etomidate: clinical use

Prescribing considerations

• Restrict administration to clinicians skilled in airway management, with ventilation and resuscitation facilities immediately available.
• Provide appropriate analgesia for painful procedures.
• Use particular caution in critical illness, sepsis, severe physiological stress, adrenal dysfunction, hypotension, older or debilitated patients, and hepatic impairment.
• Avoid repeated administration or continuous infusion for maintenance because adrenal suppression may be prolonged.
• Check formulation-specific excipients, compatibility and handling requirements.

Contraindications and cautions

• Hypersensitivity to etomidate or any formulation excipient.
• The lipid emulsion is contraindicated with soya or peanut hypersensitivity.
• For the lipid emulsion, neonates and infants up to 6 months should not receive it except for imperative inpatient indications.

Monitoring

• Continuously monitor ventilation, oxygenation, circulation and depth of anaesthesia.
• Watch for apnoea, respiratory depression, hypotension, dysrhythmia, myoclonus and injection reactions.
• Consider adrenal function and corticosteroid support in severe stress or known adrenocortical dysfunction.
• Account for additive effects from opioids, sedatives, neuroleptics, alcohol and antihypertensive medicines.

Clinical pharmacology

A rapidly acting intravenous hypnotic with no intrinsic analgesic action. Its short clinical effect reflects rapid redistribution and metabolic inactivation. It is substantially protein-bound, undergoes mainly hepatic ester hydrolysis and reversibly inhibits adrenal 11-beta-hydroxylase.

Formulation and product differences

• Hypnomidate is an aqueous solution containing propylene glycol; renal or hepatic monitoring may be relevant when propylene-glycol toxicity is a concern.
• The emulsion contains refined soya-bean oil, medium-chain triglycerides and egg phospholipids; soya and peanut hypersensitivity are contraindications.
• The emulsion must be shaken, used only when homogeneous and milky-white, used immediately after opening and not mixed with other medicines.
• Hypnomidate has different documented diluent and incompatibility information; consult its product-specific SmPC before preparation.

Injection

Route: Parenteral

Strengths: 2 mg/mL