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chloral [hydrate] (Noctec)
Tradename: Noctec. (trichloroacetaldehyde monohydrate) DEA-controlled substance: class 4.
Indications:
1) short-term (< 2 weeks) sedative/hypnotic
- 500 mg PO QHS
2) sedation, general anesthesia for dental & diagnostic procedures
- 500 to 1000 mg 15-30 minutes prior to procedure
3) sedation prior to EEG
4) used as alcohol replacement in alcohol withdrawal
- 500 to 1000 mg PO every 6 hours PRN
Contraindications: recovered alcoholics
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:
1) well absorbed after oral administration
2) peak effect within 30 minutes to 1 hour
3) duration of action 4-8 hours
4) metabolized by liver to active metabolite trichloroethanol (active metabolite)
Adverse effects:
1) common (> 10%)
- nausea/vomiting
- stomach pain
2) less common (1-10%)
- skin rash, clumbsiness, hallucinations, diarrhea, drowsiness, "hangover"
3) 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 interactions:
1) chloral hydrate may increase effects of:
a) warfarin
b) CNS depressants
c) alcohol
2) concurrent use of furosemide (Lasix) may result in flushing, diaphoresis & changes in blood pressure
3) concurrent use of metronidazole (Flagyl) causes a disulfiram-like reaction
Laboratory:
1) specimen: serum
2) methods: GLC, color
3) interferences:
a) other chlorinated hydrocarbons may interfere with colorimetric assay
b) substances metabolized to trichloroethanol will interfere with GLC assay
Mechanism of action: CNS depressant
Interactions
drug adverse effects (more general classes)
General
aldehyde
sedative/hypnotic (tranquilizer)
Properties
MISC-INFO: elimination route LIVER
KIDNEY
1/2life 4 MIN
4-14 HOURS
therapeutic-range 2-12 UG/ML
toxic-range >20 UG/ML
protein-binding 35%
elimination by hemodialysis +
hemoperfusion +
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed.,
W.B. Saunders, 1995