ADMINISTRATION ROUTES:
PO
ALTERNATIVE NAMES:
Trichloroacetaldehyde hydrate
ICU INDICATIONS:
- 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
GFR (ml/min) | DOSE |
---|---|
<10 | do not use |
10-20 | 10 mg/kg PRN 4-6 hrly |
>20-50 | dose as in normal renal function |
Dose in renal replacement therapy
MODALITY | DOSE |
---|---|
CAPD | do not use |
HD | do not use |
CVVHDF | 10 mg/kg PRN 4-6 hrly |
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:
- Children with marked hepatic or renal impairment
- Children with severe cardiac disease
- Gastritis
- 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