Chloral hydrate


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Insomnia; Hypnotic 0.5-1 g as a single dose 15-30 min before bedtime or 30 min prior to surgery. Max: 2 g/day. Sedation 250 mg tid. Max: 2 g/day.
Dosage Details
Oral
Hypnotic, Insomnia
Adult: 0.5-1 g as a single dose 15-30 min before bedtime or 30 min prior to surgery. Max: 2 g daily. Treatment duration: ≤2 wk.
Child: 2-11 yr 30-50 mg/kg as a single dose 15-30 min before bedtime. Max: 1 g daily; ≥12 yr 0.5-1 g as a single dose 15-30 min before bedtime. Max: 2 g daily. Treatment duration: ≤2 wk.
Elderly: 250 mg 15-30 min before bedtime.

Oral
Sedation
Adult: 250 mg tid. Max: 2 g daily.
Renal Impairment
Contraindicated.
Hepatic Impairment
Contraindicated.
Reconstitution
Dilute w/ water or other liquids (e.g. fruit juice, ginger ale).
Incompatibility
Incompatible w/ alkalis, alkali carbonates, alkaline earth, alcohol, tannin, iodide, borax, soluble barbiturates, permanganate, and oxidising agents.
Contraindications
Severe cardiac disease, acute porphyria, gastritis, oesophagitis, gastric/duodenal ulcer; obstructive sleep apnoea in childn. Marked hepatic or renal impairment. Lactation.
Special Precautions
Patient w/ resp insufficiency, sleep apnoea, depression, suicidal tendency, history of drug or alcohol abuse. Childn, elderly. Pregnancy.
Adverse Reactions
Significant: Gastric irritation (e.g. nausea, vomiting, diarrhoea), abdominal distention, flatulence, tolerance, dependence.
Nervous: Drowsiness, light-headedness, headache, paradoxical excitement, hallucination, nightmares, confusion, ataxia.
GI: Gastritis, unpleasant taste.
Genitourinary: Ketonuria, parenchymatous renal injury.
Dermatologic: Erythema multiforme, Stevens-Johnson syndrome.
Potentially Fatal: Delirium tremens.
Patient Counseling Information
Avoid contact w/ skin or mucous membranes. Avoid prolonged use or abrupt withdrawal. This drug may cause drowsiness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor vital signs, oxygen saturation, and BP.
Overdosage
Symptoms: Resp depression, arrhythmia, hypothermia, hypotension, pin-point pupils, coma, muscle flaccidity, icterus, jaundice, albuminuria, vomiting, oesophageal stricture; gastric necrosis, perforation, and haemorrhage. Management: Symptomatic and supportive treatment including oxygen admin, assisted respiration, and maintenance of airway, body temp, and circulation. Continuously monitor cardiac function. Employ activated charcoal or gastric lavage, and induce emesis.
Drug Interactions
Enhanced sedative effect w/ opiates, barbiturates, TCAs, antipsychotics, antihistamines, and other sedatives. May cause hot flushes, sweating, and HTN w/ IV furosemide. May cause delirium w/ anticholinergics or psychotropics. May produce a transient increase in hypoprothrombinemic response to warfarin.
Food Interaction
Enhanced sedative effect and may cause tachycardia, palpitations, facial flushing, and dysphoria w/ alcohol.
Lab Interference
May interfere w/ tests for determining urinary glucose using copper sulfate (e.g. Clinitest) and urinary 17-hydroxycorticosteroid (e.g. Reddy, Jenkins, and Thorn procedure), fluorometric tests for urine catecholamine, and thyroid function tests.
Action
Description: Chloral hydrate is a sedative and hypnotic w/ properties similar to paraldehyde and barbiturates. Its exact mechanism of action is unknown, however, it is believed that its CNS depressant effects are due to its active metabolite, trichloroethanol.
Onset: W/in 30 min.
Duration: 4-8 hr.
Pharmacokinetics:
Absorption: Rapidly and well absorbed from the GI tract.
Distribution: Widely distributed throughout the body, including CSF. Crosses the placenta and enters breast milk. Plasma protein binding: 35-40% (trichloroethanol); approx 94% (trichloroacetic acid).
Metabolism: Rapidly metabolised in the liver, erythrocytes, and other tissues by alcohol dehydrogenase to the active metabolite, trichloroethanol, and further oxidised in the liver and kidneys to the inactive metabolite, trichloroacetic acid. Trichloroethanol may also be conjugated w/ glucuronic acid to form an inactive metabolite, urochloralic acid.
Excretion: Via urine (as metabolites) and faeces (in small amounts). Elimination half-life: 8-10 hr (trichloroethanol); 67.2 hr (trichloroacetic acid).
Chemical Structure

Chemical Structure Image
Chloral hydrate

Source: National Center for Biotechnology Information. PubChem Database. Chloral hydrate, CID=2707, https://pubchem.ncbi.nlm.nih.gov/compound/Chloral-hydrate (accessed on Jan. 21, 2020)

Storage
Store below 25°C. Protect from light.
ATC Classification
N05CC01 - chloral hydrate ; Belongs to the class of aldehydes and derivatives. Used as hypnotics and sedatives.
References
Anon. Chloral Hydrate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com . Accessed 20/02/2017.

Buckingham R (ed). Cloral Hydrate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/02/2017.

Joint Formulary Committee. Chloral Hydrate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 2002/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Chloral Hydrate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 20/02/2017.

Disclaimer: This information is independently developed by MIMS based on Chloral hydrate from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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