etomidate

Therapeutic Classification: general anesthetics

Pharmacologic Classification: nonbarbiturates

High Alert

Induction of general anesthesia.
Supplemental anesthesia with other agents (nitrous oxide) for short procedures.

Hypnotic CNS depressant without analgesic activity.

Therapeutic effects:

Induction/supplementation of general anesthesia.

Absorption: IV administration results in complete bioavailability.

Distribution: Distributes rapidly from blood into CNS, followed by rapid clearance and tissue distribution.

Metabolism/Excretion: Mostly metabolized by the liver. 75% excreted in urine as inactive metabolite; 10–13% excreted in bile and feces.

Half-Life: 1.25–5 hr.

(hypnosis)

ROUTE	ONSET	PEAK	DURATION
IV	within 1 min	unknown	3–5 min

Contraindicated in:

Hypersensitivity;
Prolonged infusion not recommended (suppresses cortisol production);
OB: Pregnancy, labor, delivery (including cesarean section); may affect child's brain development when used during 3rd trimester.

Use Cautiously in:

Patients undergoing severe stress (may require supplemental corticosteroids);
Geri: Geriatric patients;
Lactation: Safety not established;
Pedi: Children <10 yr (safety not established); Children <3 yr (may affect brain development).

CV: arrhythmias, hypertension, hypotension

GI: postoperative nausea/vomiting

Local: transient injection site pain

MS: transient skeletal muscle movements

Resp: APNEA, hyperventilation, hypoventilation, LARYNGOSPASM

Drug-drug:

↑CNS depression with other CNS depressants including antihistamines, antidepressants, sedative/hypnotics, antipsychotics and opioids; ↓ dosage of other CNS depressants if necessary.
Verapamil may ↑ anesthetic effect, which may ↑ risk of respiratory depression and apnea.

IV (Adults and Children >10 yr): 0.2–0.6 mg/kg (usual dose is 0.3 mg/kg) for induction. Smaller increments may be used during short procedures to supplement other agents.

(Generic available)

Solution for injection: 2 mg/mL

Assess respiratory status, pulse, and BP continuously throughout etomidate therapy. May cause brief periods of apnea. Maintain patent airway and adequate ventilation.
Assess level of sedation and level of consciousness throughout and following administration.
May cause pain at injection site lasting <1 min. Pain is less frequent when larger veins are used for injection.

Toxicity and Overdose:

If overdose occurs, monitor pulse, respiration, and BP continuously. Maintain patent airway and assist ventilation as needed.

High Alert: Etomidate should be used only by individuals experienced in endotracheal intubation. Equipment for airway management should be readily available.
Dose is titrated to patient response.
- Etomidate has no effect on the pain threshold. Adequate analgesia should always be used when etomidate is used as an adjunct to surgical procedures.
- Opioid analgesics, such as fentanyl, may be administered immediately prior to etomidate to provide analgesia, minimize pain at injection site and involuntary muscle movements. Diazepam may also be used to reduce incidence and magnitude of involuntary muscle movements.

IV Administration:

IV Push: Diluent: Administer undiluted..
Rate: Administer slowly over 30–60 seconds. Titrate to desired level of sedation.
Y-Site Compatibility:
- atracurium
- atropine
- dexmedetomidine
- doxacurium
- ephedrine
- fentanyl
- lidocaine
- lorazepam
- midazolam
- morphine
- phenylephrine
- succinylcholine
- sufentanil
Y-Site Incompatibility:
- ascorbic acid
- vecuronium

Inform patient of the purpose of medication.
May cause drowsiness or dizziness. Advise patient to request assistance prior to ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr following administration.
Advise patient to avoid alcohol or other CNS depressants without the advice of a heath care professional for 24 hr following administration.

Induction and maintenance of anesthesia.

NDC Code

0143- West-Ward Pharmaceuticals Corp
- 0143-9310- Etomidate
  - 0143-9310-10- 10 VIAL, SINGLE-DOSE in 1 CARTON (0143-9310-10) > 10 mL in 1 VIAL, SINGLE-DOSE (0143-9310-01)

0143- West-Ward Pharmaceuticals Corp
- 0143-9311- Etomidate
  - 0143-9311-10- 10 VIAL, SINGLE-DOSE in 1 CARTON (0143-9311-10) > 20 mL in 1 VIAL, SINGLE-DOSE (0143-9311-01)

