CLINICAL USE

Non-depolarising muscle relaxant of short duration

DOSE IN NORMAL RENAL FUNCTION

IV injection: 70–250 micrograms/kg; maintenance 100 micrograms/kg every 15 minutes

IV infusion

: maintenance of block 8–10 micrograms/kg/minute, adjusted to maintenance dose of 6–7 micrograms/kg/minute according to response

PHARMACOKINETICS

  • Molecular weight                           :1029; (1100.2 as chloride)
  • %Protein binding                           :No data
  • %Excreted unchanged in urine     :
  • <10           :
  • Volume of distribution (L/kg)       :0.1–0.3
  • half-life – normal/ESRD (hrs)      :2–10 minutes/ –

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Adjust to response. Slower infusion rate may be required
  • 10 to 20     : Adjust to response. Slower infusion rate may be required
  • <10           : Reduce dose.

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unknown dialysability. Adjust infusion to response
  • HD                     :Unknown dialysability. Adjust infusion to response
  • HDF/high flux   :Unknown dialysability. Adjust infusion to response
  • CAV/VVHD      :Unknown dialysability. Adjust infusion to response

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anaesthetics: enhanced muscle relaxant effect
  • Anti-arrhythmics: procainamide enhances muscle relaxant effect
  • Antibacterials: effect enhanced by aminoglycosides, clindamycin, polymyxins and piperacillinBotulinum toxin: neuromuscular blockade enhanced, (risk of toxicity)

    ADMINISTRATION

    Reconstition

    _

    Route

    IV bolus,

    IV infusion

    Rate of Administration

    IV bolus: Doses of up to 0.15 mg/kg may be administered over 5–15 seconds. Higher doses should be administered over 30 seconds

    Comments

    Compatible with sodium chloride 0.9%; glucose 5%; dilute to 500 micrograms/mLCompatible with fentanyl, alfentanil, droperidol and midazolam

    OTHER INFORMATION

    Spontaneous recovery is complete in approximately 15 minutes and is independent of dose administeredIn patients with CKD 5 the clinically effective duration of block produced by 0.15 mg/kg is approximately 1.5 times longer than in patients with normal renal function; hence, dosage should be adjusted according to individual clinical responseResults from a study comparing 20 anephric patients with 20 healthy patients highlight the need for reduced dosages of Mivacron in patients with renal failure: patients with renal failure had a slightly shorter time to maximum depression of T1/T0, a slower recovery of T1/T0 to 5% (15.3 vs 9.8 min), required a slower infusion rate (6.3 vs 10.4 micrograms/kg/min) and experienced slower spontaneous recovery (12.2 vs 7.7 min). The drug company has no specific guidelines as to the extent of dose reduction required.

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