Etomidate Injection Shortage

• • Etomidate injection, Armas Pharmaceuticals, 2 mg/mL, 10 mL vial, 10 count, NDC 72485-0508-10
  • Etomidate injection, Armas Pharmaceuticals, 2 mg/mL, 20 mL vial, 10 count, NDC 72485-0509-10
  • Etomidate injection, Eugia US, 2 mg/mL, 10 mL vial, 10 count, NDC 55150-0221-10
  • Etomidate solution for injection, Fosun Pharma, 2 mg/mL, 10 mL vial, 10 count, NDC 72266-0146-10 - discontinued
  • Etomidate solution for injection, Fosun Pharma, 2 mg/mL, 20 mL vial, 10 count, NDC 72266-0147-10 - discontinued
  • Etomidate injection, Fresenius Kabi, 2 mg/mL, 10 mL vial, 10 count, NDC 65219-0445-10
  • Etomidate injection, Hikma, 2 mg/mL, 20 mL vial, 10 count, NDC 00143-9507-10

• • Armas did not provide a reason for the shortage.[1]
  • Eugia has etomidate on shortage due to increased demand.[2]
  • Fresenius Kabi did not provide a reason for the shortage[3]
  • Fosun has exited the market.[4]
  • Hikma has etomidate on shortage due to increased demand.[5]
  • Pfizer has etomidate injection available.[6]
  • Sagent discontinued etomidate in April 2023.[7]
  • Viatris (Mylan Institutional) has etomidate injection available.[8]

• • Amidate injection, Pfizer, 2 mg/mL, 10 mL vial, 10 count, NDC 00409-6695-01
  • Amidate injection, Pfizer, 2 mg/mL, 20 mL vial, 10 count, NDC 00409-6695-02
  • Etomidate injection, Eugia US, 2 mg/mL, 20 mL vial, 10 count, NDC 55150-0222-20
  • Etomidate injection, Fresenius Kabi, 2 mg/mL, 20 mL vial, 10 count, NDC 65219-0447-10
  • Etomidate injection, Hikma, 2 mg/mL, 10 mL vial, 10 count, NDC 00143-9506-10
  • Etomidate injection, Mylan Institutional (Viatris), 2 mg/mL, 10 mL vial, 10 count, NDC 67457-0902-10
  • Etomidate injection, Mylan Institutional (Viatris), 2 mg/mL, 20 mL vial, 10 count, NDC 67457-0903-20

Estimated Resupply Dates

• • Armas has etomidate 2 mg/mL 10 mL and 20 mL vials on back order and the company estimates a release date of early-June2025.[1]
  • Eugia has etomidate 2 mg/mL 10 mL vials on back order and the company cannot estimate a release date.[2]
  • Fresenius Kabi has etomidate 2 mg/mL 10 mL vials on back order and the company estimates a release date of mid-to late-May 2025.[3]
  • Hikma has etomidate 2 mg/mL 20 mL vials on back order and the company estimates a release date of late-May 2025.[5]

Implications for Patient Care

• • Etomidate is an injectable sedative medication used for the induction of general anesthesia and procedural anesthesia as well as supplementation of subpotent anesthetic agents. It has also been used for rapid sequence intubation.[9-10]

Safety

• • Etomidate is beneficial in its hemodynamic stability, when considering alternatives it is important to be aware of possible changes to hemodynamics.[11]

Alternative Agents & Management

• • Ketamine and propofol are common alternatives for etomidate. There are practice guidelines available for moderate procedural sedation and analgesia. These are available at https://pubs.asahq.org/anesthesiology/article/128/3/437/18818/Practice-Guidelines-for-Moderate-Procedural.

References

• 1. Armas (personal communication). July 5, 2024; March 7 and 14, April 4, and May 9 and 16, 2025.
  2. Eugia (personal communication). September 26, October 14, November 11, December 9 and 22, 2022; January 6 and 20, February 17, March 3, 16, and 31, April 17, May 26, June 9, July 10 and 21, August 4 and 31, October 27, December 19, 2023; April 15, May 15, July 1 and 15, November 11, 2024; January 1, February 15, March 15, and April 1, 2025.
  3. Fresenius Kabi (personal communication). September 30, October 28, November 19, December 2, 9, and 21, 2022; January 20 and 27, February 10 and 17, March 3, 10, and 17, April 7, 14, and 21, June 9 and 16, July 7 and 27, August 3, 10, 17, and 31, October 19, November 2 and 16, 2023; January 18, February 2, April 18, May 30, July 5 and 24, November 15 and 27, 2024; January 3 and 31, March 7 and 13, April 3, and May 8 and 15, 2025.
  4. Fosun (personal communication). November 22, 2022; March 7 and 17, April 24, June 8, July 10, August 11, October 19, November 3, 2023; February 5, May 7, November 18, 2024; and January 10, 2025.
  5. Hikma (personal communication). September 28, November 3 and 17, December 9 and 22, 2022; January 19 and 25, February 8, March 2, 8, and 15, April 6, 13, 20, and 26, May 25, June 8 and 15, July 5 and 27, August 2, 16, and 30, October 18, November 1 and 15, 2023; January 17, February 28, April 17, May 29, July 3 and 24, November 13 and 27, 2024; January 8 and 29, February 5, March 5 and 12, April 2, and May 7 and 14, 2025.
  6. Pfizer (personal communication). September 30, November 6 and 20, December 5, 14, and 22, 2022; January 22 and 27, February 12 and 20, March 6, 13, and 17, April 11, 18, and 23, May 1 and 31, June 9, July 10 and 26, August 13 and 19, and September 4, October 23, November 3 and 17, 2023; January 23, February 4, April 22, June 4, July 5 and 26, November 15, December 3, 2024; January 8, February 3, March 9 and 14, April 4, and May 14, 2025.
  7. Sagent (personal communication). September 29, November 3 and 17, December 9 and 12, 2022; January 19, February 9, March 2, and 9, and April 20, 2023.
  8. Viatris (personal communication). September 28, November 22, 2022; February 22, April 12, 19, and 24, May 2, June 1 and 6, July 11, August 28, October 9, 2023; January 22, 2024, June 5, October 31, 2024; January 20, and April 8, 2025.
  9. Amidate injection (etomidate) [prescribing information]. Lake Forest, IL: Hospira Inc; April 2022.
  10. Etomidate. Lexicomp Online. Wolters Kluwer Clinical Drug Information. Hudson, Ohio, USA. Accessed; Accessed July 13, 2023.
  11. Jellish WS, Edelstein S. Chapter 106 - Neuroanesthesia. In: Biller J, Ferro JM, eds. Handbook of Clinical Neurology. Vol 121. Neurologic Aspects of Systemic Disease Part III. Elsevier; 2014:1623-1633. doi:10.1016/B978-0-7020-4088-7.00106-1