Mivacurium is a benzylisoquinolinium nondepolarizing neuromuscular-blocking drug that was developed in the early 1980s and disappeared from the U.S. market in 2006. It was reintroduced in December 2016, and many have asked what the appropriate niche is for this seemingly resurrected medication.
Since the successful introduction of succinylcholine in the mid-20th century, there have been many attempts to duplicate its quick onset and short duration of action without the negative effects of depolarizing paralytics. Mivacurium has an onset time similar to most other intermediate-acting neuromuscular blocking agents (NMBAs), but a shorter duration of action. While it was available, many used the drug for short cases or for cases when reversal was not wanted. Others avoided the drug due to untoward side effects, notably histamine release.
In 2006, due to manufacturing problems, possibly related to an intermediary product’s availability, the supply of the drug to the U.S. ended. In part due...
