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Chloral Hydrate
Chloral Hydrate is a sedative-hypnotic medication used to treat insomnia, anxiety, and for the sedation of patients undergoing minor surgical or diagnostic procedures. It is also sometimes used as a pre-anesthetic medication. Chloral Hydrate works by depressing the central nervous system (CNS) to produce calming, sedative, and sleep-inducing effects. Due to its potential for abuse and dependence, it is not commonly prescribed today and has largely been replaced by newer medications.
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Frequently Asked Questions
How long does it take for Chloral Hydrate to work?
Chloral Hydrate typically begins to work within 15 to 30 minutes after oral administration, with its sedative effects lasting for several hours.
Can Chloral Hydrate be used long-term?
No, Chloral Hydrate is not recommended for long-term use due to the risk of dependence, tolerance, and withdrawal. It should be used only for short-term sedation or insomnia.
What should I do if I miss a dose of Chloral Hydrate?
For sedation or sleep, if you miss a dose, take it as soon as you remember, but skip the missed dose if it’s close to the next scheduled dose. Do not double the dose.
Can Chloral Hydrate be used in children?
Chloral Hydrate is sometimes used for sedation in children undergoing diagnostic procedures. The dose is based on the child's weight, and its use should be closely supervised by a healthcare provider.
Is Chloral Hydrate still commonly prescribed?
Chloral Hydrate has largely fallen out of favor due to the availability of safer, more effective medications with fewer side effects and lower potential for abuse. It is rarely prescribed today.
What should I do if I experience side effects?
If you experience any serious side effects, such as difficulty breathing, irregular heartbeat, or signs of an allergic reaction, seek immediate medical attention.
Comprehensive Drug Guide
How Does Chloral Hydrate Work?
Chloral Hydrate is metabolized in the liver to trichloroethanol, the active metabolite responsible for its sedative effects. Trichloroethanol enhances the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, which helps to slow down brain activity and produce sedation and sleep.
What is Chloral Hydrate Used For?
Chloral Hydrate is predominantly used to manage insomnia and is often used in a short-term capacity. It can also be used as a sedative before prior to a minor surgery or procedure.
Common Dosages
- Insomnia (Adults): 500 mg to 1000 mg taken 15 to 30 minutes before bedtime.
- Sedation (Adults): 500 mg to 1000 mg taken 30 to 60 minutes before a procedure.
- Pediatric Sedation: 25 to 50 mg/kg administered 30 to 60 minutes before a procedure, with a maximum dose of 1000 mg.
Typical Dosing
- Administration: Chloral Hydrate can be taken orally as a liquid or capsule. It should be taken with water, and the liquid form can be mixed with a sweetened liquid to improve taste.
- Frequency: Usually taken once daily for insomnia, or as a single dose before a procedure.
- Duration of Use: Chloral Hydrate is typically prescribed for short-term use due to the risk of dependence and tolerance with long-term use.
Typical Dosing
FDA Approved Indications
- Insomnia: Short-term treatment of difficulty falling or staying asleep.
- Sedation: For patients undergoing minor surgical or diagnostic procedures.
- Pre-Anesthetic Medication: To induce calmness and sedation before general anesthesia.
Off-Label Uses
Alcohol withdrawal symptoms: Depends on the severity of the symptoms and should be determined by a healthcare professional.
Pediatric Dosing
Sleep disorders in children: Dosing is usually based on weight, so always follow the doctor's instructions.
Who Shouldn't Take Chloral Hydrate?
- Hypersensitivity to chloral hydrate or any component of the formulation.
- Severe liver or kidney disease, as the drug is metabolized in the liver and excreted by the kidneys.
- History of substance abuse due to the risk of dependence.
- Severe cardiovascular disease, as chloral hydrate can cause arrhythmias.
Advice From The Pharmacist
- Take the medication exactly as prescribed and for the shortest duration possible to reduce the risk of dependence.
- Avoid alcohol or other central nervous system depressants, as these can increase the sedative effects and risk of overdose.
- Avoid driving or operating heavy machinery after taking the medication, as it can cause drowsiness, dizziness, and impaired motor skills.
- Inform their healthcare provider if they have a history of liver or kidney disease, substance abuse, or heart problems before using Chloral Hydrate.
- Do not abruptly stop taking Chloral Hydrate after prolonged use, as it can lead to withdrawal symptoms.
Side Effects of Chloral Hydrate
Common Side Effects
- Drowsiness or dizziness
- Nausea or vomiting
- Stomach pain or bloating
- Diarrhea
- Headache
Uncommon/Severe Side Effects
- Respiratory Depression: Slow or shallow breathing, particularly when combined with other CNS depressants.
- Cardiovascular Effects: Irregular heartbeat, fainting, or chest pain.
- Allergic Reactions: Rash, itching, swelling, or difficulty breathing.
- Dependence and Withdrawal: Long-term use can lead to physical and psychological dependence, with withdrawal symptoms if stopped suddenly.
Risks and Warnings of Chloral Hydrate
- Risk of Dependence: Chloral Hydrate has a high potential for abuse, dependence, and tolerance, especially when used for extended periods or at higher doses.
- Respiratory Depression: Use with caution in patients with respiratory conditions, as it can cause significant CNS depression.
- Overdose Risk: Taking too much Chloral Hydrate, especially when combined with alcohol or other sedatives, can result in overdose, leading to respiratory failure or death.
- Withdrawal: Abrupt cessation after long-term use can cause withdrawal symptoms, including anxiety, tremors, hallucinations, and seizures.
Interactions with Chloral Hydrate
Common Drug Interactions
- Alcohol: Increases the risk of severe CNS depression, respiratory failure, and death.
- Benzodiazepines and Barbiturates: Increase the sedative effects, leading to a higher risk of overdose.
- Opioids: Can enhance CNS and respiratory depression.
- Anticoagulants (e.g., warfarin): Chloral Hydrate can increase the anticoagulant effect, raising the risk of bleeding.
Alternatives to Chloral Hydrate
- Benzodiazepines: Such as lorazepam or diazepam, for anxiety and sedation.
- Z-Drugs: Such as zolpidem or eszopiclone, for short-term treatment of insomnia.
- Antihistamines: Such as diphenhydramine or hydroxyzine, for mild sedation and sleep aid.
- Melatonin or Ramelteon: For regulating sleep patterns in patients with insomnia.
