Chloral Hydrate

Insomnia, Sedation, Anxiety

Oral Insomnia Short-term treatment (maximum 2 weeks) of severe insomnia which is interfering with normal daily life and where other therapies (behavioural and pharmacologic) have failed Adult: The usual dose is 430-860 mg (15-30 ml of the 143mg/5ml strength). Higher doses should not exceed a maximum of 2 g chloral hydrate (70 ml of the 143mg/5ml strength) per dose.

Oral Insomnia Short-term treatment (maximum 2 weeks) of severe insomnia in children and adolescents with suspected or definite neurodevelopmental disorder, when the insomnia is interfering with normal daily life and other therapies (behavioural and pharmacologic) have failed Child: Children 12 years and over: The usual dose is 430-860 mg (15-30 ml of the 143mg/5ml strength). Higher doses should not exceed a maximum of 2 g chloral hydrate (70 ml of the 143mg/5ml strength) per dose. Children (between 2 and 11 years): 30-50 mg/kg (1-1.75 ml/kg of the 143mg/5ml strength) of bodyweight. The dose should not exceed 1 g chloral hydrate (35 ml of the 143 mg/5ml strength) per dose. Children under 2 years: Chloral hydrate should not be used because the safety and efficacy of chloral hydrate in children aged under 2 years has not been established

Renal Impairment Contraindicated in moderate-severe renal impairment

Elderly: Dosage as for adults, except for the frail elderly or those with hepatic impairment where a reduction in dose may be appropriate

Hepatic Impairment Contraindicated in moderate-severe hepatic impairment

Upon discontinuation withdraw gradually over 2 weeks if patient maintained on high doses for prolong periods of time; abrupt discontinuation may result in delirium. Dilute w/ water or other liquids (e.g. fruit juice, ginger ale).

Hypersensitivity/idiosyncrasy to chloral derivatives. Severe cardiac disease, acute porphyria, gastritis, oesophagitis, gastric/duodenal ulcer; obstructive sleep apnoea in childn. Marked hepatic or renal impairment. Lactation.

Patient w/ resp insufficiency, sleep apnoea, depression, suicidal tendency, history of drug or alcohol abuse. Childn, elderly. Pregnancy. Potential toxic dose <6 years old: 50 mg/kg Use with caution in porphyria Use caution in long term care patients, elderly, and neonates Use not recommended for >2 weeks Abrupt discontinuation may cause withdrawal symptoms

C Pregnancy Category: C Lactation: small amount secreted into breast milk

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 psychotropic. May produce a transient increase in hypoprothrombinemic response to warfarin. Contraindicated (2) calcium/magnesium/potassium/sodium oxybates sodium oxybate Serious (14) benzhydrocodone/acetaminophen fentanyl fentanyl intranasal fentanyl transdermal fentanyl transmucosal hydrocodone lemborexant mefloquine metoclopramide intranasal olopatadine intranasal selinexor sufentanil SL valerian zuranolone

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.

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.