Chloral hydrate

Chloral hydrate

ADMINISTRATION ROUTES:

  • PO

ALTERNATIVE NAMES:

Chloral hydrate

ICU INDICATIONS:

  1. paediatric sedation

PRESENTATION AND ADMINISTRATION:

  • PO:
    100mg/ml liquid in 200ml bottle Section 29 Medicine

DOSAGE:

  • PO:
    Not used in adults

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: do not use
    10-20: 10mg/kg PRN 4-6 hrly
    >20-50: dose as in normal renal function
  • Dose in renal replacement therapy
    CAPD: do not use
    HD: do not use
    CVVHDF: 10mg/kg PRN 4-6 hrly

DOSAGE IN PAEDIATRICS:

  • PO:
    25mg/kg/dose PRN 4-6hrly (do not chart higher regular doses than this; additional stat doses may be given if required)
    Often an initial loading dose of 50mg/kg may be needed

CLINICAL PHARMACOLOGY:

  • The mechanism of action of chloral hydrate is not known, but the CNS depressant effects are believed to be due to its active metabolite trichloroethanol.

CONTRAINDICATIONS:

Chloral hydrate is contraindicated in:

  1. patients with marked hepatic or renal impairment
  2. patients with severe cardiac disease.
  3. the presence of gastritis.
  4. patients with a known hypersensitivity to the drug.

WARNINGS

  • Chloral hydrate is genotoxic and may be carcinogenic in mice. Chloral hydrate should not be used when less potentially dangerous agents would be effective.

PRECAUTIONS

  • General:
    Chloral hydrate has been reported to precipitate attacks of acute intermittent porphyria and should be used with caution in susceptible patients.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions:
    Chloral hydrate may interfere with copper sulfate tests for glycosuria (suspected glycosuria should be confirmed by a glucose oxidase test when the patient is receiving chloral hydrate), fluorometric tests for urine catecholamines (it is recommended that the medication not be administered for 48 hours preceding the test), or urinary 17- hydroxycorticosteroid determinations.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Chloral hydrate may cause hypoprothrombinemic effects in patients taking oral anticoagulants
  • Administration of chloral hydrate followed by intravenous furosemide may result in sweating, hot flashes, and variable blood pressure including hypertension due to a hypermetabolic state caused by displacement of thyroid hormone from its bound state.
  • CNS depressants are additive in effect and the dosage should be reduced when combinations of sedatives are given concurrently.

ADVERSE REACTIONS

  • Central Nervous System:
    Excitement, tolerance, addiction, delirium, drowsiness, staggering gait, ataxia, lightheadedness, vertigo, dizziness, nightmares, malaise, mental confusion, and hallucinations.
  • Hematological:
    Leukopenia and eosinophilia.
  • Dermatological:
    Allergic skin rashes including hives, erythema, eczematoid dermatitis, urticaria, and scarlatiniform exanthems.
  • Gastrointestinal:
    Gastric irritation and occasionally nausea and vomiting, flatulence, diarrhoea, and unpleasant taste.
  • Miscellaneous:
    Headache, hangover, idiosyncratic syndrome, and ketonuria have been reported.

Critical Care Drug Manual

Print Friendly