Difference between revisions of "Mivacurium"
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Mivacurium is a short acting non-depolarizing neuromuscular blocking agent used for optimizing tracheal intubation conditions, surgical relaxation, optimizing mechanical ventilation, and preventing fasciculation from succinylcholine when administered prior. This is medication is available in most of the world, however, it is not sold in the United States of America. | Mivacurium is a short acting non-depolarizing neuromuscular blocking agent used for optimizing tracheal intubation conditions, surgical relaxation, optimizing mechanical ventilation, and preventing fasciculation from succinylcholine when administered prior. This is medication is available in most of the world, however, it is not sold in the United States of America<ref name=":0">{{Cite journal|date=2015|editor-last=Kaye|editor-first=Alan David|editor2-last=Kaye|editor2-first=Adam M.|editor3-last=Urman|editor3-first=Richard D.|title=Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care|url=http://dx.doi.org/10.1007/978-1-4614-8948-1|doi=10.1007/978-1-4614-8948-1}}</ref><ref name=":1">{{Citation|last=Lien|first=Cynthia A.|title=Neuromuscular Blockers and Reversal Drugs|date=2019|url=http://dx.doi.org/10.1016/b978-0-323-48110-6.00022-3|work=Pharmacology and Physiology for Anesthesia|pages=428–454|publisher=Elsevier|access-date=2023-01-05|last2=Eikermann|first2=Matthias}}</ref>. | ||
== Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. --> == | == Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. --> == | ||
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=== Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. --> === | === Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. --> === | ||
Duration of action | |||
* Duration of action after 2.5 x ED<sub>95</sub> is approximately less than 30 minutes <ref name=":1" /><ref>{{Cite journal|last=Frampton|first=James E.|last2=McTavish|first2=Donna|date=1993-06|title=Mivacurium: A Review of its Pharmacology and Therapeutic Potential in General Anaesthesia|url=http://link.springer.com/10.2165/00003495-199345060-00009|journal=Drugs|language=en|volume=45|issue=6|pages=1066–1089|doi=10.2165/00003495-199345060-00009|issn=0012-6667}}</ref> | |||
* Onset of action is about 2 to 3.3 minutes <ref name=":1" /> | |||
== Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. --> == | == Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. --> == | ||
Comprised of a mixture of 3 stereoisomers, one of which -the cis-cis isomer- is less than one-tenth as potent as the trans-trans and cis-trans isomers | |||
* Comprised of a mixture of 3 stereoisomers, one of which -the cis-cis isomer- is less than one-tenth as potent as the trans-trans and cis-trans isomers<ref name=":1" /> | |||
* Not available in the United States of America <ref name=":0" /><ref name=":1" /> | |||
== History<!-- Describe the historical development of the drug. --> == | == History<!-- Describe the historical development of the drug. --> == | ||
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== References == | == References == | ||
* Goodwin, G., Joseph, V. (2015). Neuromuscular Blockers. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. <nowiki>https://doi-org.laneproxy.stanford.edu/10.1007/978-1-4614-8948-1_12</nowiki><ref name=":0" /> | |||
* Goodwin, G., Joseph, V. (2015). Neuromuscular Blockers. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. <nowiki>https://doi-org.laneproxy.stanford.edu/10.1007/978-1-4614-8948-1_12</nowiki> | *Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", ''Pharmacology and Physiology for Anesthesia'', Elsevier, pp. 325–348, retrieved 2023-01-05<ref name=":1" /> | ||
*Frampton JE, McTavish D. Mivacurium. A review of its pharmacology and therapeutic potential in general anaesthesia. Drugs. 1993 Jun;45(6):1066-1089. doi: 10.2165/00003495-199345060-00009. PMID: 7691494. | |||
[[Category:Drug reference]] | [[Category:Drug reference]] | ||
[[Category:Neuromuscular blockers]] | [[Category:Neuromuscular blockers]] | ||
[[Category:Nondepolarizing neuromuscular blockers]] | [[Category:Nondepolarizing neuromuscular blockers]] | ||
Revision as of 07:53, 5 January 2023
Mivacurium
 | |
| Clinical data | |
| Drug class |
Neuromuscular blocker |
|---|---|
| Routes of administration |
Intravenous |
| Pharmacodynamics | |
| Mechanism of action |
Nicotinic acetylcholine antagonism |
| Pharmacokinetics | |
| Physical and chemical data | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Mivacurium is a short acting non-depolarizing neuromuscular blocking agent used for optimizing tracheal intubation conditions, surgical relaxation, optimizing mechanical ventilation, and preventing fasciculation from succinylcholine when administered prior. This is medication is available in most of the world, however, it is not sold in the United States of America[1][2].
