No

Neuromuscular Blocker Agent, Nondepolarizing

Short-acting nondepolarizing neuromuscular blocking agent; an adjunct to general anesthesia; facilitates endotracheal intubation; provides skeletal muscle relaxation during surgery or mechanical ventilation

C

Hypersensitivity to mivacurium chloride or other benzylisoquinolinium agents; pre-existing tachycardia

>10%: Cardiovascular: Flushing of face

1% to 10%: Cardiovascular: Hypotension

<1%: Bradycardia, tachycardia, dizziness, cutaneous erythema, rash, injection site reaction, muscle spasms, bronchospasm, wheezing, hypoxemia, endogenous histamine release

Prolonged neuromuscular blockade: Inhaled anesthetics; local anesthetics; calcium channel blockers; antiarrhythmics (eg, quinidine or procainamide); antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin); immunosuppressants (eg, cyclosporine)

Store at room temperature (15°C to 25°C/59°F to 77°F)

Protect from direct ultraviolet light

Mivacurium is a short-acting, nondepolarizing, neuromuscular-blocking agent. Like other nondepolarizing drugs, mivacurium antagonizes acetylcholine by competitively binding to cholinergic sites on motor endplates in skeletal muscle. This inhibits contractile activity in skeletal muscle leading to muscle paralysis. This effect is reversible with cholinesterase inhibitors such as edrophonium, neostigmine, and physostigmine.

Onset of neuromuscular blockade effect: I.V.: Within 2-3 minutes

Peak effect: 1.5-8 minutes

Duration of action: Short due to rapid hydrolysis by plasma cholinesterases; recovery from muscular paralysis occurs within 15-30 minutes

Continuous infusion requires an infusion pump; dose should be based on ideal body weight

Adults: Initial: I.V.: 0.15 mg/kg bolus; for prolonged neuromuscular block, infusions of 1-15 mcg/kg/minute are used

Dosing adjustment in renal impairment: 150 mcg/kg I.V. bolus; duration of action of blockade: 1.5 times longer in ESRD, may decrease infusion rates by as much as 50%, dependent on degree of renal impairment

Dosing adjustment in hepatic impairment: 150 mcg/kg I.V. bolus; duration of blockade: 3 times longer in ESLD, may decrease rate of infusion by as much as 50% in ESLD, dependent on the degree of impairment

Children require higher mivacurium infusion rates than adults; during opioid/nitrous oxide/oxygen anesthesia, the infusion rate required to maintain 89% to 99% neuromuscular block averages 14 mcg/kg/minute (range: 5-31). For adults and children, the amount of infusion solution required per hour depends upon the clinical requirements of the patient, the concentration of mivacurium in the infusion solution, and the patient's weight. The contribution of the infusion solution to the fluid requirements of the patient must be considered. The following tables provide guidelines for delivery in mL/hour (equivalent to microdrops/minute when 60 microdrops = 1 mL) of mivacurium premixed infusion (0.5 mg/mL) and of mivacurium injection (2 mg/mL).

