Chloral Hydrate

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Chloral Hydrate

Definition

Chloral hydrate is a drug used to help sedate persons before and after surgery, to help relieve anxiety or tension, and to promote sleep in individuals with insomnia. It is sold in the United States under the brand names Aquachloral®, Aquachloral Supprettes®, and Noctec®. It is also available under its generic name.

Purpose

Because of its calming effect, chloral hydrate is primarily used to help sedate persons before and after surgery, especially children. It is also used to help people with sleep difficulties fall asleep. Chloral hydrate can be used to help calm tense or nervous persons as well.

Description

Chloral hydrate is classified as a sedative-hypnotic drug. The mechanism by which this drug works is not completely understood. It is believed that a chemical produced by chloral hydrate, called trichlor-oethanol, causes a mild depressive effect on the brain.

Recommended dosage

Chloral hydrate is available in oral and suppository forms. The oral form includes both capsules and syrup. Adults usually receive 500-1,000 mg taken 15-30 minutes before bedtime or one to two hours before surgery. These dosages are for hypnotic effects. For sedative effects, 250 mg is usually taken three times daily after meals. Total daily dosage should not be more than 2 g (2,000 mg). The hypnotic dose for children is usually 50 mg for every kilogram of body weight. The maximum amount per single dose is 1 g.

Daily dosage is usually divided into several smaller doses and taken throughout the day. The sedative dose is typically one-half of the hypnotic dose. The syrup form should be combined with a half glass of fruit juice or water. The capsules should be taken with a full glass of water or juice to help prevent stomach upset.

The typical dose using suppositories is 500 to 1,000 mg at bedtime for adults to address trouble sleeping, and 325 mg three times a day for daytime sedation in adults. For children in preparation for a medical procedure, the dose is calculated based on body weight, usually at 50 mg per kilogram. Children also may receive this as light sedation before an electroencephalograph test, in which case the dose is usually 25 mg per kilogram of body weight.

Precautions

The treating doctor needs to check the progress of any patients taking this drug for more than a few days to ensure significant side effects are not developing. Patients should not stop taking chloral hydrate suddenly. Instead, the dosage should be gradually decreased over time. Chloral hydrate can produce increased effects when combined with other central nervous depressants such as alcohol, antihistamines, and tranquilizers, resulting in significant drowsiness. This drug can sometimes cause persons to become drowsy, light-headed, or dizzy, and should generally not be used in patients with a history of severe kidney disease, severe liver disease, or those with a history of significant heart disease.

Chloral hydrate should be used with great caution only where necessary in persons with a history of heart disease, people with gastrointestinal problems or por-phyria, those with a history of drug abuse , and in the elderly. It should be used with caution in pregnant women and in women who are nursing. Chloral hydrate, like most drugs, can be taken in excess to the point of overdose. Signs of overdose include difficulty in swallowing, extreme weakness, confusion, seizures , extreme drowsiness, low body temperature, staggering, changes in heart rate, and breathing problems.

Side effects

Uncommon but serious side effects of chloral hydrate use include skin rash or hives. Even more rare side effects include confusion, hallucination, and excessive excitement. The development of any of these side effects should be promptly reported to a doctor.

Less serious but more common side effects of chloral hydrate use include nausea, stomach pain,

KEY TERMS

Hydrated —A substance combined chemically with water.

Hypnotic —A type of medication that induces sleep.

Porphyria —A group of disorders that arise from changes in the metabolism of porphyrin, a naturally occurring compound in the body, and that are characterized by acute abdominal pain and neurological problems.

Sedative —A medication that induces relaxation and sleep.

and vomiting. Less common and not particularly serious side effects include diarrhea, light-headedness, drowsiness, and clumsiness.

Interactions

Because of additive depressant effects on the central nervous system, this drug should not be combined with alcohol as the combination can lead to significant drowsiness. Likewise, chloral hydrate should not be combined with tricyclic antidepressants or with the blood-thinning drug called warfarin. The prescribing physician should be made aware of any drugs or medications you are taking.