- Useful where a short duration of neuromuscular blockade is required (e.g. nerve monitoring)
- Presents as an aqueous solution with concentration 2mg/ml and pH 3.5-5.0
- 18-month shelf life if stored below 25ºC
Mivacurium
Mivacurium
- Mivacurium is a benzylisoquinolinium neuromuscular blocking agent that is a mixture of three stereoisomers:
- 58% trans-trans isomer
- 36% cis-trans isomer
- 6% cis-cis isomer [has 10% potency but 10x half-life of other stereoisomers]
Metabolism
- Plasma (butyl) cholinesterase metabolises the cis-trans and trans-trans isomers
- Therefore patients with inherited or acquired plasma cholinesterase deficiency are at risk of prolonged blockade akin to suxamethonium apnoea
- Cis-cis isomer is not metabolised enzymatically
- Is not subject to Hoffman degradation
- High doses may cause histamine release and anaphylactoid reactions