Identification

Name
Mivacurium
Accession Number
DB01226  (APRD01119)
Type
Small Molecule
Groups
Approved
Description

Mivacurium is a bisbenzylisoquinolinium based neuromuscular blocker or muscle relaxant. It binds competitively to cholinergic receptors on the motor end-plate to antagonize the action of acetylcholine, resulting in a block of neuromuscular transmission.

Structure
Thumb
Synonyms
  • Mivacurium
Product Ingredients
IngredientUNIICASInChI Key
Mivacurium chloride600ZG213C3106861-44-3WMSYWJSZGVOIJW-ONUALHDOSA-L
Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
MivacronLiquid2 mgIntravenousAbbvie1994-12-312012-11-03Canada
MivacronSolution2 mg/mLIntravenousAbbvie2015-01-30Not applicableUs
Categories
UNII
77D66S9Q93
CAS number
133814-19-4
Weight
Average: 1029.2608
Monoisotopic: 1028.560955278
Chemical Formula
C58H80N2O14
InChI Key
ILVYCEVXHALBSC-OTBYEXOQSA-N
InChI
InChI=1S/C58H80N2O14/c1-59(25-21-41-35-47(63-3)49(65-5)37-43(41)45(59)29-39-31-51(67-7)57(71-11)52(32-39)68-8)23-17-27-73-55(61)19-15-13-14-16-20-56(62)74-28-18-24-60(2)26-22-42-36-48(64-4)50(66-6)38-44(42)46(60)30-40-33-53(69-9)58(72-12)54(34-40)70-10/h13-14,31-38,45-46H,15-30H2,1-12H3/q+2/b14-13+/t45-,46-,59?,60?/m1/s1
IUPAC Name
(1R)-2-(3-{[(4E)-8-{3-[(1R)-6,7-dimethoxy-2-methyl-1-[(3,4,5-trimethoxyphenyl)methyl]-1,2,3,4-tetrahydroisoquinolin-2-ium-2-yl]propoxy}-8-oxooct-4-enoyl]oxy}propyl)-6,7-dimethoxy-2-methyl-1-[(3,4,5-trimethoxyphenyl)methyl]-1,2,3,4-tetrahydroisoquinolin-2-ium
SMILES
COC1=CC(C[[email protected]@H]2C3=CC(OC)=C(OC)C=C3CC[N+]2(C)CCCOC(=O)CC\C=C\CCC(=O)OCCC[N+]2(C)CCC3=CC(OC)=C(OC)C=C3[[email protected]]2CC2=CC(OC)=C(OC)C(OC)=C2)=CC(OC)=C1OC

Pharmacology

Indication

For inpatients and outpatients, as an adjunct to general anesthesia, to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation.

Structured Indications
Not Available
Pharmacodynamics

Mivacurium is a short-acting, nondepolarizing skeletal neuromuscular blocking agent which is hydrolyzed by plasma cholinesterase. Mivacurium results in a blockade of neuromuscular transmission by binding competitively with cholinergic receptors on the motor end-plate to antagonize the action of acetylcholine. The neuromuscular block produced by mivacurium is readily antagonized by anticholinesterase agents. The deeper the level of neuromuscular block at reversal, the longer the time required for recovery of neuromuscular function and the greater the dose of anticholinesterase agent required. Because spontaneous recovery after mivacurium is rapid, routine reversal may not always result in a clinical benefit.

Mechanism of action

Mivacurium binds competitively to cholinergic receptors on the motor end-plate to antagonize the action of acetylcholine, resulting in a block of neuromuscular transmission. This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine.

TargetActionsOrganism
ANeuronal acetylcholine receptor subunit alpha-2
antagonist
Human
NMuscarinic acetylcholine receptor M2
antagonist
partial agonist
Human
NMuscarinic acetylcholine receptor M3
antagonist
Human
UCholinesteraseNot AvailableHuman
Absorption
Not Available
Volume of distribution
Not Available
Protein binding

The protein binding of mivacurium has not been determined due to its rapid hydrolysis by plasma cholinesterase.

Metabolism

Extensive and rapid via enzymatic hydrolysis catalyzed by plasma cholinesterase. Biotransformation may be significantly slowed in patients with abnormal or decreased plasma cholinesterase activity, especially individuals with a homozygous atypical cholinesterase gene abnormality.

