chloral [hydrate] (Noctec)
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Introduction
Tradename: Noctec. (trichloroacetaldehyde monohydrate) DEA-controlled substance: class 4.
Indications
- short-term (< 2 weeks) sedative/hypnotic
- sedation, general anesthesia for dental & diagnostic procedures
- 500 to 1000 mg 15-30 minutes prior to procedure
- sedation prior to EEG
- used as alcohol replacement in alcohol withdrawal
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
- 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%)
- 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 interactions
- chloral hydrate may increase effects of:
- 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
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