Formulary
Etomidate: Indications, Dosing, Side Effects and Interactions
Etomidate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Etomidate: Indications, Dosing, Side Effects and Interactions
Etomidate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Induction of anaesthesia**
- **Adult** (By Slow Intravenous Injection): 150-300 micrograms/kg (max. per dose 60 mg), to be administered over 30-60 seconds (60 seconds in patients in whom hypotension might be hazardous).
- **Elderly** (By Slow Intravenous Injection): 150-200 micrograms/kg (max. per dose 60 mg), to be administered over 30-60 seconds (60 seconds in patients in whom hypotension might be hazardous).
**Induction of anaesthesia for etomidate**
- **Child 1 month-14 years** (By slow intravenous injection): 150-300 micrograms/kg (max. per dose 60 mg), to be administered over 30-60 seconds (60 seconds for children in whom hypotension might be hazardous), increased if necessary to 400 micrograms/kg.
- **Child 15-17 years** (By slow intravenous injection): 150-300 micrograms/kg (max. per dose 60 mg), to be administered over 30-60 seconds (60 seconds for children in whom hypotension might be hazardous).
Cautions
Acute circulatory failure (shock); adrenal insufficiency; avoid in Acute porphyrias ; cardiovascular disease; elderly; fixed cardiac output; hypovolaemia Cautions, further information Adrenal insufficiency Etomidate suppresses adrenocortical function, particularly during continuous administration, and it should not be used for maintenance of anaesthesia. It should be used with caution in patients with underlying adrenal insufficiency, for example, those with sepsis.
Side effects
Common or very common Apnoea; hypotension; movement disorders; nausea; respiratory disorders; skin reactions; vascular pain; vomiting Uncommon Arrhythmias; cough; hiccups; hypersalivation; hypertension; muscle rigidity; neuromuscular dysfunction; nystagmus; procedural complications Frequency not known Adrenal insufficiency; atrioventricular block; cardiac arrest; embolism and thrombosis; seizures; shock; Stevens-Johnson syndrome; trismus Side-effects, further information Pain on injection Can be reduced by injecting into a larger vein or by giving an opioid analgesic just before induction. Extraneous muscle movements Extraneous muscle movements can be minimised by an opioid analgesic or a short-acting benzodiazepine given just before induction.
Interactions
**Severe interactions:**
- Ketamine Co-administration of etomidate and ketamine appears to have no significant effect on the plasma concentrations or pharmacokinetic parameters of ketamine or its principal metabolite,...
**Other interactions (8):**
- The hypnotic effect of etomidate may be enhanced by: neuroleptic drugs opioids sedatives alcohol.
- Induction with etomidate may be accompanied by a slight and transient reduction in peripheral resistance which may enhance the effect of other drugs reducing blood pressure.
- Alfentanil Co-administration of etomidate with alfentanil has been reported to decrease the terminal half-life of etomidate to approximately 29 minutes.
- Caution should be used when both drugs are administered together as the concentrations of etomidate may drop below the hypnotic threshold.
- Fentanyl The total plasma clearance and volume of distribution of etomidate is decreased by a factor of 2 to 3 without a change in half-life when administered with fentanyl intravenously.
- When etomidate is co-administered with fentanyl intravenously, the dose may need to be reduced.
Pregnancy
May depress neonatal respiration if used during delivery.
Breast feeding
Breast-feeding can be resumed as soon as mother has recovered sufficiently from anaesthesia.
Hepatic impairment
Dose adjustments Manufacturer advises reduce dose in liver cirrhosis.
Medicinal forms
Solution,Injection
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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