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Indications and Dosage
Intravenous
Induction of anaesthesia Adult: 300 mcg/kg via slow inj over 30-60 seconds into a large vein in the arm.
Elderly: 150-200 mcg/kg, subsequently adjusted according to effects. Child: Up to 30% more than the standard adult dose. |
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Hepatic Impairment
Reduce dose in liver cirrhosis.
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Incompatibility
Incompatible w/ compound Na lactate infusion BP (Hartmann’s soln), ascorbic acid, vecuronium. May show slight opalescence w/ pancuronium bromide.
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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.
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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.
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IV/Parenteral: C
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Patient Counseling Information
May impair ability to drive or operate machinery.
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Monitoring Parameters
Monitor BP, renal function, CV or resp status, signs of adrenal insufficiency.
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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.
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Drug Interactions
Increased hypnotic effect when used w/ neuroleptic drugs, opioids and sedatives. May enhance the effect of hypotensive drugs.
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Food Interaction
Enhanced hypnotic effect w/ alcohol.
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Action
Description:
Mechanism of Action: 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. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Etomidate, CID=36339, https://pubchem.ncbi.nlm.nih.gov/compound/Etomidate (accessed on Jan. 23, 2020) |
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Storage
Store between 20-25°C.
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MIMS Class
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ATC Classification
N01AX07 - etomidate ; Belongs to the class of other general anesthetics.
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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.
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