Drug interactions - summary-

Chloral Hydrate +

Alcohol

  synergic effect with chloral hydrate

Anticoagulants

hypoprothrombinemic effect may occur,

CNS depressants

 may have additive CNS effect with chloral hydrate admin. ( barbiturates )

Furosemide

 admn. of chloral hydrate followed by IV furosemide may result in sweating etc.

Hydantoin

 elimination of phenytoin increased by concurrent admin of chloral hydrate, possibly reducing its effectiveness

Drug/Lab test interactions-

chloral hydrate may interfere with copper sulphate test for glycosuria ( confirm suspected glycosuria by a glucose oxidase test ,flurometric for urine catecholamines ( do not administer medication for 48 hours preceding the test ) or urinary 17-hydroxycorticosteroid determinations ( when using the Reddy Jenkins and Tom procedure )

Nocturnal sedation

CNS- somnambulism, disorientation, incoherance, paranoid behaviour, excitement, delirium, drowsiness, staggering gait, ataxia, lightheadedness, vertigo, dizziness, nightmares, mental confusion.

Hematologcal- Leukopenia, eosinophillia ( occasional )

Dermatologic- allergic skin rashes, including hives, erythema, eczematoid dermatitis, urticaria, scalatiniform exanthems ( occasional )

GI - Gastric irritation, nausea, vomiting, (Occassional ) flatulence, diarrhoea, unpleasant taste in mouth

Miscellaneous- hangover, idiosyncratic syndrome, ketonuria ( rare )

Marked hepatic or renal impairment,severe cardiac disease, gastritis,hypersensitivity or idiosyncracies to chloral derivatives.

Warning- Pregnancy-

Safety for use during pregnancy hass not bben established. Use only when clearly needed

Lactation- Chloral hydrate is excreted in breast milk, use by nursing mothers may cause sedation in the infant Special precautions: Potentially hazardous tasks- May produce drowsiness.Patients should observe caution while driving or doing tasks which require mental alertness.

Cardiac disease-- continued use of therapeutic doses does not have deleterious effects. Do not use large doses in patients with cardiac disease.

GI conditions- Avoid use in patients with esophagitis,gastritis or gastric or deuodenal ulcer.

Drug dependency- abuse- may be habit forming. Excecise caution in administering to patients prone to addition. Drowsiness, lethargy and hang over are frequently observed from excessive drug intake

Indications:

Nocturnal sedation

Dosage:

Adult- Single dose or daily dose should not exceed 2g. Hypnotic - 500 to 1g 15 to 30 minutes before bed time or 30 minutes before surgery Sedative- 250mg 3 times daily after meals.

Children- Hypnotic - 50mg/kg/day upto 1g per single dose or in divided doses.. Sedative - 25mg/kg/day upto 500mg per single dose or in divided dose..

CHLORAL HYDRATE- SEDATIVES

1.May cause GI upset. Take capsules with a full glass of water or friut juice,swallow capsule as a whole. Do not chew. Dilute syrup in a half glass of water or friut juice.

2. May cause drowsiness,use caution while performng hazardous tasks requiring alertness.

3.Avoid alcohol and other CNS depressants.

4.May be habit forming,do not discontinue the drug abruptly.

5. Allergy- Tell your doctor if you have ever had any unusual allergic reaction to chloral hydrate, or any oher food substances, presrvatives

6. Pregnancy- Studies on birth defects have not been done either on humans or animals. Too much use of chloral hydrate may cause the baby to become dependent on the medicine. This may lead to withdrawal of side effects after birth.

7. Breast feeding- Passes into breast milk and may cause drowsiness in babies of mothers using this medicine

8. Children- Serious problems including deaths have occured when children are given wrong strengths. Make sure your doctor has told your pharmacist both how many miligrams and how many capsules, teaspoonfuls or suppositories your child should receive. This information is needed to be sure the right amout of medicine is given.

9.Older adults- No specific information available comparing use of chloral hydrate in the elderly with use in other age groups

10. Other medicines- Tell your doctor if you taking other medicines- Anticoagulants - chloral hydrate may change the amount of anticoagulant you need to take. Central nervous system depressants or Tricyclic antidepressants - using these medicines and chloral hydrate together may increase the CNS and other depressant effects.

11. Other medical problems- Tell your doctor if have any other medical problems especially- Alcohol abuse- Drug abuse or dependence - dependendence on chloral hydrate may develop Proctitis or inflammation of the rectum - chloral hydrate used rectally may make the condion worse

12. Dosing- Follow the doctors instructios

13. Missed dose- if you taking this medicine regularly and you miss a dose, take it as soon as possible. However if it is amost time for the next dose, skip the missed dose and go back to your normal schedule Do no double doses.

14. Storage- Keep te medicines away from children Do not store the capsule or tablets in the barth room or near the sink or in damp places. Dampness and heat will cause the medicine to break down Do not keep outdated or unwanted medicines. Make sure that all discarded medicines are kept out of reach of children.

Pharmacology:

Mechanism of is not clearly understood. Hypnotic dosage produces cerbral depression and quiet deep sleep.

Pharmacokinetics:

Readily absorbed and metabolised to trichloroethanol,the principal active metabolite. Trichloroethanol has a plasma half-life of 7 to 10 hours. The drug is converted in the liver and kidney to trichloroacetic acid and excreted in the urine and bile.

Not significant.

Pregnancy-

Safety for use during pregnancy hass not bben established. Use only when clearly needed

Lactation-

Chloral hydrate is excreted in breast milk, use by nursing mothers may cause sedation in the infant