Mivacurium

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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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