chloral hydrate (Rx)

Brand and Other Names:Somnote
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule: Schedule IV

  • 500mg

syrup: Schedule IV

  • 500mg/5mL

Insomnia

Indicated for use as hypnotic for simple insomnia; rarely used for this indication

500 mg to 1 g PO 15-30 minutes before bedtime; for short-term use only (ie, up to 2 weeks); not to exceed 2 g/24hr

Sedative/Anxiety

250 mg PO PC q8hr; not to exceed 2 g/day

Renal Impairment

Contraindicated in moderate-severe renal impairment

Hepatic Impairment

Contraindicated in moderate-severe hepatic impairment

Administration

Upon discontinuation withdraw gradually over 2 weeks if patient maintained on high doses for prolong periods of time; abrupt discontinuation may result in delirium

Dosage Forms & Strengths

capsule: Schedule IV

  • 500mg

syrup: Schedule IV

  • 500mg/5mL

Sedation for Procedures (Off-label)

50-75 mg/kg PO 30-60 min before procedure; may repeat in 30 min if necessary  

Not to exceed 120 mg/kg or 1 g/dose in infants or 2 g/dose in children

Sedation/Anxiety (Off-label)

May be used prior to procedure or EEG evaluation

25-50 mg/kg/day PO divided q6-8hr; not to exceed 500 mg/dose  

Next:

Interactions

Interaction Checker

and chloral hydrate

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            Contraindicated (2)

            • calcium/magnesium/potassium/sodium oxybates

              chloral hydrate, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

            • sodium oxybate

              chloral hydrate, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

            Serious - Use Alternative (13)

            • benzhydrocodone/acetaminophen

              benzhydrocodone/acetaminophen, chloral hydrate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • fentanyl

              fentanyl, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl intranasal

              fentanyl intranasal, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transdermal

              fentanyl transdermal, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • fentanyl transmucosal

              fentanyl transmucosal, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

            • hydrocodone

              hydrocodone, chloral hydrate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • lemborexant

              lemborexant, chloral hydrate. Either increases effects of the other by sedation. Avoid or Use Alternate Drug. Use of lemborexant with other drugs to treat insomnia is not recommended.

            • mefloquine

              mefloquine increases toxicity of chloral hydrate by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.

            • metoclopramide intranasal

              chloral hydrate, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            • selinexor

              selinexor, chloral hydrate. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

            • sufentanil SL

              sufentanil SL, chloral hydrate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • valerian

              valerian and chloral hydrate both increase sedation. Avoid or Use Alternate Drug.

            • warfarin

              chloral hydrate increases effects of warfarin by plasma protein binding competition. Avoid or Use Alternate Drug.

            Monitor Closely (188)

            • albuterol

              chloral hydrate increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alfentanil

              chloral hydrate and alfentanil both increase sedation. Use Caution/Monitor.

            • alprazolam

              alprazolam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • amitriptyline

              chloral hydrate and amitriptyline both increase sedation. Use Caution/Monitor.

            • amobarbital

              amobarbital and chloral hydrate both increase sedation. Use Caution/Monitor.

            • amoxapine

              chloral hydrate and amoxapine both increase sedation. Use Caution/Monitor.

            • apomorphine

              chloral hydrate and apomorphine both increase sedation. Use Caution/Monitor.

            • arformoterol

              chloral hydrate increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aripiprazole

              chloral hydrate and aripiprazole both increase sedation. Use Caution/Monitor.

            • armodafinil

              chloral hydrate increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • azelastine

              azelastine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • baclofen

              chloral hydrate and baclofen both increase sedation. Use Caution/Monitor.

            • belladonna and opium

              chloral hydrate and belladonna and opium both increase sedation. Use Caution/Monitor.

            • benperidol

              chloral hydrate and benperidol both increase sedation. Use Caution/Monitor.

            • benzphetamine

              chloral hydrate increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • brexanolone

              brexanolone, chloral hydrate. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • brompheniramine

              brompheniramine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • buprenorphine

              chloral hydrate and buprenorphine both increase sedation. Use Caution/Monitor.

            • buprenorphine buccal

              chloral hydrate and buprenorphine buccal both increase sedation. Use Caution/Monitor.