For a 10 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 5 mL/hour

To deliver 5 mcg/kg/minute; infuse at 6 mL/hour

To deliver 6 mcg/kg/minute; infuse at 7 mL/hour

To deliver 7 mcg/kg/minute; infuse at 8 mL/hour

To deliver 8 mcg/kg/minute; infuse at 10 mL/hour

To deliver 10 mcg/kg/minute; infuse at 12 mL/hour

To deliver 14 mcg/kg/minute; infuse at 17 mL/hour

To deliver 16 mcg/kg/minute; infuse at 19 mL/hour

To deliver 18 mcg/kg/minute; infuse at 22 mL/hour

To deliver 20 mcg/kg/minute; infuse at 24 mL/hour

For a 15 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 7 mL/hour

To deliver 5 mcg/kg/minute; infuse at 9 mL/hour

To deliver 6 mcg/kg/minute; infuse at 11 mL/hour

To deliver 7 mcg/kg/minute; infuse at 13 mL/hour

To deliver 8 mcg/kg/minute; infuse at 14 mL/hour

To deliver 10 mcg/kg/minute; infuse at 18 mL/hour

To deliver 14 mcg/kg/minute; infuse at 25 mL/hour

To deliver 16 mcg/kg/minute; infuse at 29 mL/hour

To deliver 18 mcg/kg/minute; infuse at 32 mL/hour

To deliver 20 mcg/kg/minute; infuse at 36 mL/hour

For a 20 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 10 mL/hour

To deliver 5 mcg/kg/minute; infuse at 12 mL/hour

To deliver 6 mcg/kg/minute; infuse at 15 mL/hour

To deliver 7 mcg/kg/minute; infuse at 17 mL/hour

To deliver 8 mcg/kg/minute; infuse at 19 mL/hour

To deliver 10 mcg/kg/minute; infuse at 24 mL/hour

To deliver 14 mcg/kg/minute; infuse at 34 mL/hour

To deliver 16 mcg/kg/minute; infuse at 38 mL/hour

To deliver 18 mcg/kg/minute; infuse at 43 mL/hour

To deliver 20 mcg/kg/minute; infuse at 48 mL/hour

For a 25 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 12 mL/hour

To deliver 5 mcg/kg/minute; infuse at 15 mL/hour

To deliver 6 mcg/kg/minute; infuse at 18 mL/hour

To deliver 7 mcg/kg/minute; infuse at 21 mL/hour

To deliver 8 mcg/kg/minute; infuse at 24 mL/hour

To deliver 10 mcg/kg/minute; infuse at 30 mL/hour

To deliver 14 mcg/kg/minute; infuse at 42 mL/hour

To deliver 16 mcg/kg/minute; infuse at 48 mL/hour

To deliver 18 mcg/kg/minute; infuse at 54 mL/hour

To deliver 20 mcg/kg/minute; infuse at 60 mL/hour

For a 35 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 17 mL/hour

To deliver 5 mcg/kg/minute; infuse at 21 mL/hour

To deliver 6 mcg/kg/minute; infuse at 26 mL/hour

To deliver 7 mcg/kg/minute; infuse at 29 mL/hour

To deliver 8 mcg/kg/minute; infuse at 34 mL/hour

To deliver 10 mcg/kg/minute; infuse at 42 mL/hour

To deliver 14 mcg/kg/minute; infuse at 59 mL/hour

To deliver 16 mcg/kg/minute; infuse at 67 mL/hour

To deliver 18 mcg/kg/minute; infuse at 76 mL/hour

To deliver 20 mcg/kg/minute; infuse at 84 mL/hour

For a 50 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 24 mL/hour

To deliver 5 mcg/kg/minute; infuse at 30 mL/hour

To deliver 6 mcg/kg/minute; infuse at 36 mL/hour

To deliver 7 mcg/kg/minute; infuse at 42 mL/hour

To deliver 8 mcg/kg/minute; infuse at 46 mL/hour

To deliver 10 mcg/kg/minute; infuse at 60 mL/hour

To deliver 14 mcg/kg/minute; infuse at 84 mL/hour

