Chloral Hydrate

ADMINISTRATION ROUTES:

PO

ALTERNATIVE NAMES:

Trichloroacetaldehyde hydrate

ICU INDICATIONS:

1. Paediatric sedation

PRESENTATION AND ADMINISTRATION:

PO:

100 mg/mL liquid in 200 mL bottle Chloral hydrate is light sensitive so should be stored in dark container. Shake bottle before use. Administer with milk or after feed

Note: Section 29 drug (requires specific notification to Director-General of Health)

DOSAGE:

Not used in adults

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment

Dose in renal replacement therapy

DOSAGE IN PAEDIATRICS:

PO:

25 mg/kg PRN 4-6 hrly

Do not chart higher regular doses than this. Additional stat doses may be given if required.

Often an initial loading dose of 50 mg/kg may be needed.

Give after feeding to reduce gastric irritation

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. The drug has no analgesic properties

CONTRAINDICATIONS:

1. Children with marked hepatic or renal impairment
2. Children with severe cardiac disease
3. Gastritis
4. Children 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 sulphate 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 IN ICU:

Chloral hydrate may cause hypoprothrombinaemic effects in patients taking oral anticoagulants

Administration of chloral hydrate followed by intravenous furosemide may result in sweating, hot flushes, 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, hallucinations

Haematological:

Leukopaenia and eosinophilia

Dermatological:

Allergic skin rashes including hives, erythema, eczematoid dermatitis, urticaria, scarlatiniform exanthems

Gastrointestinal:

Gastric irritation and occasionally nausea and vomiting, flatulence, diarrhoea, unpleasant taste

Miscellaneous:

Headache, hangover, idiosyncratic syndrome, and ketonuria have been reported