Route of elimination
Not Available
Half life

The mean elimination half-life ranges from 1.7 to 2.6 minutes in healthy, young adults administered 0.1 to 0.25 mg/kg mivacurium. In 9 patients with end-stage liver disease undergoing liver transplant surgery, plasma clearance was approximately 50% lower than that in 8 control patients with normal hepatic function, while the elimination half-life increased to 4.4 minutes from the 1.8 minute control value.

Clearance
Not Available
Toxicity

Overdosage with neuromuscular blocking agents may result in neuromuscular block beyond the time needed for surgery and anesthesia.

Affected organisms
  • Humans and other mammals
Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
DrugInteractionDrug group
AcetyldigitoxinMivacurium may increase the arrhythmogenic activities of Acetyldigitoxin.Approved
AcetyldigoxinMivacurium may increase the arrhythmogenic activities of Acetyldigoxin.Experimental
AclarubicinAclarubicin may increase the respiratory depressant activities of Mivacurium.Investigational
AldoxorubicinAldoxorubicin may increase the respiratory depressant activities of Mivacurium.Investigational
AmikacinAmikacin may increase the respiratory depressant activities of Mivacurium.Approved, Vet Approved
AmrubicinAmrubicin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational
AnnamycinAnnamycin may increase the respiratory depressant activities of Mivacurium.Investigational
ApramycinApramycin may increase the respiratory depressant activities of Mivacurium.Experimental, Vet Approved
ArbekacinArbekacin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational
BekanamycinBekanamycin may increase the respiratory depressant activities of Mivacurium.Experimental
Botulinum Toxin Type ABotulinum Toxin Type A may increase the neuromuscular blocking activities of Mivacurium.Approved, Investigational
Botulinum Toxin Type BMivacurium may increase the neuromuscular blocking activities of Botulinum Toxin Type B.Approved
BumetanideBumetanide may decrease the neuromuscular blocking activities of Mivacurium.Approved
CapreomycinCapreomycin may increase the neuromuscular blocking activities of Mivacurium.Approved
ChlortetracyclineChlortetracycline may increase the neuromuscular blocking activities of Mivacurium.Approved, Investigational, Vet Approved
ClindamycinClindamycin may increase the neuromuscular blocking activities of Mivacurium.Approved, Vet Approved
ColistimethateColistimethate may increase the neuromuscular blocking activities of Mivacurium.Approved, Vet Approved
CyclosporineCyclosporine may increase the neuromuscular blocking activities of Mivacurium.Approved, Investigational, Vet Approved
CymarinMivacurium may increase the arrhythmogenic activities of Cymarin.Experimental
DaunorubicinDaunorubicin may increase the respiratory depressant activities of Mivacurium.Approved
DemeclocyclineDemeclocycline may increase the neuromuscular blocking activities of Mivacurium.Approved
DeslanosideMivacurium may increase the arrhythmogenic activities of Deslanoside.Approved
DibekacinDibekacin may increase the respiratory depressant activities of Mivacurium.Experimental
DigitoxinMivacurium may increase the arrhythmogenic activities of Digitoxin.Approved, Investigational
DigoxinMivacurium may increase the arrhythmogenic activities of Digoxin.Approved
Digoxin Immune Fab (Ovine)Mivacurium may increase the arrhythmogenic activities of Digoxin Immune Fab (Ovine).Approved
DihydrostreptomycinDihydrostreptomycin may increase the respiratory depressant activities of Mivacurium.Investigational, Vet Approved
DoxorubicinDoxorubicin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational
DoxycyclineDoxycycline may increase the neuromuscular blocking activities of Mivacurium.Approved, Investigational, Vet Approved
EpirubicinEpirubicin may increase the respiratory depressant activities of Mivacurium.Approved
Etacrynic acidEtacrynic acid may decrease the neuromuscular blocking activities of Mivacurium.Approved
FramycetinFramycetin may increase the respiratory depressant activities of Mivacurium.Approved
FurosemideFurosemide may decrease the neuromuscular blocking activities of Mivacurium.Approved, Vet Approved
GeneticinGeneticin may increase the respiratory depressant activities of Mivacurium.Experimental
GentamicinGentamicin may increase the respiratory depressant activities of Mivacurium.Approved, Vet Approved
GENTAMICIN C1AGENTAMICIN C1A may increase the respiratory depressant activities of Mivacurium.Experimental