To deliver 16 mcg/kg/minute; infuse at 96 mL/hour

To deliver 18 mcg/kg/minute; infuse at 108 mL/hour

To deliver 20 mcg/kg/minute; infuse at 120 mL/hour

For a 60 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 29 mL/hour

To deliver 5 mcg/kg/minute; infuse at 36 mL/hour

To deliver 6 mcg/kg/minute; infuse at 43 mL/hour

To deliver 7 mcg/kg/minute; infuse at 50 mL/hour

To deliver 8 mcg/kg/minute; infuse at 58 mL/hour

To deliver 10 mcg/kg/minute; infuse at 72 mL/hour

To deliver 14 mcg/kg/minute; infuse at 101 mL/hour

To deliver 16 mcg/kg/minute; infuse at 115 mL/hour

To deliver 18 mcg/kg/minute; infuse at 130 mL/hour

To deliver 20 mcg/kg/minute; infuse at 144 mL/hour

For a 70 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 34 mL/hour

To deliver 5 mcg/kg/minute; infuse at 42 mL/hour

To deliver 6 mcg/kg/minute; infuse at 50 mL/hour

To deliver 7 mcg/kg/minute; infuse at 59 mL/hour

To deliver 8 mcg/kg/minute; infuse at 67 mL/hour

To deliver 10 mcg/kg/minute; infuse at 84 mL/hour

To deliver 14 mcg/kg/minute; infuse at 118 mL/hour

To deliver 16 mcg/kg/minute; infuse at 134 mL/hour

To deliver 18 mcg/kg/minute; infuse at 151 mL/hour

To deliver 20 mcg/kg/minute; infuse at 168 mL/hour

For a 80 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 39 mL/hour

To deliver 5 mcg/kg/minute; infuse at 48 mL/hour

To deliver 6 mcg/kg/minute; infuse at 58 mL/hour

To deliver 7 mcg/kg/minute; infuse at 67 mL/hour

To deliver 8 mcg/kg/minute; infuse at 77 mL/hour

To deliver 10 mcg/kg/minute; infuse at 96 mL/hour

To deliver 14 mcg/kg/minute; infuse at 134 mL/hour

To deliver 16 mcg/kg/minute; infuse at 154 mL/hour

To deliver 18 mcg/kg/minute; infuse at 173 mL/hour

To deliver 20 mcg/kg/minute; infuse at 192 mL/hour

For a 90 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 44 mL/hour

To deliver 5 mcg/kg/minute; infuse at 54 mL/hour

To deliver 6 mcg/kg/minute; infuse at 65 mL/hour

To deliver 7 mcg/kg/minute; infuse at 76 mL/hour

To deliver 8 mcg/kg/minute; infuse at 86 mL/hour

To deliver 10 mcg/kg/minute; infuse at 108 mL/hour

To deliver 14 mcg/kg/minute; infuse at 151 mL/hour

To deliver 16 mcg/kg/minute; infuse at 173 mL/hour

To deliver 18 mcg/kg/minute; infuse at 194 mL/hour

To deliver 20 mcg/kg/minute; infuse at 216 mL/hour

For a 100 kg patient (Using mivacurium premixed infusion 0.5 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 48 mL/hour

To deliver 5 mcg/kg/minute; infuse at 60 mL/hour

To deliver 6 mcg/kg/minute; infuse at 72 mL/hour

To deliver 7 mcg/kg/minute; infuse at 84 mL/hour

To deliver 8 mcg/kg/minute; infuse at 96 mL/hour

To deliver 10 mcg/kg/minute; infuse at 120 mL/hour

To deliver 14 mcg/kg/minute; infuse at 168 mL/hour

To deliver 16 mcg/kg/minute; infuse at 192 mL/hour

To deliver 18 mcg/kg/minute; infuse at 216 mL/hour

To deliver 20 mcg/kg/minute; infuse at 240 mL/hour

Infusion rates for maintenance of neuromuscular block during opioid/nitrous oxide/oxygen anesthesia using mivacurium injection (2 mg/mL):

