- Dosages
- Side effects in children
- Warnings & precautions in children
- Contra-indications in children
-
Interactions - PK
- Renal impairment
- References
Pharmacokinetics in children
Etomidate has no analgetic effect, to receive good analgesia an analgesic should be administered, such as fentanyl before the induction with etomidate. The effect duration is around 4 to 5 minutes. The pharmacokinetics of etomidate was studied in children. A study performed in 12 children (aged 7-13 years, weight 22-48 kg) reported a mean total volume of distribution (4.0 L/kg), similar to that of adults (see table 1). Etomidate is lipophilic and its metabolism depends on the hepatic esterase activity (hydrolyzes the drugs to a carboxylic acid and an ethanol leaving group). The carboxylate metabolite is excreted mostly in urine, and to a lesser degree in bile (SmPC Etomidaat Lipuro)). The drug clearance per weight in children was approximately 58% higher than in adults, however this applies to older children. These data indicate that children would need higher doses than adults (Dennhart 2020).
|
Age |
Dose (mg/kg) |
Clearance (L/min/kg) |
Vdcentral (L/kg) |
Vdperipheral (L/kg) |
Vd,ss (L/kg) |
Vdtotal apparant (L/kg) |
Vd (L/kg) |
T1/2β (min) |
Ref. |
|
Adults |
0,3 |
0,0109 |
0,27 |
2,5 |
4,1 |
Sfez et al. 1990 |
|||
|
4,5 |
180-300ᶻ |
KNMP |
|||||||
|
Children |
0,4 |
0,0172 |
0,66 |
2,8 |
4,0 |
175 |
Sfez et al.1990 |
||
|
Children - 4y, 16kg |
0,3 |
CL1 0,031; CL2 0,04; CL3 0,025 |
0,136 |
V2 0,157; V3 1,13 |
1,423b |
Lin et al. 2012 |
|||
|
Neonates - Infants |
0,3 |
0,017 |
0,135 |
0,326 |
0,461b |
Su et al. 2015 |
ᶻ Range,ꙺ Data derived from popPK model and Vd or Cl. Vd,ss = V1+V2+V3.
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dose recommendation of formulary compared to licensed use (on-label versus off-label)
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Available formulations
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Dosages
| Anaesthesia: induction |
|---|
|
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Renal impaiment in children > 3 months
No information available on dose adjustment in renal impairment.
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The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here
Side effects in children
Muscle twitching because of subcortical disinhibition. Haemodynamically stable. Monitor the adrenocortical suppression in long-term use.
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The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here
Contra-indications
No information available on specific contra indications in children.
The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here
Warnings & precautions in children
Always combined with corticosteroids because of adrenal suppression by etomidate (even for a one-time administration).
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Interactions
The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here
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| Halogenated hydrocarbons | ||
|---|---|---|
| N01AB07 | ||
| N01AB06 | ||
| N01AB08 | ||
| Barbiturates, plain | ||
|---|---|---|
| N01AF03 | ||
| Opioid anesthetics | ||
|---|---|---|
| N01AH02 | ||
| N01AH01 | ||
| N01AH06 | ||
| N01AH03 | ||
| Other general anesthetics | ||
|---|---|---|
| N01AX01 | ||
| N01AX14 | ||
| N01AX10 | ||
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References
- Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
- Den Brinker M et al, One single dose of etomidate negatively influences adrenocortical performance for at least 24h in children with meningococcal sepsis., Intensive Care Med, 2008, Jan 34(1), 163-8
- B.Braun Melsungen AG, SmPC Etomidaat Lipuro (RVG 19122) 28-04-2022, www.geneesmiddeleninformatiebank.nl
- Forman SA., Clinical and molecular pharmacology of etomidate, Anesthesiology, 2011, 114(3), 695-707
- Sfez M, et al., Comparaison de la pharmacocinétique de l'étomidate chez l'enfant et chez l'adulte. , Annales Françaises d'Anesthésie et de Réanimation., 1990, 9(2), 127-31
- Su F, et al., Population pharmacokinetics of etomidate in neonates and infants with congenital heart disease., Biopharm Drug Dispos., 2015, 36(2), 104-14
- Kay B., A clinical assessment of the use of etomidate in children, Br J Anaesth, 1976, 48(3), 207-11
- Dennhardt N, et al., Effect of etomidate on systemic and regional cerebral perfusion in neonates and infants with congenital heart disease: A prospective observational study., Paediatr Anaesth, 2020, 30(9), 984-9
- Sfez M, et al., Comparaison de la pharmacocinétique de l'étomidate chez l'enfant et chez l'adulte., Annales Françaises d'Anesthésie et de Réanimation., 1990, 9(2), 127-31
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Changes
Changes
