Etomidate
AMIDATE
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What it isGABA-A positive modulator; induction of anesthesia.
Why this oneIts hemodynamic stability makes it a common induction choice in shock or major cardiac disease.
What limits itIt suppresses adrenal steroidogenesis after even a single dose, which is why continuous infusion was abandoned. Myoclonus and injection pain.
FDA-approved for
- induction of anesthesia (1983)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Induction of anesthesia | adult & pediatric >10 years | 0.3 mg/kg IV over 30-60 sec | 0.2-0.6 mg/kg IV | 0.6 mg/kg IV |
| Induction of anesthesia | geriatric | reduced dose | individualized |
Renal Undefined
Hepatic Undefined
Instructions
- Intravenous route only
- Individualize dose
- Do not use unless solution is clear and container undamaged; discard unused portion
- Not recommended below age 10 years
Available strengths
- inj 2 mg/mL
Cautions
- Transient venous pain on injection
- Transient skeletal muscle movements / myoclonus
Adverse reactions
- Transient venous pain on injection (~20%)
- Transient skeletal muscle movements incl. myoclonus (~32%)
Pregnancy No adequate studies; animal studies show fetal deaths/reduced pup survival; anesthetics blocking NMDA / potentiating GABA may increase neuronal apoptosis in developing brain with prolonged use.
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 2 mg/mL | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskAdrenal suppression after even a single dose
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityAdrenal suppression and anesthesia-related airway/cardiorespiratory risk
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