GitoformateMivacurium may increase the arrhythmogenic activities of Gitoformate.Experimental
GPX-150GPX-150 may increase the respiratory depressant activities of Mivacurium.Investigational
Hygromycin BHygromycin B may increase the respiratory depressant activities of Mivacurium.Vet Approved
IdarubicinIdarubicin may increase the respiratory depressant activities of Mivacurium.Approved
IsepamicinIsepamicin may increase the respiratory depressant activities of Mivacurium.Experimental
KanamycinKanamycin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational, Vet Approved
Lanatoside CMivacurium may increase the arrhythmogenic activities of Lanatoside C.Experimental
LincomycinLincomycin may increase the neuromuscular blocking activities of Mivacurium.Approved, Vet Approved
LithiumLithium may increase the neuromuscular blocking activities of Mivacurium.Approved
LorpiprazoleThe therapeutic efficacy of Mivacurium can be increased when used in combination with Lorpiprazole.Approved
MetildigoxinMivacurium may increase the arrhythmogenic activities of Metildigoxin.Experimental
MetrizamideMetrizamide may increase the respiratory depressant activities of Mivacurium.Approved
MicronomicinMicronomicin may increase the respiratory depressant activities of Mivacurium.Experimental
MinocyclineMinocycline may increase the neuromuscular blocking activities of Mivacurium.Approved, Investigational
NeamineNeamine may increase the respiratory depressant activities of Mivacurium.Experimental
NeomycinNeomycin may increase the respiratory depressant activities of Mivacurium.Approved, Vet Approved
NetilmicinNetilmicin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational
OleandrinMivacurium may increase the arrhythmogenic activities of Oleandrin.Experimental, Investigational
OuabainMivacurium may increase the arrhythmogenic activities of Ouabain.Approved
ParomomycinParomomycin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational
PeruvosideMivacurium may increase the arrhythmogenic activities of Peruvoside.Experimental
PirarubicinPirarubicin may increase the respiratory depressant activities of Mivacurium.Investigational
PiretanidePiretanide may decrease the neuromuscular blocking activities of Mivacurium.Experimental
PirlimycinPirlimycin may increase the neuromuscular blocking activities of Mivacurium.Vet Approved
PlazomicinPlazomicin may increase the respiratory depressant activities of Mivacurium.Investigational
PlicamycinPlicamycin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational, Withdrawn
Polymyxin B SulfatePolymyxin B Sulfate may increase the neuromuscular blocking activities of Mivacurium.Approved, Vet Approved
ProcainamideProcainamide may increase the neuromuscular blocking activities of Mivacurium.Approved
ProscillaridinMivacurium may increase the arrhythmogenic activities of Proscillaridin.Experimental
PuromycinPuromycin may increase the respiratory depressant activities of Mivacurium.Experimental
QuinidineQuinidine may increase the neuromuscular blocking activities of Mivacurium.Approved
QuinineQuinine may increase the neuromuscular blocking activities of Mivacurium.Approved
RibostamycinRibostamycin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational
SabarubicinSabarubicin may increase the respiratory depressant activities of Mivacurium.Investigational
SisomicinSisomicin may increase the respiratory depressant activities of Mivacurium.Investigational
SP1049CSP1049C may increase the respiratory depressant activities of Mivacurium.Investigational
SpectinomycinSpectinomycin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational, Vet Approved
StreptomycinStreptomycin may increase the respiratory depressant activities of Mivacurium.Approved, Vet Approved
StreptozocinStreptozocin may increase the respiratory depressant activities of Mivacurium.Approved
TobramycinTobramycin may increase the respiratory depressant activities of Mivacurium.Approved, Investigational
TorasemideTorasemide may decrease the neuromuscular blocking activities of Mivacurium.Approved
ValrubicinValrubicin may increase the respiratory depressant activities of Mivacurium.Approved
VancomycinVancomycin may increase the neuromuscular blocking activities of Mivacurium.Approved
Zoptarelin doxorubicinZoptarelin doxorubicin may increase the respiratory depressant activities of Mivacurium.Investigational
ZorubicinZorubicin may increase the respiratory depressant activities of Mivacurium.Experimental
Food Interactions
Not Available

