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Mivacron 2mg/mL Injection
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Indications & Clinical Uses
- Mivacron (mivacurium chloride) 2 mg/mL is a short-acting, non-depolarising neuromuscular blocking agent ("muscle relaxant") used during general anaesthesia.
- The Mivacron brand name was discontinued by its manufacturer in the United States (last labeled for AbbVie Inc.) for commercial, not safety, reasons; this content is based on the most recent FDA-approved Mivacron labeling, and a current, actively marketed US generic mivacurium chloride product was not located on DailyMed at the time of writing, so prescribers should confirm local product availability.
- Where marketed, mivacurium is indicated as an adjunct to general anaesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation, in both inpatient and outpatient settings, in adults and children.
- It is given exclusively by an anaesthetist or other clinician trained in its use, intravenously, in an operating theatre or intensive care setting; it is never self-administered or given by any other route.
Side Effects
- Mivacron has no boxed warning.
- The most common side effect, seen in about 16% of patients, is transient flushing of the face, neck, or chest, related to histamine release; this usually resolves on its own.
- Less common reactions (each below 1%) include a drop in blood pressure, a fast or slow heart rate, other changes in heart rhythm, wheezing or bronchospasm, skin rash, and hives.
- Serious hypersensitivity (anaphylactic) reactions can occur, including some that have been life-threatening or fatal; these can happen even after previous uneventful use of neuromuscular blocking drugs.
- Because Mivacron paralyses the muscles used for breathing, prolonged or unexpectedly deep muscle weakness can occur, especially in people with reduced plasma cholinesterase activity, and mechanical ventilation is continued until muscle strength has fully recovered.
- Because this is a hospital-administered anaesthetic drug, patients are continuously monitored throughout, and any concerns are managed immediately by the anaesthesia team rather than by the patient.
Precautions & Warnings
- Mivacron is given only intravenously by staff trained to manage anaesthesia and airway support, since it causes paralysis of the breathing muscles; a nerve stimulator is recommended to monitor the depth and recovery of neuromuscular block, particularly in patients with neuromuscular disease.
- It is contraindicated in known hypersensitivity to mivacurium or its components.
- Caution is needed in people with reduced plasma cholinesterase activity (for example from liver or kidney disease, malnutrition, or an inherited atypical cholinesterase gene), as its effects can be markedly prolonged; in cardiovascular disease, where histamine-related effects may be more pronounced; and in conditions such as asthma where bronchospasm risk is higher.
- Doses are adjusted carefully in hepatic or renal impairment, burns, and obesity.
- There are no long-term intensive-care safety data.
- Use in pregnancy and breastfeeding should be decided by the anaesthesia team based on the clinical situation, since mivacurium is only ever given as part of a supervised anaesthetic.
Avoid Interactions
- The anaesthesia team reviews all other medicines before Mivacron is given, since several drugs change its effect.
- Volatile inhaled anaesthetics, particularly isoflurane and enflurane, increase and prolong the neuromuscular block produced by Mivacron; halothane has a smaller effect.
- Certain antibiotics (including aminoglycosides), magnesium salts, and lithium can enhance the muscle-relaxant effect and increase the risk of prolonged paralysis.
- Anti-seizure medicines such as phenytoin and carbamazepine may reduce Mivacron's effectiveness with long-term use.
- Other drugs that reduce plasma cholinesterase activity, or share the same metabolic pathway, can significantly prolong its action and need dose adjustment or extra monitoring.
- Mivacron should not be mixed in the same syringe or line as alkaline solutions, such as barbiturate anaesthetic drugs, because this can cause the drug to break down.
- Because this medicine is only given under direct anaesthetic supervision, all these interactions are managed by the clinical team, not by the patient.
References
Frequently Asked Questions
Mivacron (mivacurium chloride) is a short-acting muscle-relaxant drug used during general anaesthesia to help place a breathing tube and to relax the muscles during surgery or mechanical ventilation. It is given only in hospital, by an anaesthetist, never by the patient.
Mivacron is given only by intravenous injection or infusion, by an anaesthetist, once you are already under anaesthetic for surgery. The dose, timing, and any repeat doses are decided entirely by the anaesthesia team based on the procedure and how you respond.
The most common Mivacron side effect is temporary flushing of the face, neck, or chest, affecting around 1 in 6 patients, from histamine release. Serious but rare reactions include severe allergic (anaphylactic) reactions and unusually prolonged muscle weakness after surgery ends.
The team checks for liver or kidney problems, low plasma cholinesterase activity, asthma, and heart disease, and reviews your other current medicines, since drugs such as certain antibiotics, magnesium salts, and lithium can prolong Mivacron's muscle-relaxant effect and recovery time.
The Mivacron brand name was discontinued from US sale in 2006 for commercial reasons, not safety, according to the FDA. Hospitals may use an equivalent generic mivacurium chloride product where one is available; ask your anaesthesia team which product is used locally.
Mivacron's labeling covers use in both adults and children as part of a supervised general anaesthetic to aid intubation and muscle relaxation. Dosing in children is calculated by the anaesthesia team based on body weight and the specific procedure being performed.
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