For a 10 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 1.2 mL/hour

To deliver 5 mcg/kg/minute; infuse at 1.5 mL/hour

To deliver 6 mcg/kg/minute; infuse at 1.8 mL/hour

To deliver 7 mcg/kg/minute; infuse at 2.1 mL/hour

To deliver 8 mcg/kg/minute; infuse at 2.4 mL/hour

To deliver 10 mcg/kg/minute; infuse at 3 mL/hour

To deliver 14 mcg/kg/minute; infuse at 4.2 mL/hour

To deliver 16 mcg/kg/minute; infuse at 4.8 mL/hour

To deliver 18 mcg/kg/minute; infuse at 5.4 mL/hour

To deliver 20 mcg/kg/minute; infuse at 6 mL/hour

For a 15 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 1.8 mL/hour

To deliver 5 mcg/kg/minute; infuse at 2.3 mL/hour

To deliver 6 mcg/kg/minute; infuse at 2.7 mL/hour

To deliver 7 mcg/kg/minute; infuse at 3.2 mL/hour

To deliver 8 mcg/kg/minute; infuse at 3.6 mL/hour

To deliver 10 mcg/kg/minute; infuse at 4.5 mL/hour

To deliver 14 mcg/kg/minute; infuse at 6.3 mL/hour

To deliver 16 mcg/kg/minute; infuse at 7.2 mL/hour

To deliver 18 mcg/kg/minute; infuse at 8.1 mL/hour

To deliver 20 mcg/kg/minute; infuse at 9 mL/hour

For a 20 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 2.4 mL/hour

To deliver 5 mcg/kg/minute; infuse at 3 mL/hour

To deliver 6 mcg/kg/minute; infuse at 3.6 mL/hour

To deliver 7 mcg/kg/minute; infuse at 4.2 mL/hour

To deliver 8 mcg/kg/minute; infuse at 4.8 mL/hour

To deliver 10 mcg/kg/minute; infuse at 6 mL/hour

To deliver 14 mcg/kg/minute; infuse at 8.4 mL/hour

To deliver 16 mcg/kg/minute; infuse at 9.5 mL/hour

To deliver 18 mcg/kg/minute; infuse at 10.8 mL/hour

To deliver 20 mcg/kg/minute; infuse at 12 mL/hour

For a 25 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 3 mL/hour

To deliver 5 mcg/kg/minute; infuse at 3.8 mL/hour

To deliver 6 mcg/kg/minute; infuse at 4.5 mL/hour

To deliver 7 mcg/kg/minute; infuse at 5.3 mL/hour

To deliver 8 mcg/kg/minute; infuse at 6 mL/hour

To deliver 10 mcg/kg/minute; infuse at 7.5 mL/hour

To deliver 14 mcg/kg/minute; infuse at 10.5 mL/hour

To deliver 16 mcg/kg/minute; infuse at 12 mL/hour

To deliver 18 mcg/kg/minute; infuse at 13.5 mL/hour

To deliver 20 mcg/kg/minute; infuse at 15 mL/hour

For a 35 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 4.2 mL/hour

To deliver 5 mcg/kg/minute; infuse at 5.3 mL/hour

To deliver 6 mcg/kg/minute; infuse at 6.3 mL/hour

To deliver 7 mcg/kg/minute; infuse at 7.4 mL/hour

To deliver 8 mcg/kg/minute; infuse at 8.4 mL/hour

To deliver 10 mcg/kg/minute; infuse at 10.5 mL/hour

To deliver 14 mcg/kg/minute; infuse at 14.7 mL/hour

To deliver 16 mcg/kg/minute; infuse at 16.8 mL/hour

To deliver 18 mcg/kg/minute; infuse at 18.9 mL/hour

To deliver 20 mcg/kg/minute; infuse at 21 mL/hour

For a 50 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 6 mL/hour

To deliver 5 mcg/kg/minute; infuse at 7.5 mL/hour

To deliver 6 mcg/kg/minute; infuse at 9 mL/hour

To deliver 7 mcg/kg/minute; infuse at 10.5 mL/hour

To deliver 8 mcg/kg/minute; infuse at 12 mL/hour

To deliver 10 mcg/kg/minute; infuse at 15 mL/hour

To deliver 14 mcg/kg/minute; infuse at 21 mL/hour

To deliver 16 mcg/kg/minute; infuse at 24 mL/hour

To deliver 18 mcg/kg/minute; infuse at 27 mL/hour

