Mivacurium and Metoclopramide Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Metoclopramide Injection
Mivacurium
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Prolonged neuromuscular block
Interaction Deep Dive
Metoclopramide was shown to prolong the times to recovery of T1 after mivacurium by more than 30%. No significant differences were noted in onset times or recovery index between the study subjects and the controls1.
Why it happens (mechanism)
Inhibition of plasma cholinesterase by metoclopramide inhibits the metabolism of mivacurium
Literature reports
2 reports — tap to read
a) Metoclopramide was shown to prolong the times to recovery of T1 by more than 30% in patients who received mivacurium. During a randomized, double-blind, placebo-controlled study, patients received either metoclopramide 0.15 mg/kg intravenously or saline. Anesthesia was induced with fentanyl 2 mcg/kg and propofol 2.5 mg/kg and maintained with a propofol infusion. Following a 5-minute stable baseline period, mivacurium 0.15 mg/kg was administered over 5 seconds. Recovery of T1 to 25%, 75%, and 90% was 17.8 minutes, 25.3 minutes, and 28.8 minutes, respectively, in patients who received metoclopramide; the same values were 13.4 minutes, 19.3 minutes, and 21.9 minutes, respectively, in placebo-treated subjects. The onset time and recovery index were not significantly altered by metoclopramide. A likely explanation for this effect is that metoclopramide has been shown to inhibit plasma cholinesterase by 10% to 20%, thereby increasing the duration of action of mivacurium 1.
b) A study by 2 demonstrated that intravenous administration of metoclopramide 10 or 20 mg before an intubating dose of mivacurium hastened the onset of maximum blockade by 30% and prolonged recovery by at least 50%. A slight but significant reduction in cholinesterase activity was detected 2 minutes after the injection of metocloprmaide 20 mg, most likely due to metoclopramide inhibiting the pCHE activity.
Common questions
Can I take Mivacurium and Metoclopramide Injection together?
Prolonged neuromuscular block Always confirm with your pharmacist or prescriber before making any change.
How serious is the Mivacurium and Metoclopramide Injection interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Mivacurium or Metoclopramide Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (2)
- Skinner HJ, Girling KJ, Whitehurst A, et al: Influence of metoclopramide on plasma cholinesterase and duration of action of mivacurium. Br J Anaesth 1999; 82:542-545. DOI
- Motamed C, Kirov K, Combes X, et al: Effect of metoclopramide on mivacurium-induced neuromuscular block. Acta Anaesthesiol Scand 2002; 46:214-216. PubMed
Keep reading about Metoclopramide Injection
Keep reading about Mivacurium
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