chloral hydrate

(klor' al hye' drate)

Aquachloral Supprettes, PMS-Chloral Hydrate (CAN)

Pregnancy Category C
Controlled Substance C-IV

Drug class
Sedative-hypnotic (nonbarbiturate)

Therapeutic actions
Mechanism by which CNS is affected is not known; hypnotic dosage produces mild
cerebral depression and quiet, deep sleep; does not depress REM sleep, produces less
hangover than most barbiturates and benzodiazepines.

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

Contraindications and cautions

• Contraindicated with hypersensitivity to chloral derivatives; allergy to tartrazine
(in 324-mg and 648-mg suppositories marketed as Aquachloral Supprettes);
severe cardiac disease, gastritis; hepatic or renal impairment; lactation.
• Use cautiously with acute intermittent porphyria (may precipitate attacks).

Available forms
Capsules—500 mg; syrup—250, 500 mg/5 mL; suppositories—324, 500, 648 mg

Dosages
ADULTS
Single doses or daily dosage 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.

Pharmacokinetics
Route Onset Peak Duration
Oral, PR 30–60 min 1–3 hr 4–8 hr
Metabolism: Hepatic; T1/2: 7–10 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine and bile

Adverse effects
• CNS: Somnambulism, disorientation, incoherence, paranoid behavior,
excitement, delirium, drowsiness, staggering gait, ataxia, light-headedness,
vertigo, nightmares, malaise, mental confusion, headache, hallucinations
• Dermatologic: Skin irritation; allergic rashes including hives, erythema,
eczematoid dermatitis, urticaria
• GI: Gastric irritation, nausea, vomiting, gastric necrosis (following intoxicating
doses), flatulence, diarrhea, unpleasant taste
• Hematologic: Leukopenia, eosinophilia
• Other: Physical, psychological dependence; tolerance; withdrawal reaction

Interactions
Drug-drug
• Additive CNS depression with alcohol, other CNS depressants
• Mutual inhibition of metabolism with alcohol (possible vasodilation reaction
characterized by tachycardia, palpitations, and facial flushing)
• Complex effects on oral (coumarin) anticoagulants given with chloral hydrate;
monitor prothrombin levels and adjust coumarin dosage whenever chloral hydrate
is instituted or withdrawn from drug regimen
Drug-lab test
• Interference with the copper sulfate test for glycosuria, fluorometric tests for urine
catecholamines, and urinary 17-hydroxycorticosteroid determinations (when
using the Reddy, Jenkins, and Thorn procedure)

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; liver and kidney 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 care provider if you wish to
discontinue the drug.
• Avoid alcohol, sleep-inducing, or over-the-counter drugs; these could cause
dangerous effects.
• These side effects may occur: Drowsiness, dizziness, light-headedness (avoid
driving or performing tasks requiring alertness); GI upset (eat small, frequent
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.

Adverse effects in Italic are most common; those in Bold are life-threatening.