References

Synthesis Reference

Maurizio Francesco Velati, Andrea Busca, Cristina Manfrotto, Marco Nicolini, Claudio Gianluca Pozzoli, "Process for the preparation of mivacurium chloride." U.S. Patent US20070293534, issued December 20, 2007.

US20070293534
General References
Not Available
External Links
Human Metabolome Database
HMDB0015357
KEGG Compound
C07550
PubChem Compound
5281042
PubChem Substance
46505071
ChemSpider
4444509
ChEBI
6958
ChEMBL
CHEMBL1182833
Therapeutic Targets Database
DAP000716
PharmGKB
PA450528
RxList
RxList Drug Page
Wikipedia
Mivacurium
ATC Codes
M03AC10 — Mivacurium chloride
FDA label
Download (1.5 MB)
MSDS
Download (25.3 KB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
1CompletedTreatmentMuscle Relaxation / Sex1
2RecruitingTreatmentLiver Dysfunction1
4CompletedPreventionProstate Hypertrophy / Renal Diseases1
4CompletedTreatmentEfficacy and Safety of Mivacurium Chloride for Pediatric Patients1
4CompletedTreatmentIntubations / Newborns / Preterms1
Not AvailableCompletedNot AvailableNeuromuscular Blockade1
Not AvailableCompletedTreatmentIntubating Conditions / Performance With Respiratory Exercise Device / Postoperative Myalgia1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage forms
FormRouteStrength
LiquidIntravenous2 mg
SolutionIntravenous2 mg/mL
Prices
Not Available
Patents
Not Available

Properties

State
Liquid
Experimental Properties
Not Available
Predicted Properties
PropertyValueSource
Water Solubility3.26e-05 mg/mLALOGPS
logP3.8ALOGPS
logP-0.76ChemAxon
logS-7.5ALOGPS
pKa (Strongest Acidic)18.59ChemAxon
pKa (Strongest Basic)-4.1ChemAxon
Physiological Charge2ChemAxon
Hydrogen Acceptor Count12ChemAxon
Hydrogen Donor Count0ChemAxon
Polar Surface Area144.9 Å2ChemAxon
Rotatable Bond Count30ChemAxon
Refractivity308.74 m3·mol-1ChemAxon
Polarizability116.68 Å3ChemAxon
Number of Rings6ChemAxon
Bioavailability0ChemAxon
Rule of FiveNoChemAxon
Ghose FilterNoChemAxon
Veber's RuleNoChemAxon
MDDR-like RuleYesChemAxon
Predicted ADMET features
PropertyValueProbability
Human Intestinal Absorption-0.9832
Blood Brain Barrier+0.9465
Caco-2 permeable+0.629
P-glycoprotein substrateSubstrate0.8476
P-glycoprotein inhibitor INon-inhibitor0.5119
P-glycoprotein inhibitor IIInhibitor0.7645
Renal organic cation transporterNon-inhibitor0.5515
CYP450 2C9 substrateNon-substrate0.8376
CYP450 2D6 substrateNon-substrate0.7529
CYP450 3A4 substrateSubstrate0.6975
CYP450 1A2 substrateNon-inhibitor0.8986
CYP450 2C9 inhibitorNon-inhibitor0.9583
CYP450 2D6 inhibitorNon-inhibitor0.8914
CYP450 2C19 inhibitorNon-inhibitor0.9348
CYP450 3A4 inhibitorNon-inhibitor0.8426
CYP450 inhibitory promiscuityLow CYP Inhibitory Promiscuity0.919
Ames testNon AMES toxic0.7046
CarcinogenicityNon-carcinogens0.9137
BiodegradationNot ready biodegradable0.876
Rat acute toxicity2.6607 LD50, mol/kg Not applicable
hERG inhibition (predictor I)Weak inhibitor0.8134
hERG inhibition (predictor II)Non-inhibitor0.6401
ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

Spectra

Mass Spec (NIST)
Not Available
Spectra
Not Available

Taxonomy

Description
This compound belongs to the class of organic compounds known as benzylisoquinolines. These are organic compounds containing an isoquinoline to which a benzyl group is attached.
Kingdom
Organic compounds
Super Class
Organoheterocyclic compounds
Class
Isoquinolines and derivatives
Sub Class
Benzylisoquinolines
Direct Parent
Benzylisoquinolines
Alternative Parents
Tetrahydroisoquinolines / Phenoxy compounds / Anisoles / Methoxybenzenes / Alkyl aryl ethers / Aralkylamines / Fatty acid esters / Dicarboxylic acids and derivatives / Tetraalkylammonium salts / Carboxylic acid esters
show 7 more
Substituents
Benzylisoquinoline / Tetrahydroisoquinoline / Phenoxy compound / Anisole / Phenol ether / Methoxybenzene / Alkyl aryl ether / Fatty acid ester / Aralkylamine / Monocyclic benzene moiety
show 21 more
Molecular Framework
Aromatic heteropolycyclic compounds
External Descriptors
isoquinolines (CHEBI:6958)