Uses
- Optimizing tracheal intubation condition among patients with renal or hepatic dysfunction
- Abduction of vocal cords
- Opening of mouth
- Reduction in coughing and gagging
- Provide surgical relaxation among patients with renal or hepatic dysfunction
- Optimizing mechanical ventilation conditions among patients with renal or hepatic dysfunction
- Reduction in bucking/coughing
- Reduction in breath stacking
Contraindications
Absolute contraindications
Known hypersensitivity
Precautions
- Prolonged duration of action in patients who are homozygous for atypical pseudocholinesterase
- Large doses of mivacurium can be divided into smaller doses to avoid hemodynamic side effects from the histamine release
- Myasthenia gravis/myathenic syndrome
- Amyotrophic lateral sclerosis
- Autoimmune disorders including polymyositis, dermatomyositis and systemic lupus erythematous
- Familial periodic paralysis hyperkalemia
- Guillain-Barré syndrome
- Muscular dystrophy (Duchenne type)
- Myotonia including dystrophic, congenital,, and paramyotonia
- Patient may have resistance include:
- Burn injury
- Cerebral palsy
- Hemiplegia (on the affected side)
- Muscular denervation
- Severe chronic infection such as tetanus and botulism
Pharmacology
Pharmacodynamics
Eliminated via pseudocholinesterase
Mechanism of action
Competitive antagonism of acetylcholine at the post junctional receptors preventing depolarization of the muscle preventing any movement. Only one molecule of the neuromuscular blocker is needed to prevent activation of the receptor as it competes with acetylcholine at the two binding sites.
Adverse effects
- Anaphylactic reaction due to the ammonium ion in the NMB
- Histamine release
- Muscle weakness or myopathy due to persistent failure of neuromuscular transmission and immobilization-induced atrophy of diaphragm when used for a prolonged duration
- Posttraummatic stress syndrome from awareness during paralysis if sedation is not used adequately.
- Impairment of ventilation-perfusion distribution and decreased right ventricular end-diastolic volume due to abolishment of spontaneous breathing.
Pharmacokinetics
- Duration of action after 2.5 x ED95 is approximately less than 30 minutes [2][3]
- Onset of action is about 2 to 3.3 minutes [2]
Chemistry and formulation
- Comprised of a mixture of 3 stereoisomers, one of which -the cis-cis isomer- is less than one-tenth as potent as the trans-trans and cis-trans isomers[2]
- Not available in the United States of America [1][2]
History
References
- Goodwin, G., Joseph, V. (2015). Neuromuscular Blockers. In: Kaye, A., Kaye, A., Urman, R. (eds) Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care. Springer, New York, NY. https://doi-org.laneproxy.stanford.edu/10.1007/978-1-4614-8948-1_12[1]
- Lien, Cynthia A.; Eikermann, Matthias (2013), "Neuromuscular Blockers and Reversal Drugs", Pharmacology and Physiology for Anesthesia, Elsevier, pp. 325–348, retrieved 2023-01-05[2]
- Frampton JE, McTavish D. Mivacurium. A review of its pharmacology and therapeutic potential in general anaesthesia. Drugs. 1993 Jun;45(6):1066-1089. doi: 10.2165/00003495-199345060-00009. PMID: 7691494.
- ↑ 1.0 1.1 1.2 Kaye, Alan David; Kaye, Adam M.; Urman, Richard D., eds. (2015). "Essentials of Pharmacology for Anesthesia, Pain Medicine, and Critical Care". doi:10.1007/978-1-4614-8948-1. Cite journal requires
|journal=(help) - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Lien, Cynthia A.; Eikermann, Matthias (2019), "Neuromuscular Blockers and Reversal Drugs", Pharmacology and Physiology for Anesthesia, Elsevier, pp. 428–454, retrieved 2023-01-05
- ↑ Frampton, James E.; McTavish, Donna (1993-06). "Mivacurium: A Review of its Pharmacology and Therapeutic Potential in General Anaesthesia". Drugs. 45 (6): 1066–1089. doi:10.2165/00003495-199345060-00009. ISSN 0012-6667. Check date values in:
|date=(help)
Top contributors: Cornel Chiu and Chris Rishel