Drug Class Description

Generic Name

Drug Description

Presentation

Indications

Adult Dosage

For intravenous administration.

Adults and children:

A dose of 0.3 mg/kg given intravenously at induction of anaesthesia, gives sleep lasting from 6 to 10 minutes.

Elderly Dosage

A dose of 0.15-0.2 mg/kg bodyweight should be given and the dose should be further adjusted according to effects.

Since Hypnomidate has no analgesic action, appropriate analgesics should be used in procedures involving painful stimuli.

Do not exceed a total dose of 30 ml (3 ampoules).

Hypnomidate should only be given by slow intravenous injection.

Hypnomidate may be diluted with sodium chloride infusion BP or dextrose infusion BP but it is not compatible with compound sodium lactate infusion BP (Hartmann's solution). Combinations with pancuronium bromide may show a very slight opalescence; for this reason the two should not be mixed together.

Contra Indications

Hypnomidate is contraindicated in patients with known hypersensitivity to etomidate

Special Precautions

Warnings: In patients with liver cirrhosis, or in those who have already received neuroleptic, opiate or sedative agents, the dose of etomidate should be reduced.

When Hypnomidate is used, resuscitation equipment should be readily available to manage apnoea. In cases of adrenocortical gland dysfunction and during very long surgical procedures, a prophylactic cortisol supplement may be required (for example 50 to 100 mg hydrocortisone).

Reduced serum cortisol levels, unresponsive to ACTH injections, have been reported in some patients during induction of anaesthesia but particularly during maintenance of anaesthesia with etomidate; for this reason etomidate should not be used for maintenance. However, when etomidate is used for induction, the post-operative rise in serum cortisol which has been observed after thiopentone induction is delayed for approximately 3-6 hours.

Hypnomidate should not be administered to patients with evidence or suggestion of reduced adrenal cortical function.

Hypnomidate should be used with caution in elderly patients, since the potential exists for decreases in cardiac output, which have been reported with doses greater than recommended.

Convulsions may occur in unpremedicated patients.

Precautions: Hypnomidate by injection should be given slowly.

Interactions

Sedative drugs potentiate the hypnotic effect of Hypnomidate.

Hypnomidate is pharmacologically compatible with the muscle relaxants, premedicant drugs and inhalation anaesthetics in current clinical use.

Adverse Reactions

The use of narcotic analgesics or diazepam as premedication and during surgery will reduce the uncontrolled spontaneous muscle movements shown by some patients after Hypnomidate administration.

Pain can occur after injection into the small veins of the dorsum of the hand. Use of larger veins or an intravenous application of a small dose of fentanyl 1-2 minutes before induction reduces pain on injection. In a small number of patients, thrombophlebitis has been reported.

Nausea and/or vomiting may occur although these are mainly as a result of concurrent use of opiates. Coughing, hiccough and/or shivering may also be experienced. Allergic reactions, including rare cases of bronchospasm and anaphylactoid reactions, have been reported. Rare cases of laryngospasm, cardiac arrhythmias and convulsions have also been reported.

A slight and transient drop in blood pressure may occur due to a reduction of the peripheral vascular resistance. In vulnerable patients, special care should be exercised to minimise this effect.

Respiratory depression and apnoea may occur.

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