Chloral hydrate
Chloral hydrate
Chloral hydrate
( KLOH-ral HY-drayt)
Pregnancy Category: C Aquachloral Supprettes Novo-Chlorhydrate PMS-Chloral Hydrate (C-IV) (Rx)

Classification: Nonbenzodiazepine, nonbarbiturate sedative-hypnotic

Action/Kinetics: Metabolized to trichloroethanol, which is the active metabolite causing CNS depression. Produces only slight hangover effects and is said not to affect REM sleep. High doses lead to severe CNS depression, as well as depression of respiratory and vasomotor centers (hypotension). Both psychologic and physical dependence develop. Onset: Within 30 min. Duration: 4-8 hr. t 1/2, trichloroethanol: 7-10 hr. Readily absorbed from the GI tract and distributed to all tissues; passes the placental barrier and appears in breast milk. Metabolites excreted by kidney.

Uses: Short-term hypnotic. Daytime sedative and sedation prior to EEG procedures. Preoperative sedative and postoperative as adjunct to analgesics. Prevent or reduce symptoms of alcohol withdrawal.

Contraindications: Marked hepatic or renal impairment, severe cardiac disease, lactation. PO use in clients with esophagitis, gastritis, or gastric or duodenal ulcer.

Special Concerns: Use by nursing mothers may cause sedation in the infant. Dose decrease may be necessary in geriatric clients due to age-related decrease in both hepatic and renal function.

Side Effects: CNS: Paradoxical paranoid reactions. Sudden withdrawal in dependent clients may result in "chloral delirium.'' Sudden intolerance to the drug following prolonged use may result in respiratory depression, hypotension, cardiac effects, and possibly death. GI: N&V;, diarrhea, bad taste in mouth, gastritis, increased peristalsis. GU: Renal damage, decreased urine flow and uric acid excretion. Miscellaneous: Skin reactions, hepatic damage, allergic reactions, leukopenia, eosinophilia.
Chronic toxicity is treated by gradual withdrawal and rehabilitative measures such as those used in treatment of the chronic alcoholic. Poisoning by chloral hydrate resembles acute barbiturate intoxication; the same supportive treatment is indicated (see Barbiturates.

Laboratory Test Alterations: 17-Hydroxycorticosteroids. Interference with fluorescence tests for catecholamines and copper sulfate test for glucose.

Drug Interactions: Anticoagulants, oral / Anticoagulant effect by plasma protein binding CNS depressants / Additive CNS depression; concomitant use may lead to drowsiness, lethargy, stupor, respiratory collapse, coma, or death Furosemide (IV) / Concomitant use results in diaphoresis, tachycardia, hypertension, flushing

How Supplied: Capsule: 500 mg; Suppository: 325 mg, 500 mg, 650 mg; Syrup: 500 mg/5 mL

Dosage
?Capsules, Syrup Daytime sedative.
Adults: 250 mg t.i.d. after meals.
Preoperative sedative.
Adults: 0.5-1.0 g 30 min before surgery.
Hypnotic.
Adults: 0.5-1 g 15-30 min before bedtime. Pediatric: 50 mg/kg (1.5 g/m ²) at bedtime (up to 1 g may be given as a single dose).
Daytime sedative.
Pediatric: 8.3 mg/kg (250 mg/m ²) up to a maximum of 500 mg t.i.d. after meals.
Premedication prior to EEG procedures.
Pediatric: 20-25 mg/kg.
?Suppositories, Rectal Daytime sedative.
Adults: 325 mg t.i.d. Pediatric: 8.3 mg/kg (250 mg/m ²) t.i.d.
Hypnotic.
Adults: 0.5-1 g at bedtime. Pediatric: 50 mg/kg (1.5 g/m ²) at bedtime (up to 1 g as a single dose).