To deliver 20 mcg/kg/minute; infuse at 30 mL/hour

For a 60 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 7.2 mL/hour

To deliver 5 mcg/kg/minute; infuse at 9 mL/hour

To deliver 6 mcg/kg/minute; infuse at 10.8 mL/hour

To deliver 7 mcg/kg/minute; infuse at 12.8 mL/hour

To deliver 8 mcg/kg/minute; infuse at 14.4 mL/hour

To deliver 10 mcg/kg/minute; infuse at 18 mL/hour

To deliver 14 mcg/kg/minute; infuse at 25.2 mL/hour

To deliver 16 mcg/kg/minute; infuse at 28.8 mL/hour

To deliver 18 mcg/kg/minute; infuse at 32.4 mL/hour

To deliver 20 mcg/kg/minute; infuse at 36 mL/hour

For a 70 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 8.4 mL/hour

To deliver 5 mcg/kg/minute; infuse at 10.5 mL/hour

To deliver 6 mcg/kg/minute; infuse at 12.6 mL/hour

To deliver 7 mcg/kg/minute; infuse at 14.7 mL/hour

To deliver 8 mcg/kg/minute; infuse at 16.8 mL/hour

To deliver 10 mcg/kg/minute; infuse at 21 mL/hour

To deliver 14 mcg/kg/minute; infuse at 29.4 mL/hour

To deliver 16 mcg/kg/minute; infuse at 33.6 mL/hour

To deliver 18 mcg/kg/minute; infuse at 37.8 mL/hour

To deliver 20 mcg/kg/minute; infuse at 42 mL/hour

For a 80 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 9.6 mL/hour

To deliver 5 mcg/kg/minute; infuse at 12 mL/hour

To deliver 6 mcg/kg/minute; infuse at 14.4 mL/hour

To deliver 7 mcg/kg/minute; infuse at 16.8 mL/hour

To deliver 8 mcg/kg/minute; infuse at 19.2 mL/hour

To deliver 10 mcg/kg/minute; infuse at 24 mL/hour

To deliver 14 mcg/kg/minute; infuse at 33.6 mL/hour

To deliver 16 mcg/kg/minute; infuse at 38.4 mL/hour

To deliver 18 mcg/kg/minute; infuse at 43.2 mL/hour

To deliver 20 mcg/kg/minute; infuse at 48 mL/hour

For a 90 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 10.8 mL/hour

To deliver 5 mcg/kg/minute; infuse at 13.5 mL/hour

To deliver 6 mcg/kg/minute; infuse at 16.2 mL/hour

To deliver 7 mcg/kg/minute; infuse at 18.9 mL/hour

To deliver 8 mcg/kg/minute; infuse at 21.6 mL/hour

To deliver 10 mcg/kg/minute; infuse at 27 mL/hour

To deliver 14 mcg/kg/minute; infuse at 37.8 mL/hour

To deliver 16 mcg/kg/minute; infuse at 43.2 mL/hour

To deliver 18 mcg/kg/minute; infuse at 48.6 mL/hour

To deliver 20 mcg/kg/minute; infuse at 54 mL/hour

For a 100 kg patient (using mivacurium injection 2 mg/mL):

To deliver 4 mcg/kg/minute; infuse at 12 mL/hour

To deliver 5 mcg/kg/minute; infuse at 15 mL/hour

To deliver 6 mcg/kg/minute; infuse at 18 mL/hour

To deliver 7 mcg/kg/minute; infuse at 21 mL/hour

To deliver 8 mcg/kg/minute; infuse at 24 mL/hour

To deliver 10 mcg/kg/minute; infuse at 30 mL/hour

To deliver 14 mcg/kg/minute; infuse at 42 mL/hour

To deliver 16 mcg/kg/minute; infuse at 48 mL/hour

To deliver 18 mcg/kg/minute; infuse at 54 mL/hour

To deliver 20 mcg/kg/minute; infuse at 60 mL/hour

Use with caution in patients in whom histamine release would be detrimental (eg, patients with severe cardiovascular disease or asthma)

Infusion, as chloride, in D₅W: 0.5 mg/mL (50 mL)

Injection, as chloride: 2 mg/mL (5 mL, 10 mL)

Cook DR, Freeman JA, Lai AA, et al, "Pharmacokinetics of Mivacurium in Normal Patients and in Those With Hepatic or Renal Failure," Br J Anaesth, 1992, 69(6):580-5.