            • buprenorphine, long-acting injection

              chloral hydrate increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

            • butabarbital

              butabarbital and chloral hydrate both increase sedation. Use Caution/Monitor.

            • butalbital

              butalbital and chloral hydrate both increase sedation. Use Caution/Monitor.

            • butorphanol

              chloral hydrate and butorphanol both increase sedation. Use Caution/Monitor.

            • caffeine

              chloral hydrate increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • carisoprodol

              chloral hydrate and carisoprodol both increase sedation. Use Caution/Monitor.

            • cenobamate

              cenobamate, chloral hydrate. Either increases effects of the other by sedation. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide and chloral hydrate both increase sedation. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • chlorpromazine

              chloral hydrate and chlorpromazine both increase sedation. Use Caution/Monitor.

            • chlorzoxazone

              chloral hydrate and chlorzoxazone both increase sedation. Use Caution/Monitor.

            • cinnarizine

              cinnarizine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • clemastine

              clemastine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • clobazam

              chloral hydrate, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

            • clomipramine

              chloral hydrate and clomipramine both increase sedation. Use Caution/Monitor.

            • clonazepam

              clonazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • clorazepate

              clorazepate and chloral hydrate both increase sedation. Use Caution/Monitor.

            • clozapine

              chloral hydrate and clozapine both increase sedation. Use Caution/Monitor.

            • codeine

              chloral hydrate and codeine both increase sedation. Use Caution/Monitor.

            • cyclizine

              cyclizine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • cyclobenzaprine

              chloral hydrate and cyclobenzaprine both increase sedation. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • dantrolene

              chloral hydrate and dantrolene both increase sedation. Use Caution/Monitor.

            • daridorexant

              chloral hydrate and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • desipramine

              chloral hydrate and desipramine both increase sedation. Use Caution/Monitor.

            • deutetrabenazine

              chloral hydrate and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • dexfenfluramine

              chloral hydrate increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmedetomidine

              chloral hydrate and dexmedetomidine both increase sedation. Use Caution/Monitor.

            • dexmethylphenidate

              chloral hydrate increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextroamphetamine

              chloral hydrate increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dextromoramide

              chloral hydrate and dextromoramide both increase sedation. Use Caution/Monitor.

            • diamorphine

              chloral hydrate and diamorphine both increase sedation. Use Caution/Monitor.

            • diazepam

              diazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • diazepam intranasal

              diazepam intranasal, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

            • diethylpropion

              chloral hydrate increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • difelikefalin

              difelikefalin and chloral hydrate both increase sedation. Use Caution/Monitor.

            • difenoxin hcl

              chloral hydrate and difenoxin hcl both increase sedation. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate and chloral hydrate both increase sedation. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • diphenoxylate hcl

              chloral hydrate and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

            • dipipanone

              chloral hydrate and dipipanone both increase sedation. Use Caution/Monitor.

            • dobutamine

              chloral hydrate increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopamine

              chloral hydrate increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dopexamine

              chloral hydrate increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dosulepin

              chloral hydrate and dosulepin both increase sedation. Use Caution/Monitor.

            • doxepin

              chloral hydrate and doxepin both increase sedation. Use Caution/Monitor.

            • doxylamine

              chloral hydrate and doxylamine both increase sedation. Use Caution/Monitor.

            • droperidol

              chloral hydrate and droperidol both increase sedation. Use Caution/Monitor.

            • ephedrine

              chloral hydrate increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine

              chloral hydrate increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • epinephrine racemic

              chloral hydrate increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • estazolam

              estazolam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • ethanol

              chloral hydrate and ethanol both increase sedation. Use Caution/Monitor.

            • etomidate

              etomidate and chloral hydrate both increase sedation. Use Caution/Monitor.

            • fenfluramine

              chloral hydrate increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flibanserin

              chloral hydrate and flibanserin both increase sedation. Modify Therapy/Monitor Closely. Risk for sedation increased if flibanserin is coadministration with other CNS depressants.

            • fluphenazine

              chloral hydrate and fluphenazine both increase sedation. Use Caution/Monitor.

