Etomidate

Hepatic cirrhosis: Dose reduction may be needed.

Incompatible with compound sodium lactate infusion (Hartmann's solution). May cause a very slight opalescence with pancuronium bromide.

Patient with CV disease, epilepsy, hepatic cirrhosis. Patients undergoing severe stress, particularly those with adrenocortical dysfunction. Critically ill (including patients with sepsis) and debilitated patients. Avoid administration into small blood vessels. Not recommended to be given via prolonged or continuous infusion. Renal and hepatic impairment. Children and elderly. Pregnancy and lactation.

Significant: Adrenal suppression (e.g. transient adrenal insufficiency, decreased serum cortisol and aldosterone levels); hypotension; involuntary or spontaneous skeletal muscle movements (e.g. myoclonus) and convulsions, particularly in patients who did not receive premedication.
Cardiac disorders: Bradycardia, extrasystoles, tachycardia.
Gastrointestinal disorders: Vomiting, nausea, salivary hypersecretion.
General disorders and administration site conditions: Inj site pain.
Immune system disorders: Hypersensitivity reaction (e.g. anaphylactic shock, anaphylaxis, anaphylactoid reaction).
Musculoskeletal and connective tissue disorders: Muscle rigidity.
Nervous system disorders: Dyskinesia, hypertonia, nystagmus.
Respiratory, thoracic and mediastinal disorders: Apnoea, stridor, hyperventilation, hypoventilation, hiccups, cough.
Skin and subcutaneous tissue disorders: Rash, erythema.
Vascular disorders: Hypertension.

IV/Parenteral: C

This drug may impair mental alertness, if affected, do not drive or operate machinery. Interrupt breastfeeding for 24 hours after administration.

Monitor cardiac function, blood pressure, renal function, and respiratory, CV or CNS status. Assess for signs and symptoms of adrenal insufficiency (including hypotension and hyperkalaemia) and infusion site irritation.

Symptoms: Depressed cortical secretion (associated with disorientation or delayed awakening), hypotension, and respiratory depression.

Management: Symptomatic and supportive treatment. Establish a patent airway and provide respiratory support if necessary. Administration of 50-100 mg hydrocortisone (not ACTH) may be needed for depression of cortisol secretion.

Enhanced hypnotic effect with neuroleptic drugs, opioids, and sedatives. May increase the hypotensive effect of adrenergic blockers, alpha blockers, and calcium channel blockers (e.g. verapamil, diltiazem). Plasma concentration may be reduced (which may be below the hypnotic threshold) with alfentanil.

Enhanced hypnotic effect with alcohol.

Description:
Overview: Etomidate, a carboxylated imidazole, is a short-acting sedative and hypnotic agent and a general anaesthetic.
Mechanism of Action: Etomidate enhances the activity of γ-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the CNS, by modulating and directly activating the GABA receptor complex, thereby exerting its anaesthetic effect.
Pharmacodynamics: Etomidate produces CNS depression; however, it has no analgesic effect. It causes a transient 20-30% decrease in cerebral blood flow, which appears to be uniform in the absence of intracranial space-occupying lesions. In patients with and without intracranial space-occupying lesions, etomidate induction is typically followed by a moderate reduction of intracranial pressure, lasting several minutes.

Etomidate causes minimal haemodynamic/CV effects and a slight elevation in the arterial carbon dioxide tension (PaCO₂). However, in the elderly (particularly those with hypertension), it may result in a decrease in heart rate, cardiac index, and mean arterial blood pressure. Etomidate inhibits endogenous cortisol synthesis and reduces plasma cortisol and aldosterone levels. Cortisol suppression persists for approx 6-8 hours and is unresponsive to ACTH administration.
Onset: 30-60 seconds.
Duration: Dose dependent: 2-3 minutes (0.15 mg/kg); 3-5 minutes (0.3 mg/kg).
Pharmacokinetics:
Absorption: Time to peak plasma concentration: 7 minutes.
Distribution: Rapidly distributed into the CNS and other body tissues. Crosses the placenta and enters breast milk. Volume of distribution: 2-4.5 L/kg. Plasma protein binding: 76%.
Metabolism: Metabolised rapidly in the liver and plasma.
Excretion: Via urine (approx 75%; 80% as metabolite, 2% as unchanged drug). Terminal elimination half-life: 2.6-3.5 hours.

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 667484, Etomidate. https://pubchem.ncbi.nlm.nih.gov/compound/Etomidate. Accessed Oct. 28, 2025.

Store between 20-25°C.

Anaesthetics - Local & General

N01AX07 - etomidate ; Belongs to the class of other general anesthetics.

Amidate Injection, Solution (Hospira, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 09/10/2025.

Brayfield A, Cadart C (eds). Etomidate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/10/2025.

Etomidate 2 mg/mL Emulsion for Injection (B. Braun Melsungen AG). MHRA. https://products.mhra.gov.uk. Accessed 09/10/2025.

Etomidate-Lipuro (B. Braun Medical Industries Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 09/10/2025.

Etomidate. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 09/10/2025.

Etomidate. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/10/2025.

Etomidate. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 09/10/2025.

Hypnomidate 2 mg/mL Injection (Piramal Critical Care Limited). MHRA. https://products.mhra.gov.uk. Accessed 09/10/2025.

Joint Formulary Committee. Etomidate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/10/2025.