chloral hydrate

Generic Name : chloral hydrate
Brand Name: Aquachloral Supprettes, PMS-Chloral Hydrate (CAN), Chloral Hydrate-Odan (CAN), Somnote
Classification: Sedative-hypnotic (nonbarbiturate)
Pregnancy Category C
Controlled Substance C-IV

Dosage & Route

Adults

Single doses or daily dose should not exceed 2 g.

• Hypnotic: 500 mg–1 g PO or rectally 15–30 min before bedtime or 30 min before surgery. It is not usually considered safe practice to give oral medication to patients who are NPO for anesthesia or surgery.
• Sedative: 250 mg PO or rectally tid after meals.

Pediatric Patients

• Hypnotic: 50 mg/kg/day PO up to 1 g per single dose; may be given in divided doses.
• Sedative: 25 mg/kg/day PO up to 500 mg per single dose; may be given in divided doses.

Therapeutic actions

• Chloral hydrate is used principally as a hypnotic in the treatment of insomnia; effective only for short-term use. Its CNS depressant effect, similar to those of paraldehyde and barbiturates, may be attributed to its metabolite, trichloroethanol.

Indications

• Nocturnal sedation
• Preoperative sedation to lessen anxiety and induce sleep without depressing respiration or cough reflex
• Adjunct to opiates and analgesics in postoperative care and control of pain

Adverse effects

• Gastric irritation, abdominal distention and flatulence, vertigo, ataxia, staggering gait, rashes, malaise, lightheadedness, headache, ketonuria, excitement, nightmares, delirium (especially in elderly), eosinophilia, reduction in white blood cell count; dependence on prolonged use.

Contraindications

• Hepatic or renal impairment, cardiac disease, hypersensitivity, porphyria, esophagitis, gastritis. Pregnancy and lactation.

Nursing considerations

Assessment

• History: Hypersensitivity to chloral derivatives, allergy to tartrazine, severe cardiac disease, gastritis, hepatic or renal impairment, acute intermittent porphyria, lactation
• Physical: Skin color, lesions; orientation, affect, reflexes; P, BP, perfusion; bowel sounds, normal output, liver evaluation; LFTs, renal function tests, CBC and differential, stool guaiac test

Interventions

• Give capsules with a full glass of liquid; ensure that patient swallows capsules whole; give syrup in half glass of water, fruit juice, or ginger ale.
• Supervise dose and amount of drug prescribed for patients who are addiction prone or alcoholic; give least amount feasible to patients who are depressed or suicidal.
• Withdraw gradually over 2 wk if patient has been maintained on high doses for weeks or months; if patient has built up high tolerance, withdrawal should occur in a hospital, using supportive therapy similar to that for barbiturate withdrawal; fatal withdrawal reactions have occurred.
• Reevaluate patients with prolonged insomnia; therapy for the underlying cause (eg, pain, depression) is preferable to prolonged use of sedative–hypnotic drugs.

Teaching points

• Take this drug exactly as prescribed: Swallow capsules whole with a full glass of liquid (take syrup in half glass of water, fruit juice, or ginger ale).
• Do not discontinue the drug abruptly. Consult your health care provider if you wish to discontinue the drug.
• Avoid alcohol, sleep-inducing, or over-the-counter drugs; these could cause dangerous effects.
• You may experience these side effects: Drowsiness, dizziness, light-headedness (avoid driving or performing tasks requiring alertness); GI upset (eat frequent small meals); sleep-walking, nightmares, confusion (use caution: close doors, keep medications out of reach so inadvertent overdose does not occur while confused).
• Report rash, coffee ground vomitus, black or tarry stools, severe GI upset, fever, sore throat.

Posted in: Pharmacology