clinical use

Prescribing considerations

• Administer only by or under an experienced anaesthetist with immediate intubation and ventilation facilities.
• Remember that paralysis does not impair consciousness; adequate anaesthesia or sedation must be maintained.
• Reduced plasma cholinesterase activity can produce intensified or prolonged blockade.
• Use particular caution with asthma or histamine sensitivity, hypovolaemia, burns, neuromuscular disease, cachexia, major acid-base or electrolyte disturbance, and severe renal or hepatic failure.
• Use in neonates and infants younger than 2 months is not recommended because clinical data are limited.

Contraindications and cautions

• Known hypersensitivity to mivacurium
• Known or suspected homozygosity for the atypical plasma cholinesterase gene

Monitoring

• Monitor neuromuscular function with a peripheral nerve stimulator.
• Confirm spontaneous recovery before considering pharmacological reversal.
• Continue airway, ventilation and cardiovascular monitoring until adequate recovery.
• Investigate suspected peri-anaesthetic hypersensitivity, including possible cross-sensitivity with other neuromuscular blockers.

Clinical pharmacology

A short-acting competitive non-depolarising blocker at motor end-plate cholinergic receptors. It is primarily inactivated by enzymatic hydrolysis through plasma cholinesterase; reduced enzyme activity can substantially prolong blockade.

Formulation and product differences

• Preservative-free acidic liquid for intravenous injection or infusion
• Presented in single-use glass ampoules
• Contains hydrochloric acid and water for injections
• Protect from light, do not freeze and avoid mixing with highly alkaline solutions

Injection

Route: Parenteral

Strengths: 2 mg/mL