0143- West-Ward Pharmaceuticals Corp
- 0143-9506- Etomidate
  - 0143-9506-10- 10 VIAL, SINGLE-DOSE in 1 CARTON (0143-9506-10) > 10 mL in 1 VIAL, SINGLE-DOSE (0143-9506-01)

0143- West-Ward Pharmaceuticals Corp
- 0143-9507- Etomidate
  - 0143-9507-10- 10 VIAL, SINGLE-DOSE in 1 CARTON (0143-9507-10) > 20 mL in 1 VIAL, SINGLE-DOSE (0143-9507-01)

0409- Hospira, Inc.
- 0409-6695- Amidate
  - 0409-6695-01- 10 VIAL, SINGLE-DOSE in 1 TRAY (0409-6695-01) > 10 mL in 1 VIAL, SINGLE-DOSE (0409-6695-11)

0409- Hospira, Inc.
- 0409-6695- Amidate
  - 0409-6695-02- 10 VIAL, SINGLE-DOSE in 1 TRAY (0409-6695-02) > 20 mL in 1 VIAL, SINGLE-DOSE (0409-6695-12)

0409- Hospira, Inc.
- 0409-8060- Amidate
  - 0409-8060-29- 10 CARTON in 1 PACKAGE (0409-8060-29) > 1 SYRINGE in 1 CARTON > 20 mL in 1 SYRINGE (0409-8060-39)

23155- Heritage Pharmaceuticals Inc.
- 23155-160- Etomidate
  - 23155-160-41- 10 VIAL in 1 CARTON (23155-160-41) > 10 mL in 1 VIAL (23155-160-31)

23155- Heritage Pharmaceuticals Inc.
- 23155-160- Etomidate
  - 23155-160-42- 10 VIAL in 1 CARTON (23155-160-42) > 20 mL in 1 VIAL (23155-160-32)

52584- General Injectables and Vaccines, Inc
- 52584-695- Amidate
  - 52584-695-01- 1 VIAL, SINGLE-DOSE in 1 BAG (52584-695-01) > 10 mL in 1 VIAL, SINGLE-DOSE

55150- AuroMedics Pharma LLC
- 55150-221- ETOMIDATE
  - 55150-221-10- 10 VIAL, SINGLE-DOSE in 1 CARTON (55150-221-10) > 10 mL in 1 VIAL, SINGLE-DOSE

55150- AuroMedics Pharma LLC
- 55150-222- ETOMIDATE
  - 55150-222-20- 10 VIAL, SINGLE-DOSE in 1 CARTON (55150-222-20) > 20 mL in 1 VIAL, SINGLE-DOSE

65841- Cadila Healthcare Limited
- 65841-818- etomidate
  - 65841-818-07- 10 VIAL in 1 TRAY (65841-818-07) > 10 mL in 1 VIAL

65841- Cadila Healthcare Limited
- 65841-818- etomidate
  - 65841-818-08- 10 VIAL in 1 TRAY (65841-818-08) > 20 mL in 1 VIAL

67457- Mylan Institutional LLC
- 67457-902- Etomidate
  - 67457-902-10- 10 VIAL in 1 CARTON (67457-902-10) > 10 mL in 1 VIAL (67457-902-00)

67457- Mylan Institutional LLC
- 67457-903- Etomidate
  - 67457-903-20- 10 VIAL in 1 CARTON (67457-903-20) > 20 mL in 1 VIAL (67457-903-00)

68382- Zydus Pharmaceuticals (USA) Inc.
- 68382-545- etomidate
  - 68382-545-07- 10 VIAL in 1 TRAY (68382-545-07) > 10 mL in 1 VIAL

68382- Zydus Pharmaceuticals (USA) Inc.
- 68382-545- etomidate
  - 68382-545-08- 10 VIAL in 1 TRAY (68382-545-08) > 20 mL in 1 VIAL

70518- REMEDYREPACK INC.
- 70518-1003- Etomidate
  - 70518-1003-0- 10 mL in 1 VIAL (70518-1003-0)

70860- Athenex Pharmaceutical Division, LLC.
- 70860-652- Etomidate
  - 70860-652-10- 10 VIAL in 1 CARTON (70860-652-10) > 10 mL in 1 VIAL (70860-652-41)

70860- Athenex Pharmaceutical Division, LLC.
- 70860-652- Etomidate
  - 70860-652-20- 10 VIAL in 1 CARTON (70860-652-20) > 20 mL in 1 VIAL (70860-652-42)

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Pronunciation ⬇

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Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

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Assessment ⬆ ⬇

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