Chloral

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Contraindications 4 Dosage 5 Pharmacokinetics 6 Adverse-effects 7 Drug-interactions 8 Laboratory 9 Mechanism-of-action 10 More General Terms 11 Internet Database 12 References

Introduction

• Tradename: Noctec. (trichloroacetaldehyde monohydrate) DEA-controlled substance: class 4.

Indications

• short-term (< 2 weeks) sedative/ hypnotic

• 500 mg PO QHS

• sedative/ hypnotic for dental & diagnostic procedures

• 500 to 1000 mg 15-30 minutes prior to procedure

• sedative prior to EEG
• used as alcohol replacement in alcohol withdrawal

• 500 to 1000 mg PO every 6 hours PRN

Contraindications

• recovered alcoholics
  

• pregnancy category = c
• safety in lactation = ?

Dosage

• 25-50 mg/kg up to 1000 mg PO Max 75 mg/kg.

• Tabs: 250 & 500 mg.
• Syrup: 250 & 500 mg/5 mL.
• Suppositories: 345, 500, 648 mg.

Pharmacokinetics

• well absorbed after oral administration
• peak effect within 30 minutes to 1 hour
• duration of action 4-8 hours
• metabolized by liver to active metabolite trichloroethanol (active metabolite)
  

• elimination via liver
• elimination via kidney
• 1/2life = 4 min
• 1/2life = 4-14 hours trichloroethanol
• protein binding = 35 % trichloroethanol
• elimination by hemodialysis = +
• elimination by hemoperfusion = +

Adverse-effects

• common (> 10%)

• nausea/vomiting
• stomach pain

• less common (1-10%)

• skin rash, clumbsiness, hallucinations, diarrhea, drowsiness, "hangover"

• uncommon (< 1%)

• confusion, disorientation, sedation, ataxia, paradoxical excitement, dizziness, fever, headache, gastric irritation, flatulence, leukopenia, eosinophilia, addiction (physical & psychological) may occur with prolonged use of large doses
  
• drug adverse effects of sedatives

Drug-interactions

• chloral hydrate may increase effects of:

• warfarin
• CNS depressants
• alcohol

• concurrent use of furosemide ( Lasix) may result in flushing, diaphoresis & changes in blood pressure
• concurrent use of metronidazole ( Flagyl) causes a disulfiram- like reaction

Laboratory

• specimen: serum
• methods: GLC, color
• interferences:

• other chlorinated hydrocarbons may interfere with colorimetric assay
• substances metabolized to trichloroethanol will interfere with GLC assay

Mechanism-of-action

• CNS depressant

More General Terms

• aldehyde
• sedative/hypnotic (tranquilizer)

Internet Database

PubChem: 2707
PubChem: 10587

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
4. Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995

chloral [hydrate] (Noctec)