Etomidate

Name: Etomidate

Adverse Effects

>10%

Transient injection site pain (30-80%)

Skeletal muscle movements, mainly myoclonic (32%)

Opsoclonus (20%)

Adrenal suppression

1-10%

Hiccups

<1%

Apnea (duration: 5-90 seconds)

Arrhythmias

Hyperventilation

HTN

Hypotension

Hypoventilation

Laryngospasm

Nausea/vomiting

Oxygen desaturation

Snoring (may be associated with partial upper airway obstruction)

Warnings

Contraindications

Hypersensitivity

Controversial: Sepsis, septic shock

Cautions

Lack of ventilatory support

Adrenal suppression (and prolonged therapy)

Prolonged IV infusion not recommended

Safety during labor and delivery not elucidated; not recommended

General anesthetics and sedation drugs in young children and pregnant women

  • Brain development
    • Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
    • Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
    • Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures

Stability

Storage

Parenteral

Injection

15–30°C.1 2

Do not use the injection unless the solution is clear and the container undamaged.1 2

Discard unused portion.1 2

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Drug Compatibility Y-Site CompatibilityHID

Compatible

Alfentanil HCl

Atracurium besylate

Atropine sulfate

Ephedrine sulfate

Fentanyl citrate

Lidocaine HCl

Lorazepam

Midazolam HCl

Mivacurium chloride

Morphine sulfate

Pancuronium bromide

Phenylephrine HCl

Succinylcholine chloride

Sufentanil citrate

Incompatible

Ascorbic acid injection

Vecuronium bromide

Actions

  • Structurally unrelated to other currently available IV anesthetics.6

  • Enhances the activity of GABA, the principal inhibitory neurotransmitter in the CNS,6 7 by interacting with the GABAA receptor complex.6 7

  • Capable of producing all levels of CNS depressionfrom light sleep to deep comadepending on the dosage.9

  • Has no analgesic activity.1 2 4

  • Substantial changes on the EEG appear to occur following induction doses.3 4 9 The EEG changes are indicative of the various stages of anesthesia and appear to be similar to those occurring following induction of anesthesia with barbiturates.3 4

  • May decrease cerebral blood flow and intracranial pressure.1 3 9

  • Causes minimal hemodynamic changes9 and is associated with a decreased incidence and severity of cardiovascular effects compared with other IV anesthetic agents.3 4 5 6 10

  • Minor increases in cardiac index and slight decreases in heart rate, systemic vascular resistance, and arterial BP reported.9

  • Equivalent induction doses of etomidate cause less respiratory depression than propofol or barbiturates.9

  • Increases in carbon dioxide tension (PCO2) reported.1 2

  • Usually reduces intraocular pressure (IOP).1 2

Advice to Patients

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1 2

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information. (See Cautions.)

What do I need to tell my doctor BEFORE I take Etomidate?

  • If you have an allergy to etomidate or any other part of etomidate.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

This medicine may interact with other drugs or health problems.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of high or low blood pressure like very bad headache or dizziness, passing out, change in eyesight.
  • Trouble breathing, slow breathing, or shallow breathing.
  • Fast or slow heartbeat.
  • A heartbeat that does not feel normal.
  • Muscle stiffness.
  • Trouble controlling body movements.
  • Not able to control eye movements.
  • Redness or swelling where the shot is given.

Consumer Information Use and Disclaimer

  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else's drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Check with your pharmacist about how to throw out unused drugs.
  • Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this medicine, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take etomidate or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to etomidate. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Review Date: October 4, 2017

PACKAGE LABEL – PRINCIPAL DISPLAY PANEL – Vial Label

NDC 70860-652-10

Etomidate Injection, USP

20 mg per 10 mL (2 mg per mL)

Rx only

For Intravenous Use Only

10 mL Single-Dose Vial

Special Populations Hepatic Function Impairment

Vd and elimination half-life increase 2-fold in patients with cirrhosis compared with healthy subjects.

Dosing Geriatric

Refer to adult dosing; reduced doses may be required.

Dosing Pediatric

General anesthesia: IV: Children >10 years and Adolescents: Initial: 0.3 mg/kg (range: 0.2 to 0.6 mg/kg) over 30 to 60 seconds for induction of anesthesia.

Dosing Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling; use with caution, risk of toxicity is greater in patients with renal impairment.

Storage

Store at 20°C to 25°C (68°F to 77°F).

Monitoring Parameters

Cardiac monitoring; blood pressure; renal function (in renal impairment)

(web3)