Details of the Drug

General Information of Drug (ID: DM473VD)

Drug Name

Mivacurium

Synonyms

Mivacron; Chlorure de mivacurium; Chlorure de mivacurium [French]; Cloruro de mivacurio; Cloruro de mivacurio [Spanish]; MIVACURIUM CHLORIDE; Mivacurii chloridum; Mivacurii chloridum [Latin]; BW B109OU dichloride; BWB109OU; BW-B1090U; BW-B109OU; MIVACRON IN DEXTROSE 5% IN PLASTIC CONTAINER; Mivacron (TN); Mivacurium chloride(USAN/INN); Mivacurium chloride [USAN:INN:BAN]; Bis[3-[(1R)-6,7-dimethoxy-2-methyl-1-[(3,4,5-trimethoxyphenyl)methyl]-3,4-dihydro-1H-isoquinolin-2-ium-2-yl]propyl] (E)-oct-4-enedioate; Bis[3-[(1R)-6,7-dimethoxy-2-methyl-1-[(3,4,5-trimethoxyphenyl)methyl]-3,4-dihydro-1H-isoquinolin-2-ium-2-yl]propyl] (E)-oct-4-enedioate dichloride; (R)-1,2,3,4-Tetrahydro-2-(3-hydroxypropyl)-6,7-dimethoxy-2-methyl-1-(3,4,5-trimethoxybenzyl)isoquinolinium chloride, (E)-4-octenedioate (2:1)

Indication

Disease Entry	ICD 11	Status	REF
Anaesthesia	9A78.6	Approved	[1], [2], [3]

Therapeutic Class

Neuromuscular Nondepolarizing Agents

Drug Type

Small molecular drug

Structure

3D MOL

2D MOL

#Ro5 Violations (Lipinski): 4

Molecular Weight (mw)

1029.3

Topological Polar Surface Area (xlogp)

8.7

Rotatable Bond Count (rotbonds)

Hydrogen Bond Donor Count (hbonddonor)

Hydrogen Bond Acceptor Count (hbondacc)

ADMET Property

Clearance: The drug present in the plasma can be removed from the body at the rate of 5.2 mL/min/kg [4]
Half-life: The concentration or amount of drug in body reduced by one-half in 1.7 - 2.6 minutes (in healthy young adults administered 0.1 to 0.25 mg/kg mivacurium) [4]
Metabolism: The drug is metabolized via the enzymatic hydrolysis catalyzed by plasma cholinesterase [5]
MRTD: The Maximum Recommended Therapeutic Dose (MRTD) of drug that ensured maximising efficacy and moderate side effect is 0.22724 micromolar/kg/day [6]
Unbound Fraction: The unbound fraction of drug in plasma is 0.7% [4]
Vd: Fluid volume that would be required to contain the amount of drug present in the body at the same concentration as in the plasma 0.27 L/kg [4]

Chemical Identifiers

Formula: C58H80N2O14+2
IUPAC Name: bis[3-[(1R)-6,7-dimethoxy-2-methyl-1-[(3,4,5-trimethoxyphenyl)methyl]-3,4-dihydro-1H-isoquinolin-2-ium-2-yl]propyl] (E)-oct-4-enedioate
Canonical SMILES: C[N+]1(CCC2=CC(=C(C=C2[C@H]1CC3=CC(=C(C(=C3)OC)OC)OC)OC)OC)CCCOC(=O)CC/C=C/CCC(=O)OCCC[N+]4(CCC5=CC(=C(C=C5[C@H]4CC6=CC(=C(C(=C6)OC)OC)OC)OC)OC)C
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
InChIKey: ILVYCEVXHALBSC-OTBYEXOQSA-N

Cross-matching ID

PubChem CID: 5281042
ChEBI ID: CHEBI:6958
CAS Number: 133814-19-4
DrugBank ID: DB01226
TTD ID: D0OB2M

Molecular Interaction Atlas of This Drug

Drug Therapeutic Target (DTT)

DTT Name	DTT ID	UniProt ID	MOA	REF
Neuronal acetylcholine receptor alpha-2 (CHRNA2)	TTF4E0J	ACHA2_HUMAN	Antagonist	[7]

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Molecular Interaction Atlas (MIA)

MIA Detail

Jump to Detail Molecular Interaction Atlas of This Drug

Drug-Drug Interaction (DDI) Information of This Drug

Coadministration of a Drug Treating the Disease Different from Mivacurium (Comorbidity)