Targets

Kind
Protein
Organism
Human
Pharmacological action
Yes
Actions
Antagonist
General Function
Drug binding
Specific Function
After binding acetylcholine, the AChR responds by an extensive change in conformation that affects all subunits and leads to opening of an ion-conducting channel across the plasma membrane.
Gene Name
CHRNA2
Uniprot ID
Q15822
Uniprot Name
Neuronal acetylcholine receptor subunit alpha-2
Molecular Weight
59764.82 Da
References
  1. Overington JP, Al-Lazikani B, Hopkins AL: How many drug targets are there? Nat Rev Drug Discov. 2006 Dec;5(12):993-6. [PubMed:17139284]
  2. Imming P, Sinning C, Meyer A: Drugs, their targets and the nature and number of drug targets. Nat Rev Drug Discov. 2006 Oct;5(10):821-34. [PubMed:17016423]
  3. Ihmsen H, Schmidt J, Schwilden H, Schmitt HJ, Muenster T: Influence of disease progression on the neuromuscular blocking effect of mivacurium in children and adolescents with Duchenne muscular dystrophy. Anesthesiology. 2009 May;110(5):1016-9. doi: 10.1097/ALN.0b013e31819daf31. [PubMed:19352159]
  4. Jonsson Fagerlund M, Dabrowski M, Eriksson LI: Pharmacological characteristics of the inhibition of nondepolarizing neuromuscular blocking agents at human adult muscle nicotinic acetylcholine receptor. Anesthesiology. 2009 Jun;110(6):1244-52. doi: 10.1097/ALN.0b013e31819fade3. [PubMed:19417616]
  5. Jonsson M, Gurley D, Dabrowski M, Larsson O, Johnson EC, Eriksson LI: Distinct pharmacologic properties of neuromuscular blocking agents on human neuronal nicotinic acetylcholine receptors: a possible explanation for the train-of-four fade. Anesthesiology. 2006 Sep;105(3):521-33. [PubMed:16931985]
  6. Chen X, Ji ZL, Chen YZ: TTD: Therapeutic Target Database. Nucleic Acids Res. 2002 Jan 1;30(1):412-5. [PubMed:11752352]
Kind
Protein
Organism
Human
Pharmacological action
No
Actions
Antagonist
Partial agonist
General Function
G-protein coupled acetylcholine receptor activity
Specific Function
The muscarinic acetylcholine receptor mediates various cellular responses, including inhibition of adenylate cyclase, breakdown of phosphoinositides and modulation of potassium channels through the...
Gene Name
CHRM2
Uniprot ID
P08172
Uniprot Name
Muscarinic acetylcholine receptor M2
Molecular Weight
51714.605 Da
References
  1. Overington JP, Al-Lazikani B, Hopkins AL: How many drug targets are there? Nat Rev Drug Discov. 2006 Dec;5(12):993-6. [PubMed:17139284]
  2. Imming P, Sinning C, Meyer A: Drugs, their targets and the nature and number of drug targets. Nat Rev Drug Discov. 2006 Oct;5(10):821-34. [PubMed:17016423]
Kind
Protein
Organism
Human
Pharmacological action
No
Actions
Antagonist
General Function
Receptor activity
Specific Function
The muscarinic acetylcholine receptor mediates various cellular responses, including inhibition of adenylate cyclase, breakdown of phosphoinositides and modulation of potassium channels through the...
Gene Name
CHRM3
Uniprot ID
P20309
Uniprot Name
Muscarinic acetylcholine receptor M3
Molecular Weight
66127.445 Da
References
  1. Habre W, Adamicza A, Lele E, Novak T, Sly PD, Petak F: The involvement of histaminic and muscarinic receptors in the bronchoconstriction induced by myorelaxant administration in sensitized rabbits. Anesth Analg. 2008 Dec;107(6):1899-906. doi: 10.1213/ane.0b013e318186587c. [PubMed:19020136]
Kind
Protein
Organism
Human
Pharmacological action
Unknown
General Function
Identical protein binding
Specific Function
Esterase with broad substrate specificity. Contributes to the inactivation of the neurotransmitter acetylcholine. Can degrade neurotoxic organophosphate esters.
Gene Name
BCHE
Uniprot ID
P06276
Uniprot Name
Cholinesterase
Molecular Weight
68417.575 Da
References
  1. Kao YJ, Le ND: The reversal of profound mivacurium-induced neuromuscular blockade. Can J Anaesth. 1996 Nov;43(11):1128-33. [PubMed:8922768]

Drug created on June 13, 2005 07:24 / Updated on January 19, 2018 10:55