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Pronunciation:

(e TOM i date)

U.S. Brand Names:

Amidate®

Generic Available:

Yes

Canadian Brand Names:

Amidate®

Use:

Induction and maintenance of general anesthesia

Use - Unlabeled/Investigational:

Sedation for diagnosis of seizure foci

Pregnancy Risk Factor:

Contraindications:

Hypersensitivity to etomidate or any component of the formulation

Warnings/Precautions:

Etomidate inhibits 11-B-hydroxylase, an enzyme important in adrenal steroid production. A single induction dose blocks the normal stress-induced increase in adrenal cortisol production for 4-8 hours, up to 24 hours in elderly and debilitated patients. Continuous infusion of etomidate for sedation in the ICU may increase mortality because patients may not be able to respond to stress. No problem has been identified with a single dose for induction of anesthesia. Consider exogenous corticosteroid replacement in patients undergoing severe stress.

Adverse Reactions:

>10%:

Endocrine & metabolic: Adrenal suppression

Gastrointestinal: Nausea, vomiting on emergence from anesthesia

Local: Pain at injection site (30% to 80%)

Neuromuscular & skeletal: Myoclonus (33%), transient skeletal movements, uncontrolled eye movements

1% to 10%: Hiccups

<1%: Apnea, arrhythmia, bradycardia, decreased cortisol synthesis, hyper-/hypotension, hyper-/hypoventilation, laryngospasm, tachycardia

Overdosage/Toxicology:

Symptoms of overdose include respiratory arrest and coma. Treatment is supportive.

Drug Interactions:

Fentanyl: Decreases etomidate elimination

Verapamil: May increase the anesthetic and respiratory depressant effects of etomidate

Stability:

Store at room temperature.

Compatibility:

Y-site administration: Compatible: Alfentanil, atracurium, atropine, doxacurium, ephedrine, fentanyl, lidocaine, lorazepam, midazolam, mivacurium, morphine, pancuronium, phenylephrine, succinylcholine, sufentanil. Incompatible: Ascorbic acid, vecuronium

Mechanism of Action:

Ultrashort-acting nonbarbiturate hypnotic (benzylimidazole) used for the induction of anesthesia; chemically, it is a carboxylated imidazole which produces a rapid induction of anesthesia with minimal cardiovascular effects; produces EEG burst suppression at high doses

Pharmacodynamics/Kinetics:

Onset of action: 30-60 seconds

Peak effect: 1 minute

Duration: 3-5 minutes; terminated by redistribution

Distribution: Vd: 2-4.5 L/kg

Protein binding: 76%;

Metabolism: Hepatic and plasma esterases

Half-life elimination: Terminal: 2.6 hours

Dosage:

Children >10 years and Adults: I.V.: Initial: 0.2-0.6 mg/kg over 30-60 seconds for induction of anesthesia; maintenance: 5-20 mcg/kg/minute

Monitoring Parameters:

Cardiac monitoring and blood pressure required

Additional Information:

Etomidate decreases cerebral metabolism and cerebral blood flow while maintaining perfusion pressure. Premedication with opioids or benzodiazepines can decrease myoclonus. Etomidate can enhance somatosensory evoked potential recordings.

Anesthesia and Critical Care Concerns/Other Considerations:

Etomidate 2 mg/mL contains propylene glycol 362.6 mg/mL (35% v/v).

Etomidate decreases cerebral metabolism and cerebral blood flow while maintaining perfusion pressure; can enhance somatosensory evoked potential recordings. Premedication with opioids or benzodiazepines can decrease myoclonus. Etomidate is a relatively safe anesthetic for use in patients with stable cardiovascular disease.

Cardiovascular Considerations:

Etomidate is a relatively safe anesthetic for use in patients with stable cardiovascular disease.

Dental Health: Effects on Dental Treatment:

Key adverse event(s) related to dental treatment: Hiccups.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

None reported

Mental Health: Effects on Psychiatric Treatment:

None reported

Dosage Forms:

Injection, solution: 2 mg/mL (10 mL, 20 mL) [contains propylene glycol 35% v/v]

International Brand Names:

Amidate® (CA); Etomidate® (BR); Etomidate-Lipuro® (FR, GB, PL, SG, TH); Etomidat-Lipuro® (AT, CH, DE, HU, IL, LU, RO, TR); Hypnomidate® (AT, BE, BG, BR, CL, CZ, DE, ES, FR, GB, HK, HR, LU, PL, RO, TR, YU, ZA); Hypnomidate pro infusione® (BE); Radenarcon® (CZ)

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