DDI Drug Name	DDI Drug ID	Severity	Mechanism	Comorbidity	REF
Paromomycin	DM1AGXN	Major	Additive neuromuscular blocking effects by the combination of Mivacurium and Paromomycin.	Amoebiasis [1A36]	[12]
Fosphenytoin	DMOX3LB	Moderate	Increased metabolism of Mivacurium caused by Fosphenytoin mediated induction of CYP450 enzyme.	Epilepsy/seizure [8A61-8A6Z]	[13]
Levobetaxolol	DMSREPX	Moderate	Additive neuromuscular blocking effects by the combination of Mivacurium and Levobetaxolol.	Glaucoma [9C61]	[14]
Lincomycin	DMVTHER	Moderate	Additive neuromuscular blocking effects by the combination of Mivacurium and Lincomycin.	Gram-positive bacterial infection [1B74-1F40]	[15]
Penbutolol	DM4ES8F	Moderate	Additive neuromuscular blocking effects by the combination of Mivacurium and Penbutolol.	Hypertension [BA00-BA04]	[16]
Nebivolol	DM7F1PA	Moderate	Additive neuromuscular blocking effects by the combination of Mivacurium and Nebivolol.	Hypertension [BA00-BA04]	[16]
Metoclopramide	DMFA5MY	Moderate	Additive neuromuscular blocking effects by the combination of Mivacurium and Metoclopramide.	Nausea/vomiting [MD90]	[17]
Dexamethasone	DMMWZET	Moderate	Additive neuromuscular blocking effects by the combination of Mivacurium and Dexamethasone.	Rheumatoid arthritis [FA20]	[18]
Vecuronium	DMP0UK2	Moderate	Additive neuromuscular blocking effects by the combination of Mivacurium and Vecuronium.	Tonus and reflex abnormality [MB47]	[19]
Plazomicin	DMKMBES	Major	Additive neuromuscular blocking effects by the combination of Mivacurium and Plazomicin.	Urinary tract infection [GC08]	[12]
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⏷ Show the Full List of 10 DDI Information of This Drug

References

1	URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Ligand id: 7243).
2	Drugs@FDA. U.S. Food and Drug Administration. U.S. Department of Health & Human Services. 2015
3	Natural products as sources of new drugs over the last 25 years. J Nat Prod. 2007 Mar;70(3):461-77.
4	Trend Analysis of a Database of Intravenous Pharmacokinetic Parameters in Humans for 1352 Drug Compounds
5	FDA approval: ado-trastuzumab emtansine for the treatment of patients with HER2-positive metastatic breast cancer. Clin Cancer Res. 2014 Sep 1;20(17):4436-41.
6	Estimating the safe starting dose in phase I clinical trials and no observed effect level based on QSAR modeling of the human maximum recommended daily dose
7	Pharmacological characteristics of the inhibition of nondepolarizing neuromuscular blocking agents at human adult muscle nicotinic acetylcholine receptor. Anesthesiology. 2009 Jun;110(6):1244-52.
8	Synergy between pairs of competitive antagonists at adult human muscle acetylcholine receptors. Anesth Analg. 2008 Aug;107(2):525-33.
9	Synthesis and pharmacological evaluation of novel 9- and 10-substituted cytisine derivatives. Nicotinic ligands of enhanced subtype selectivity. J Med Chem. 2006 May 4;49(9):2673-6.
10	Pharmacology of the agonist binding sites of rat neuronal nicotinic receptor subtypes expressed in HEK 293 cells. Bioorg Med Chem Lett. 2004 Apr 19;14(8):1845-8.
11	URL: http://www.guidetopharmacology.org Nucleic Acids Res. 2015 Oct 12. pii: gkv1037. The IUPHAR/BPS Guide to PHARMACOLOGY in 2016: towards curated quantitative interactions between 1300 protein targets and 6000 ligands. (Target id: 463).
12	Burkett L, Bikhazi GB, Thomas KC Jr, Rosenthal DA, Wirta MG, Foldes FF "Mutual potentiation of the neuromuscular effects of antibiotics and relaxants." Anesth Analg 58 (1979): 107-15. [PMID: 571233]
13	Liberman BA, Norman P, Hardy BG "Pancuronium-phenytoin interaction: a case of decreased duration of neuromuscular blockade." Int J Clin Pharmacol Ther Toxicol 26 (1988): 371-4. [PMID: 3220609]
14	Harrah MD, Way WL, Katzung BG "The interaction of d-tubocurarine with antiarrhythmic drugs." Anesthesiology 33 (1970): 406-10. [PMID: 5512329]
15	Alahdal O, Bevan DR "Clindamycin-induced neuromuscular blockade." Can J Anaesth 42 (1995): 614-7. [PMID: 7553999]
16	Chapple DJ, Clark JS, Hughes R "Interaction between atracurium and drugs used in anaesthesia." Br J Anaesth 55 Suppl 1 (1983): s17-22. [PMID: 6688011]
17	Multum Information Services, Inc. Expert Review Panel.
18	Agencia Espaola de Medicamentos y Productos Sanitarios Healthcare "Centro de informacion online de medicamentos de la AEMPS - CIMA.".
19	Pandit SK, Ferres CJ, Gibson FM, Mirakhur RK "Time course of action of combinations of vecuronium and pancuronium." Anaesthesia 41 (1986): 151-4. [PMID: 2869710]