Chloral hydrate is a CNS depressant drug that is used for the short term treatment of insomnia. It is not approved for use in the United States. It is used as a sedative drug prior to diagnostic tests and electroencephalogram, and as a sedative and hypnotic drug prior to surgical procedures. It is no longer recommended for pain control, alcohol, opioid, and barbiturate withdrawal, and for insomnia as previously recommended by the manufacturer.

Chloral hydrate Dose in Adults

Chloral hydrate for Procedural sedation:

• 500 - 1,000 mg half-an-hour before the procedure

Chloral hydrate Dose in Children

Use for Sedation in mechanically-ventilated patients:

• Infants, Children, and Adolescents:
  • 8 - 25 mg/kg/dose three or four times a day.
  • Titrate the dose up to 50 mg/kg/dose four times a day to a maximum of 1000 mg/dose.

Use for Sedation prior to a procedure (like echocardiogram or EEG):

• Infants and Children
  • 25 - 100 mg/kg/dose half an hour before the procedure to a maximum dose of 1,000 mg/dose.
  • The dose may be repeated after 30 minutes to 25 - 50 mg/kg/dose.
  • The maximum total dose should not exceed 100 mg/kg/procedure or 2000 mg/procedure

Pregnancy Risk Factor C

• It crosses the placental boundary.
• The neonate may experience withdrawal symptoms if long-term medication is taken during pregnancy.

Use while breastfeeding

• It can cause sedation in neonates and breastmilk. It should be avoided by lactating mothers.

Chloral hydrate Dose in Renal Disease:

Patients with mild to moderate renal impairment should use the drug with caution and those with severe kidney impairment(eGFR of less than 30 ml/min) should avoid its use. It is dialyzable.

Chloral hydrate Dose in Liver Disease:

Patients with mild to moderate hepatic impairment should use the drug with caution and those with severe hepatic impairment should avoid its use.

Common Side Effects Of Chloral hydrate include:

• Cardiovascular:

  • Atrial arrhythmia
  • Depression of myocardial contractility
  • Hypotension
  • Shortening of refractory periods
  • Torsades de pointes
  • Ventricular arrhythmia

• Central nervous system:

  • Abnormal gait
  • Ataxia
  • Confusion
  • Delirium
  • Dizziness
  • Drowsiness
  • Physical and psychological drug dependence with prolonged use or large doses.
  • Hallucinations
  • Hangover effect
  • Malaise
  • Nightmares
  • Paradoxical excitation
  • Somnambulism
  • Vertigo

• Dermatologic:

  • Skin rash including urticaria, erythema, eczematoid dermatitis, scarlatiniform exanthems

• Endocrine & metabolic:

  • Acute porphyria
  • Ketonuria

• Gastrointestinal:

  • Diarrhea
  • Flatulence
  • Gastric irritation
  • Nausea
  • Vomiting

• Hematologic & oncologic:

  • Acute porphyria
  • Eosinophilia
  • Leukopenia

• Ophthalmic:

  • Allergic conjunctivitis
  • Blepharoptosis
  • Keratoconjunctivitis

• Otic:

  • Increased middle ear pressure in infants and children.

• Respiratory:

  • Airway obstruction may occur in young children.
  • Laryngeal edema

• Miscellaneous:

  • Drug tolerance

Contraindication to Chloral hydrate include:

• Allergy to the drug (chloralhydrate or any component)
• Advanced liver disease
• Renal impairments are common

Warnings and Precautions

• Depression in the CNS:
  • Patients who use heavy machinery or perform skilled tasks that require mental alertness must be cautious and advised of its side effects.
• Cardiac disease
  • Patients with heart disease may experience hypotension and arrhythmias, especially if they are given larger doses.
• Gastrointestinal Disorders:
  • Because of its irritant properties, patients with gastritis or esophagitis should be cautious about using the drug.
• Porphyria
  • It could cause porphyria.
• Respiratory disease
  • Patients suffering from chronic neuromuscular or respiratory disease should be cautious about using the drug as it can cause respiratory failure.

Chloral hydrate (United States: Not available): Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

 Monitoring Parameters:

When used for conscious sedation, Monitor:

• Vital signs
• Oxygen saturation

How to take Chloral hydrate?

• It is administered orally.
• The syrup may be diluted in water or other oral liquid to reduce dyspepsia and gastric irritation. 

Mechanism of action of Chloral hydrate:

• Chloralhydrate is a sedative/hypnotic drug used to treat short-term insomnia. 
• It is a central nervous system depressant because of its active metabolite, trichloroethanol.
• It works wellIntakeThe onset of action takes between 15 and 30 minutes, with a duration of approximately 1 to 2 hours.

Active metabolites are competing with bilirubin to be albumin binding sites. It is growing rapidlyMetabolizedBy the enzyme alcohol deshydrogenase found in the liver to its activemetabolites trichloroethanol. It has been aEliminating half-lifePreterm infants are usually given approximately one hour, term neonates 3 - 6 hours, and children and teens 9 - 7 hours.

TheEliminating half-lifeThe active metabolite, tricholoroethanol, takes approximately 40+/- 14 hours in preterm babies, 27 +/ 21 hours for term infants, 9.6 +/-11.7 hours in children and adolescents, 8 - 12 hours for adults. It isExcretedThey are found primarily in the urine as metabolites.

International Brands of Chloral hydrate:

• Chloral Hydrate Odan
• PMS-Chloral Hydrate
• Chloradorm
• Chloraldurat
• Chloralhydrat 500
• Escre
• Kloral
• Pocral
• Welldorm

Chloral hydrate brands in Pakistan: