Etomidate

Etomidate is an intravenous general anesthetic. It is used in the following ways:

• Amidate (intravenous injection) is indicated to induce general anesthesia in adults and in children older than 10 years
• Etomidate injection (intravenous) is indicated to induce general anesthesia in adults and in children older than 10 years
• Amidate (intravenous) is indicated to supplement weaker anesthetic agents — such as nitrous oxide in oxygen — during short procedures like dilation and curettage or cervical conization in adult patients
• Etomidate injection (intravenous) is similarly indicated to supplement weaker anesthetic agents during short adult procedures
• Use for induction in children under age 10 is not recommended due to insufficient data
• Supplemental use during longer procedures or in pediatric patients is not recommended

Etomidate is a general anesthetic — it puts you into a state of unconsciousness — but it does not relieve pain on its own. When injected into a vein, it acts on the brain to produce anesthesia almost immediately, usually within one minute. It causes a temporary, proportional reduction in cerebral (brain) blood flow and brain oxygen use, and it typically lowers intracranial pressure (pressure inside the skull) for several minutes. One of its notable properties is that, at standard doses, it has very little effect on the heart and circulation, which makes it useful for patients who need careful cardiovascular management.

Etomidate also temporarily suppresses the adrenal glands' production of cortisol and aldosterone — the body's key stress hormones — for roughly 6 to 8 hours after an induction dose. This effect does not respond to ACTH (the hormone that normally triggers cortisol release), which is why prolonged or repeated dosing carries significant risk.

Etomidate is given only as an intravenous (IV) injection by trained anesthesia professionals in a clinical setting — it is never taken by mouth or self-administered at home. The injection is given slowly, over about 30 to 60 seconds, and the dose is carefully individualized for each patient based on body weight and other factors.

• Older adults may need a lower dose
• It is not intended for prolonged continuous infusion
• When used to supplement anesthesia during a short procedure, smaller follow-up doses may be given, but these are also individualized
• Other medications given during anesthesia — including fentanyl — can affect how much etomidate is needed; the care team manages this

The most common side effects of etomidate happen during or immediately after the injection:

Serious reactions — including laryngospasm (airway spasm), severe low blood pressure, or signs of an allergic reaction — require immediate medical attention and are managed by the anesthesia team on site.

• Trained personnel only: Etomidate must be administered solely by clinicians trained in general anesthesia, with equipment available to manage any complications immediately.
• No prolonged infusion: Because etomidate suppresses the production of cortisol and aldosterone (vital stress hormones) for 6–8 hours after a single dose — an effect that does not respond to ACTH — it must never be given as a prolonged continuous drip. Extended hormonal suppression poses serious risks.
• Developing brain risk in young children: Anesthetic drugs that act on certain brain receptors may cause nerve-cell loss and possible long-term cognitive or behavioral effects when used in the developing brain. The vulnerable window is thought to run from the third trimester of pregnancy through roughly the first 3 years of life. Families and providers should carefully weigh the necessity and timing of elective procedures in very young children.
• Older adults with high blood pressure: Elderly patients — particularly those with hypertension — face a higher risk of drops in heart rate and blood pressure (cardiac depression) with etomidate.
• Liver disease: In patients with cirrhosis, etomidate stays active in the body roughly twice as long as in healthy individuals.

Etomidate is given in a controlled medical setting, so your anesthesia team manages interactions directly. The key ones to know about include:

• Fentanyl and other neuroactive drugs: These can reduce how much etomidate is needed and may shorten recovery time — your care team will adjust doses accordingly
• Neuromuscular blocking agents (drugs that relax muscles for breathing tube placement): etomidate does not significantly change the dose needed for these, but they are always used together under close supervision
• Pre-anesthetic (premedication) drugs: Common premedications are generally compatible with etomidate, but the full medication list must be reviewed before your procedure

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

• Allergy to etomidate: Etomidate is contraindicated (must not be used) in anyone with a known hypersensitivity (allergic reaction) to it — tell your team about any prior reactions
• Children under 10: Etomidate is not recommended for induction of anesthesia in this age group due to insufficient safety data
• Young children and pregnancy: Because of the potential for anesthetic drugs to affect the developing brain, parents and pregnant women should discuss the timing of any elective procedures with their doctor
• Older adults, especially with high blood pressure: Greater risk of drops in blood pressure, heart rate, and cardiac output — dose adjustments and close monitoring are needed
• Liver disease (cirrhosis): The drug is cleared more slowly, meaning effects may last longer
• Severe trauma or very low blood volume: The cardiovascular response to etomidate in these situations is not well established — full disclosure of your condition to the care team is essential

An overdose of etomidate can occur if it is injected too rapidly or in repeated doses. Too fast an injection can cause a drop in blood pressure. If an overdose is suspected, the drug is stopped immediately, the airway is secured (with a breathing tube if necessary), and oxygen with assisted breathing is provided as needed.

Etomidate produces unconsciousness rapidly — usually within one minute — but provides no pain relief on its own. It causes a temporary 20–30% reduction in cerebral (brain) blood flow and a proportional reduction in brain oxygen use, and it typically lowers intracranial pressure (pressure inside the skull) for several minutes. At standard doses, it has little to no effect on the heart, cardiac output, or circulation, making it particularly useful in patients with cardiovascular disease. It also temporarily suppresses cortisol and aldosterone production by the adrenal glands for roughly 6 to 8 hours, an effect that does not respond to the body's normal hormonal signals.

After a single intravenous dose, etomidate takes effect within about one minute, and unconsciousness typically lasts only 3 to 5 minutes at a standard dose — making recovery relatively quick. The drug is rapidly broken down (metabolized) in the liver; the main breakdown product is excreted in the urine, with about 75% of the dose eliminated in the first day. The elimination half-life — the time it takes the body to clear half the drug — is roughly 75 minutes in healthy adults. In patients with liver disease (cirrhosis), both the volume of distribution and the half-life are approximately doubled, meaning the drug stays active longer. Older adults also clear etomidate more slowly than younger adults.

Store at 20 to 25°C (68 to 77°F).