Formulary
Chloral hydrate: Indications, Dosing, Side Effects and Interactions
Chloral hydrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Chloral hydrate: Indications, Dosing, Side Effects and Interactions
Chloral hydrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Severe insomnia [short-term use when insomnia is interfering with daily life and other therapies have failed]**
- **Adult** (By Mouth Using Oral Solution): 430-860 mg once daily for a maximum of 2 weeks, dose to be taken with water or milk at bedtime, dose may be increased if necessary up to maximum 2 g once daily, repeat courses are not recommended and can only be administered after reassessment by a specialist.
**Severe insomnia, using cloral betaine 707 mg ( 414 mg chloral hydrate) tablets [short-term use when insomnia is interfering with daily life and other therapies have failed]**
- **Adult** (By Mouth Using Tablets): 1-2 tablets once daily for a maximum of 2 weeks, dose to be taken with water or milk at bedtime, repeat courses are not recommended and can only be administered after reassessment by a specialist, alternatively 414-828 mg once daily for a maximum of 2 weeks, dose to be taken with water or milk at bedtime, repeat courses are not recommended and can only be administered after reassessment by a specialist; maximum 4 tablets per day; maximum 2 g per day.
**Sedation for painless procedures for chloral hydrate**
- **Neonate** (By mouth): 30-50 mg/kg, to be given 45-60 minutes before procedure, doses up to 100 mg/kg may be used with respiratory monitoring.
- **Child 1 month-11 years** (By mouth): 30-50 mg/kg (max. per dose 1 g), to be given 45-60 minutes before procedure, dose may be increased if necessary up to 100 mg/kg (max. per dose 2 g).
- **Child 12-17 years** (By mouth): 1-2 g, to be given 45-60 minutes before procedure.
- **Neonate** (By rectum): 30-50 mg/kg, to be given 45-60 minutes before procedure, doses up to 100 mg/kg may be used with respiratory monitoring, administration by rectum only if oral route not available.
- **Child 1 month-11 years** (By rectum): 30-50 mg/kg (max. per dose 1 g), to be given 45-60 minutes before procedure, dose may be increased if necessary up to 100 mg/kg (max. per dose 2 g), administration by rectum only if oral route not available.
- **Child 12-17 years** (By rectum): 1-2 g, to be given 45-60 minutes before procedure, administration by rectum only if oral route not available.
**Severe insomnia [short-term use in patients with a suspected or definite neurodevelopmental disorder when insomnia is interfering with daily life and other therapies have failed] (specialist use only) for chloral hydrate**
- **Child 2-11 years** (By mouth using oral solution): 30-50 mg/kg once daily (max. per dose 1 g) for a maximum of 2 weeks, dose to be taken with water or milk at bedtime, repeat courses are not recommended and can only be administered after reassessment by a specialist.
- **Child 12-17 years** (By mouth using oral solution): 430-860 mg once daily for a maximum of 2 weeks, dose to be taken with water or milk at bedtime, dose may be increased if necessary up to maximum 2 g once daily, repeat courses are not recommended and can only be administered after reassessment by a specialist.
**Severe insomnia, using cloral betaine 707 mg ( 414 mg chloral hydrate) tablets [short-term use in patients with a suspected or definite neurodevelopmental disorder when insomnia is interfering with daily life and other therapies have failed] (specialist use only) for chloral hydrate**
- **Child 12-17 years** (By mouth using tablets): 1-2 tablets once daily for a maximum of 2 weeks, dose to be taken with water or milk at bedtime, repeat courses are not recommended and can only be administered after reassessment by a specialist, alternatively 414-828 mg once daily for a maximum of 2 weeks, dose to be taken with water or milk at bedtime, repeat courses are not recommended and can only be administered after reassessment by a specialist; maximum 4 tablets per day; maximum 2 g per day.
Cautions
Avoid contact with mucous membranes; avoid contact with skin; avoid prolonged use (and abrupt withdrawal thereafter); reduce dose in frail elderly
Contraindications
Acute porphyrias ; gastritis; severe cardiac disease
Side effects
Frequency not known Agitation; allergic dermatitis; ataxia; confusion; delirium (more common on abrupt discontinuation); drug use disorders; gastrointestinal discomfort; gastrointestinal disorders; headache; injury; ketonuria; kidney injury
Interactions
**Other interactions (5):**
- Concomitant use of alcohol and chloral hydrate may potentiate the sedative effect; concomitant use should be avoided.
- Concomitant use with antipsychotics, hypnotics, anxiolytics/sedatives, antidepressant agents, centrally acting muscle relaxants, narcotic analgesics, anti-epileptic drugs, anaesthetics and sedative...
- The concomitant use of drugs that also prolong the QT interval in ECG (for example, antiarrhythmics of Class IA or III, antibiotics, agents against malaria, H1 antihistamines, antipsychotics or...
- 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...
- In patients taking anticoagulants, when chloral hydrate is added to or withdrawn from the drug regimen, or its dosage changed, careful monitoring of the prothrombin time is required.
Pregnancy
Avoid.
Breast feeding
Risk of sedation in infant-avoid.
Hepatic impairment
Manufacturer advises avoid in marked impairment. Dose adjustments Manufacturer advises consider dose reduction in the elderly with hepatic impairment.
Renal impairment
Caution in mild to moderate impairment; avoid in severe impairment. M Dose adjustments Dose adjustment may be necessary in mild to moderate impairment. M
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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