Etomidate

See critical care quick reference for drug doses by weight.

General

• Type: Sedative
• Dosage Forms: IV
• Common Trade Names: Amidate, Tomvi

Adult Dosing

RSI

• 0.3mg/kg bolus IV
• Average: 20mg
  • Consider half-dose (0.15mg/kg) for obtunded patients

Procedural Sedation

• 0.1mg/kg one time dosing
• Max: 10mg
• Minimal respiratory depression but decrease blood pressure and heart rate (alpha2 agonism)

Pediatric Dosing

See critical care quick reference for drug doses by weight.

• Children < 10 years
  • 0.2-0.3 mg/kg IV
• Children > 10 years
  • 0.3 mg/kg IV

Special Populations

• Pregnancy Rating: C
• Lactation: etomidate is present in breast milk
• Renal Dosing
  • Adult
    • Not defined however higher risk of toxicity with renal impairment
  • Pediatric
    • Not defined however higher risk of toxicity with renal impairment
• Hepatic Dosing
  • Adult
    • Not defined
  • Pediatric
    • Not defined

Contraindications

• Allergy to class/drug

Adverse Reactions

• Myoclonus
• Nausea/Vomiting
• Pain at injection site
• apnea

Controversy

• May suppress adrenal function in critically ill patient
  • "The available evidence suggests that etomidate suppresses adrenal function transiently without

demonstrating a significant effect on mortality. However, no studies to date have been powered to detect a difference in hospital, ventilator, or ICU length of stay or in mortality."

• Meta-analysis in 2023 showed increased mortality in critically ill patients

Pharmacology

• Half-life: 75 minutes
• Metabolism: Liver
• Excretion: Urine
• Mechanism of Action: GABA agonist

References

Etomidate: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.