Since etomidate is insoluble in water, the drug requires formulation with 35% propylene glycol to achieve stability at normal pH. This solvent can cause burning on injection, vein irritation, and thrombophlebitis. Administration of intravenous lidocaine prior to etomidate may decrease the pain on injection. The propylene glycol solvent may cause hemolysis.
Etomidate has significant emetogenic properties. It is not an ideal choice in patients who are at risk for severe postoperative nausea and vomiting.
Toxicity is unlikely in most patients because the lethal dose is 30 times greater than the effective dose. Therefore, it has a wider margin of safety. Even so, decreased dosing is appropriate for patients with end-stage liver disease.
et al., The effects of etomidate
on adrenal responsiveness and mortality in patients with septic shock. Intensive Care Med
SA. Clinical and molecular pharmacology of etomidate