Chemical formula: C₁₄H₁₆N₂O₂ Molecular mass: 244.289 g/mol PubChem compound: 667484
Etomidate interacts in the following cases:
The hypnotic effect of etomidate may be enhanced by neuroleptic drugs, opioids, sedatives and alcohol.
The hypnotic effect of etomidate may be enhanced by neuroleptic drugs, opioids, sedatives and alcohol.
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.
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 IV. When etomidate is co-administered with fentanyl IV, the dose may need to be reduced.
Single induction doses of etomidate can lead to transient adrenal insufficiency and decreased serum cortisol levels. Where concern exists for the patients undergoing severe stress, particularly those with adrenocortical dysfunction, supplementation with exogenous cortisol should be considered.
Etomidate should be used with caution in critically ill patients, including patients with sepsis.
Prolonged suppression of endogenous cortisol and aldosterone may occur as a direct consequence of etomidate when given by continuous infusion or in repeated doses. Use of etomidate for maintenance of anaesthesia should therefore be avoided. In such situations stimulation of the adrenal gland with adrenocorticotropic hormone (ACTH) is not useful. However, when etomidate is used for induction, the post-operative rise in serum cortisol which has been observed after thiopentone induction is delayed for approximately 3-6 hours.
Convulsions may occur in unpremedicated patients.
In animals, no primary embryotoxic or teratogenic effects were observed with etomidate. Safety in human pregnancy has not been established. Etomidate should be used during pregnancy only if the potential benefit justifies the risks to the fetus.
During obstetric anaesthesia etomidate crosses the placenta. The Apgar scores of neonates whose mothers have received etomidate are comparable to those of neonates born after the use of other hypnotic agents. A transient fall in cortisol levels lasting about 6 hours was observed in the neonate after the mother was given etomidate. The decreased values remained within the normal range.
Etomidate has been identified in breast milk. The effect of etomidate on neonates is unknown. Breast-feeding should be discontinued during treatment and for a period of approximately 24 hours after treatment with etomidate.
In a reproduction study in animals, results showed that etomidate has no effect on fertility at recommended doses.
Etomidate has a major influence on the ability to drive and use machines. Even though a patient may regain normal alertness 30 to 60 minutes after awakening, it is recommended that patients do not drive or use machines for at least 24 hours after administration of etomidate. Hence, a decision to allow for driving or operating machinery must be a judgment made by the post-anaesthesiology treatment team.
The safety of etomidate was evaluated in 812 subjects who participated in 4 open-label clinical trials of etomidate used for the induction of general anaesthesia. These subjects took at least one dose of etomidate and provided safety data. Based on pooled safety data from these clinical trials, the most commonly reported (≥5% incidence) adverse drug reactions (ADRs) were (with % incidence) dyskinesia (10.3) and vein pain (7.6).
Including the above-mentioned ADRs, the following list displays ADRs that have been reported with the use of etomidate from either clinical trial or postmarketing experiences.
The displayed frequency categories use the following convention: Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to <1/100); rare (≥1/10,000 to <1/1,000); very rare (<1/10,000); and not known (cannot be estimated from the available clinical trial data).
Not Known: Hypersensitivity (such as anaphylactic shock, anaphylactic reaction, anaphylactoid reaction)
Very Common: Cortisol decreased
Not Known: Adrenal insufficiency
Very Common: Dyskinesia
Common: Myoclonus
Uncommon: Hypertonia, Muscle contractions involuntary, Nystagmus
Not Known: Convulsion (including grand mal convulsion)
Uncommon: Bradycardia, Extrasystoles, Ventricular extrasystoles
Not Known: Cardiac arrest, Atrioventricular block complete
Common: Vein pain, Hypotension
Uncommon: Phlebitis, Hypertension
Not Known: Shock, Thrombophlebitis (including superficial thrombophlebitis and deep vein thrombosis)
Common: Apnoea, Hyperventilation, Stridor
Uncommon: Hypoventilation, Hiccups, Cough
Not Known: Respiratory depression, Bronchospasm (including fatal outcome)
Common: Vomiting, Nausea
Uncommon: Salivary hypersecretion
Common: Rash
Uncommon: Erythema
Not Known: Stevens-Johnson syndrome, Urticaria
Uncommon: Muscle rigidity
Not Known: Trismus
Uncommon: Injection site pain
Uncommon: Anaesthetic complication, Delayed recovery from anaesthesia, Inadequate analgesia, Procedural nausea
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