etomidate (Rx)

Brand and Other Names:Amidate
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 2mg/mL
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General Anesthesia Induction

0.3-0.6 mg/kg IVP over 30-60 sec 

Cushing Syndrome (Off-label)

Inhibition of steroidogenesis in patients with Cushing syndrome

0.2-0.6 mg/kg IV infused over 30-60 seconds for induction of anesthesia blocks normal stress-induced increase in adrenal cortisol production for 4-8 h 

ICU continuous infusion: 0.04-0.05 mg/kg/hr IV; continuous monitoring required

Dosing considerations

  • Used rarely; often toxic at doses required to reduce cortisol secretion
  • Long-term use limited by the requirement for repeated IV administration

Sedation (Off-label)

0.1 mg/kg IV bolus x1-3 doses; other dosing regimens may exist 

Dosage Forms & Strengths

injectable solution

  • 2mg/mL
more...

General Anesthesia Induction

<10 years: Safety and efficacy not established

>10 years: Same as adults; 0.3-0.6 mg/kg IVP over 30-60 sec 

Sedation (Off-label)

0.1-0.4 mg/kg IV bolus x1; additional doses may be necessary; other dosing regimens may exist 

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Interactions

Interaction Checker

and etomidate

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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)

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            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
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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not known if excreted in breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Nonbarbiturate hypnotic used for the induction of anesthesia; lacks analgesic activity; has minimal cardiovascular effects

            Cushing syndrome (off-label): Blocks 11-beta-hydroxylase

            Blocks steroidogenesis; 0.3 mg/kg will reduce plasma cortisol for up to 24 hr

            Does not affect cardiac metabolism; no depression of cardiac output or of peripheral or pulmonary circulation

            Absorption

            Onset: Within 60 sec

            Duration: 3-5 min due to redistribution from CNS

            Distribution

            Protein bound: 76%

            Vd: 2-4.5 L/kg

            Metabolism

            Hepatic and plasma esterases

            Elimination

            Excretion: Urine, as inactive agent

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            Administration

            IV Incompatibilities

            Y-site: Ascorbic acid, vecuronium

            IV Compatibilities

            Syringe: Heparin

            Y-site: Alfentanil, atracurium, atropine, ephedrine, fentanyl, lidocaine, lorazepam, midazolam, mivacurium, morphine sulfate, pancuronium, phenylephrine, succinylcholine, sufentanil

            IV Administration

            Inject undiluted by direct IV injection over 30-60 sec; do not administer by prolonged IV infusion

            Inject into large forearm vein

            Consider lidocaine preadministration to minimize injection-site pain

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.