chloral hydrate

chloral /chlo·ral/ (klor´al)

1. an oily liquid with a pungent, irritating odor; used in the manufacture of chloral hydrate and DDT.

2. c. hydrate.

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chloral hydrate  a hypnotic and sedative, now used mainly as an adjunct to anesthesia and as a sedative for children undergoing medical and dental procedures.

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chlo·ral hydrate (klôrl)

n.

A crystalline compound used medicinally as a sedative and hypnotic.

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chloral hydrate,

a sedative and hypnotic.

indications It is prescribed for the short-term (less than 2 wks) relief of insomnia, anxiety, or tension and as a sedative/hypnotic for diagnostic procedures.

contraindications Liver or kidney dysfunction or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse reactions are GI disturbances, skin rash, paradoxic excitement, and hypotension.

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chloral hydrate (klor´l hī´drāt),

n brand names: Aquachloral Supprettes, Novo-chlorhydrate;
drug class: sedative-hypnotic chloral derivative, controlled substance schedule IV, schedule F;
action: produces central nervous system depression;
uses: sedation, treatment of insomnia, anesthesia adjunct.

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chloral

1. an oily liquid with a pungent, irritating odor, prepared by the mutual action of alcohol and chlorine; used in the manufacture of chloral hydrate and DDT.

2. vernacular contraction of the term chloral hydrate.

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chloral betaine

formed by the reaction of chloral hydrate with betaine; used as a sedative.

chloral hydrate

rarely if ever used in small animals. Widely used as a hypnotic, analgesic and anesthetic agent in large animals, especially in horses. Has many disadvantages and has been superseded by many much more satisfactory preparations. Its continued use is a matter of economics. Chloral hydrate may be administered orally but is erratic and slow-acting in its effects by this route. Intravenously the effects are immediate; injection outside the vein causes a very severe cellulitis usually terminating in an extensive slough of tissue.

Chloral hydrate is a poor analgesic and severely depressant of respiratory and vasomotor centers in the medulla.

chloral hydrate and guaiacol glyceryl ether

used as an anesthetic combination in horses; combines muscular relaxation with hypnotic effect.

chloral hydrate and magnesium sulfate

an anesthetic preparation used in horses. Combines the hypnotic effect of chloral and the neuromuscular blocking effect of magnesium.

chloral hydrate, magnesium sulfate and pentobarbital sodium

see equithesin.

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chloral hydrate Warning - High-alert drug!

Aquachloral, Novo-Chloral hydrate (CA), PMS-Chloral Hydrate (CA), Welldorm (UK)

Pharmacologic class: CNS agent

Therapeutic class: Sedative-hypnotic

Controlled substance schedule IV

Pregnancy risk category C

Action

Unclear. Thought to produce CNS depression by converting into its metabolite, trichloroethanol.

Availability

Capsules: 250 mg, 500 mg

Suppositories: 324 mg, 500 mg, 648 mg

Syrup: 250 mg/ml, 500 mg/ml

⊘Indications and dosages

➣ Nighttime sedation

Adults: 500 mg to 1 g P.O. or P.R. 15 to 30 minutes before bedtime, not to exceed 2 g

Children: 50 mg/kg/day P.O., to a maximum dosage of 1 g given as a single dose or in divided doses

➣ Sedation

Adults: 250 mg P.O. or P.R. t.i.d. after meals

Children: 25 mg/kg/day P.O. or P.R., to a maximum daily dosage of 500 mg, given as a single dose or in divided doses

Contraindications

• Hypersensitivity to drug or tartrazine
• Coma, CNS depression, esophagitis, ulcer disease
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• hepatic dysfunction, severe renal impairment
• elderly patients.

Administration

• Know that drug may take 45 to 60 minutes to achieve adequate preprocedural sedation in children.
☞ When giving to children for preprocedural sedation, be aware that drug may cause unpredictable or paradoxical effects.

Route	Onset	Peak	Duration
P.O.	30 min	1 hr	4-8 hr
P.R.	0.5-1 hr	Unknown	4-8 hr

Adverse reactions

CNS: dizziness, drowsiness, nightmares, ataxia, paradoxical stimulation, hangover, delirium, light-headedness, hallucinations, confusion

GI: nausea, vomiting, diarrhea, flatulence

Hematologic: eosinophilia, leukopenia

Skin: hypersensitivity reactions

Other: physical and psychological drug dependence

Interactions

Drug-drug. CNS depressants (including antidepressants, antihistamines, narcotics, sedating antipsychotic drugs, and other sedative-hypnotics): excessive CNS depression

Furosemide: diaphoresis, flushing, nausea, uneasiness, variable blood pressure

Oral anticoagulants: increased risk of bleeding

Phenytoin: decreased phenytoin blood level

Drug-diagnostic tests. Eosinophils: increased count

Urinary 17-hydroxycorticosteroids: interference with test interpretation

White blood cells: decreased count

Drug-behaviors. Alcohol use: excessive CNS and respiratory depression

Patient monitoring

• Monitor respiratory status, including oxygen saturation (using pulse oximetry), especially in children.
• Assess creatinine levels in patients with chronic renal disease.
• Monitor hepatic enzyme levels in patients with chronic hepatic disease.
• After giving drug to child, turn down room lights and minimize other stimulation.

Patient teaching

• Instruct patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Caution patient not to drink alcohol during therapy.
• When administering to a child, instruct parents to minimize stimulation to decrease risk of paradoxical reaction.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.