chloral hydrate

chloral hydrate

Indication

  • For use as a short-term sedative (less than 2 weeks)
  • Sedative/hypnotic prior to diagnostic procedures

Dosage Guidelines

  • Sedation (agitation): 10-15 mg/kg/dose oral/rectal q6-8 hours as needed
  • Sedation (pre-procedure): 50-75 mg/kg/dose oral/rectal.  Give 30 to 60 minutes prior to procedure. May repeat in 30 minutes x 1 dose to a maximum of 120 mg/kg total or 500 mg total

Administration

  • Oral: Mix with feeds to minimize gastric irritation
  • Rectal: Dilute 1:1 with sterile water for injection

Adverse Effects

  • Gastric irritation, vomiting, diarrhea, paradoxical excitement and hypotension
  • CNS, myocardial and respiratory depression
  • Rarely, ketonuria, leucopenia and eosinophilia
  • Prolonged use may result in direct hyperbilirubinemia

Comments

  • For oral route, onset within 20 minutes.  Maximum effect 30 to 60 minutes
  • Avoid oral route in gastritis and gastric duodenal ulcers
  • Drug interactions:
    • CNS depressants: additive CNS depression
    • Furosemide IV in patients with cardiac disease:  diaphoresis, flushing and changes in BP within 24 hours of administration
  • Avoid use in patients with severe renal or hepatic impairment
  • Not recommended for extended routine sedation in neonates due to the possibility of accumulation of toxic metabolites

Supplied As

  • 100 mg/mL oral liquid

References

LexiComp Pediatric and Neonatal, LexiComp Sick Kids