Etomidate


Concise Prescribing Info
Indications/Uses
Induction of anaesth.
Dosage/Direction for Use
Adult : IV 300 mcg/kg over 30-60 sec.
Dosage Details
Intravenous
Induction of anaesthesia
Adult: 300 mcg/kg via slow inj over 30-60 seconds into a large vein in the arm.
Child: Up to 30% more than the standard adult dose.
Elderly: 150-200 mcg/kg, subsequently adjusted according to effects.
Hepatic Impairment
Reduce dose in liver cirrhosis.
Incompatibility
Incompatible w/ compound Na lactate infusion BP (Hartmann’s soln), ascorbic acid, vecuronium. May show slight opalescence w/ pancuronium bromide.
Special Precautions
Patient w/ cortico-adrenal insufficiency (e.g. patient w/ sepsis), pre-existing epilepsy, hepatic cirrhosis. Renal impairment. Elderly and childn. Pregnancy and lactation.
Adverse Reactions
Excitatory phenomena e.g. myoclonus; pain on inj site; hyperventilation, hypoventilation, apnoea, hiccups and snoring, HTN, hypotension, postoperative nausea and vomiting. Rarely, convulsions, cardiac arrhythmias, laryngospasm.
IV/Parenteral: C
Patient Counseling Information
May impair ability to drive or operate machinery.
MonitoringParameters
Monitor BP, renal function, CV or resp status, signs of adrenal insufficiency.
Overdosage
Symptoms: Hypotension, resp depression, which may lead to arrest, disorientation, delayed awakening. Management: Supportive treatment. Admin of hydrocortisone (not ACTH) 50-100 mg may be required.
Drug Interactions
Increased hypnotic effect when used w/ neuroleptic drugs, opioids and sedatives. May enhance the effect of hypotensive drugs.
Food Interaction
Enhanced hypnotic effect w/ alcohol.
Action
Description: Etomidate, a carboxylated imidazole, is a sedative and hypnotic agent used for general anaesthesia. It enhances the activity of γ-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the CNS, by interacting w/ the GABAA receptor complex.
Onset: 30-60 seconds.
Duration: Dose dependent: 2-3 min (0.15 mg/kg/dose); 4-10 min (0.3 mg/kg/dose).
Pharmacokinetics:
Absorption: Time to peak plasma concentration: 7 min.
Distribution: Rapidly distributed into CNS and other body tissues. Crosses placenta and enters breast milk. Volume of distribution: 2-4.5 L/kg. Plasma protein binding: Approx 76%.
Metabolism: Rapidly metabolised in the liver and plasma.
Excretion: Via urine, approx 75% (80% as metabolite, 2% as unchanged drug). Terminal elimination half-life: 2.6-3.5 hr.
Chemical Structure

Chemical Structure Image
Etomidate

Source: National Center for Biotechnology Information. PubChem Database. Etomidate, CID=36339, https://pubchem.ncbi.nlm.nih.gov/compound/Etomidate (accessed on Jan. 23, 2020)

Storage
Store between 20-25°C.
ATC Classification
N01AX07 - etomidate ; Belongs to the class of other general anesthetics.
References
Anon. Etomidate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 21/07/2016.

Buckingham R (ed). Etomidate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/07/2016.

Etomidate Inj (Heritage Pharmaceuticals Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 21/07/2016.

Joint Formulary Committee. Etomidate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/07/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Etomidate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 21/07/2016.

Disclaimer: This information is independently developed by MIMS based on Etomidate from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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