Chloral Hydrate: Uses, Dosage, Side Effects, and More

As a pharmacist with extensive experience in psychiatric medications, I often come across various sedatives and hypnotics used for different medical purposes. One such drug, chloral hydrate, has been around for quite some time and is known for its use in treating insomnia and inducing sedation. While it’s not as commonly prescribed today due to the availability of newer medications, it still holds importance, especially in pediatric and psychiatric care. In this post, we will explore the various aspects of chloral hydrate, from its uses to its side effects and preparations. Let’s dive in.

What is Chloral Hydrate?

Chloral hydrate is a sedative-hypnotic drug that has been used since the late 19th century to induce sleep and manage anxiety or agitation. Its chemical formula is C₂H₃Cl₃O₂, and it works by depressing the central nervous system, making it an effective option for short-term treatment of insomnia and preoperative sedation.

Chloral hydrate is often classified under non-barbiturate sedatives, which means it does not belong to the same class as barbiturates, although it has similar sedative effects. It has historically been utilized in both adults and children, though its usage has declined due to safety concerns and the availability of better alternatives like benzodiazepines and non-benzodiazepine hypnotics.

Uses of Chloral Hydrate

Chloral hydrate has a range of uses, particularly in clinical and pediatric settings. Its primary applications include:

1. Insomnia Treatment: It was initially used as a sleep aid, particularly for people struggling with chronic insomnia. However, it’s important to note that chloral hydrate is typically reserved for short-term use due to the risk of dependence.
2. Preoperative Sedation: Chloral hydrate is sometimes used to sedate patients before surgical procedures or diagnostic tests. This is particularly useful in children, where mild sedation is required.
3. Pediatric Sedation: In pediatrics, chloral hydrate can be given to children to keep them calm during certain procedures, such as MRI scans or dental surgeries. It is typically preferred when other sedatives are not suitable.
4. Psychiatric Use: In psychiatric settings, chloral hydrate may be used to manage acute agitation in patients or to help with sleep disturbances, especially when other medications fail.

Chloral Hydrate Dosage: Adults and Children

The dosage of chloral hydrate varies depending on the patient’s age, medical condition, and the specific use case.

Chloral Hydrate Dose for Adults

• Insomnia: The usual adult dose is 500 mg to 1 g taken 15-30 minutes before bedtime. This dose is often adjusted based on individual needs.
• Preoperative Sedation: For sedation before surgery, 500 mg to 1 g is typically administered 30 minutes to an hour before the procedure.

Chloral Hydrate Dose for Children

• Pediatric Sedation: For children, the dose is much lower and calculated based on body weight. The recommended pediatric dose is 50 mg/kg, up to a maximum of 1 g, taken orally. This is usually given 30 minutes to an hour before a procedure.

Dosage Reference for Chloral Hydrate

Preparation of Chloral Hydrate Syrup

One common formulation of chloral hydrate is in syrup form, particularly for pediatric use or patients who have difficulty swallowing pills. Here’s how it’s prepared:

Preparation of Chloral Hydrate Syrup (500mg/5ml)

• Ingredients:
  • Chloral hydrate: 500 mg
  • Distilled water: Quantity sufficient to make 5 ml of syrup.
  • Preservatives: Optional, but sodium benzoate may be added to extend shelf life.
• Procedure:
  1. Dissolve 500 mg of chloral hydrate in a small quantity of distilled water.
  2. Add a flavoring agent like vanilla or cherry to mask the bitter taste.
  3. Adjust the volume with distilled water to make 5 ml of syrup.
  4. Ensure the solution is well-mixed and store in a tightly sealed bottle.

This syrup is especially useful for children or individuals requiring precise dosing in small volumes. Always ensure that the syrup is prepared by a professional and dosed accurately.

Side Effects of Chloral Hydrate

Like any medication, chloral hydrate has a range of side effects, some of which can be severe. These should always be considered before prescribing or consuming the medication.

Common Side Effects:

• Drowsiness: As a sedative, chloral hydrate often causes drowsiness and lethargy, especially the morning after use.
• Gastrointestinal Discomfort: Nausea, vomiting, and stomach cramps are frequently reported by users.
• Headaches: Some individuals experience mild to moderate headaches.

Serious Side Effects:

• Dependence and Withdrawal: Long-term use can lead to dependence, and abrupt cessation after prolonged use may result in withdrawal symptoms like restlessness, anxiety, and even seizures.
• Cardiovascular Effects: Overdose can cause severe cardiovascular effects, including hypotension and arrhythmias.
• Respiratory Depression: In high doses, chloral hydrate can suppress breathing, particularly in elderly patients or those with respiratory conditions.

If any of these serious side effects occur, medical attention is required immediately.

Where to Buy Chloral Hydrate

Chloral hydrate is not a medication that can be purchased over the counter. In many countries, including the United States and the UK, it is a controlled substance, meaning that a doctor’s prescription is required to obtain it. This control is due to its potential for abuse, particularly because of its street name associations.

Chloral Hydrate’s Street Name

Chloral hydrate has been known colloquially as “Mickey Finn” or simply “knockout drops” in the past. This term comes from its use in the early 20th century as a substance used to incapacitate individuals, particularly in criminal settings.

Chloral Hydrate Suppositories and Other Forms

Aside from oral solutions and syrups, chloral hydrate is also available in suppository form, though this is less common. Suppositories are sometimes used for patients who are unable to take medications orally due to nausea, vomiting, or other conditions.

Chloral Hydrate Suppository Doses

• The adult dose is generally 500 mg to 1 g, inserted rectally before bedtime or a medical procedure.
• Pediatric doses are again calculated based on weight and typically administered in a hospital setting.

Alternatives to Chloral Hydrate

In recent years, chloral hydrate’s use has declined due to the availability of safer and more effective sedatives. Here’s a list of commonly prescribed alternatives:

1. Benzodiazepines: These include drugs like diazepam (Valium) or lorazepam (Ativan). They are frequently used for both sleep disorders and sedation, though they also carry risks of dependence.
2. Z-Drugs: Non-benzodiazepine hypnotics like zolpidem (Ambien) or eszopiclone (Lunesta) are often preferred for short-term management of insomnia.
3. Melatonin Receptor Agonists: Ramelteon (Rozerem) is an example of a newer sleep aid that works by targeting melatonin receptors and has a lower risk of dependence.

Conclusion: Is Chloral Hydrate Still Relevant?

While chloral hydrate is not as widely used today due to safety concerns, it remains a valuable tool in specific medical situations, particularly in pediatric sedation and in patients who cannot tolerate other medications. As a pharmacist, I believe it’s essential to understand both the benefits and risks associated with this drug. When used appropriately and under strict medical supervision, chloral hydrate can be an effective short-term solution for insomnia or preoperative sedation.

However, it’s important for both medical professionals and patients to stay informed about newer, safer alternatives that are available today.

Key Points Summary:

• Primary Uses: Insomnia, preoperative sedation, pediatric sedation.
• Dosage: Varies by age and condition, typically 500 mg to 1 g for adults and 50 mg/kg for children.
• Side Effects: Include drowsiness, gastrointestinal discomfort, and, in severe cases, dependence and respiratory depression.
• Availability: Controlled substance; requires a prescription.

As with any medication, it’s vital to consult with a healthcare provider to ensure that chloral hydrate is the right option for your specific condition.