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).

ᶻ Range,ꙺ Data derived from popPK model and Vd or Cl. Vd,ss = V1+V2+V3.

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Renal impaiment in children > 3 months

No information available on dose adjustment in renal impairment.

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.

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).

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

• NERVOUS SYSTEM
• ANESTHETICS

ANESTHETICS, GENERAL

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

References

1. Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
2. 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
3. B.Braun Melsungen AG, SmPC Etomidaat Lipuro (RVG 19122) 28-04-2022, www.geneesmiddeleninformatiebank.nl
4. Forman SA., Clinical and molecular pharmacology of etomidate, Anesthesiology, 2011, 114(3), 695-707
5. 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
6. Su F, et al., Population pharmacokinetics of etomidate in neonates and infants with congenital heart disease., Biopharm Drug Dispos., 2015, 36(2), 104-14
7. Kay B., A clinical assessment of the use of etomidate in children, Br J Anaesth, 1976, 48(3), 207-11
8. 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
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

Changes

Therapeutic Drug Monitoring

Overdose