            • flurazepam

              flurazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • formoterol

              chloral hydrate increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • gabapentin

              gabapentin, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gabapentin enacarbil

              gabapentin enacarbil, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • gotu kola

              gotu kola increases effects of chloral hydrate by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • haloperidol

              chloral hydrate and haloperidol both increase sedation. Use Caution/Monitor.

            • hawthorn

              hawthorn increases effects of chloral hydrate by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hops

              hops increases effects of chloral hydrate by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • hydromorphone

              chloral hydrate and hydromorphone both increase sedation. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • iloperidone

              chloral hydrate and iloperidone both increase sedation. Use Caution/Monitor.

            • imipramine

              chloral hydrate and imipramine both increase sedation. Use Caution/Monitor.

            • isoproterenol

              chloral hydrate increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • kava

              kava increases effects of chloral hydrate by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • ketamine

              ketamine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • ketotifen, ophthalmic

              chloral hydrate and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, chloral hydrate. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • levalbuterol

              chloral hydrate increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • levorphanol

              chloral hydrate and levorphanol both increase sedation. Use Caution/Monitor.

            • lisdexamfetamine

              chloral hydrate increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lofepramine

              chloral hydrate and lofepramine both increase sedation. Use Caution/Monitor.

            • lofexidine

              chloral hydrate and lofexidine both increase sedation. Use Caution/Monitor.

            • loprazolam

              loprazolam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • lorazepam

              lorazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • lormetazepam

              lormetazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • loxapine

              chloral hydrate and loxapine both increase sedation. Use Caution/Monitor.

            • loxapine inhaled

              chloral hydrate and loxapine inhaled both increase sedation. Use Caution/Monitor.

            • lurasidone

              lurasidone, chloral hydrate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • maprotiline

              chloral hydrate and maprotiline both increase sedation. Use Caution/Monitor.

            • marijuana

              chloral hydrate and marijuana both increase sedation. Use Caution/Monitor.

            • melatonin

              chloral hydrate and melatonin both increase sedation. Use Caution/Monitor.

            • meperidine

              chloral hydrate and meperidine both increase sedation. Use Caution/Monitor.

            • meprobamate

              chloral hydrate and meprobamate both increase sedation. Use Caution/Monitor.

            • metaproterenol

              chloral hydrate increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaxalone

              chloral hydrate and metaxalone both increase sedation. Use Caution/Monitor.

            • methadone

              chloral hydrate and methadone both increase sedation. Use Caution/Monitor.

            • methamphetamine

              chloral hydrate increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methocarbamol

              chloral hydrate and methocarbamol both increase sedation. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              chloral hydrate increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midazolam

              midazolam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • midodrine

              chloral hydrate increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mirtazapine

              chloral hydrate and mirtazapine both increase sedation. Use Caution/Monitor.

            • modafinil

              chloral hydrate increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • morphine

              chloral hydrate and morphine both increase sedation. Use Caution/Monitor.

            • motherwort

              chloral hydrate and motherwort both increase sedation. Use Caution/Monitor.

            • moxonidine

              chloral hydrate and moxonidine both increase sedation. Use Caution/Monitor.

            • nabilone

              chloral hydrate and nabilone both increase sedation. Use Caution/Monitor.

            • nalbuphine

              chloral hydrate and nalbuphine both increase sedation. Use Caution/Monitor.

            • norepinephrine

              chloral hydrate increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nortriptyline

              chloral hydrate and nortriptyline both increase sedation. Use Caution/Monitor.

            • olanzapine

              chloral hydrate and olanzapine both increase sedation. Use Caution/Monitor.

            • oliceridine

              oliceridine, chloral hydrate. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

            • opium tincture

              chloral hydrate and opium tincture both increase sedation. Use Caution/Monitor.

            • orphenadrine

              chloral hydrate and orphenadrine both increase sedation. Use Caution/Monitor.

            • oxazepam

              oxazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • oxycodone

              chloral hydrate and oxycodone both increase sedation. Use Caution/Monitor.

            • oxymorphone

              chloral hydrate and oxymorphone both increase sedation. Use Caution/Monitor.

            • paliperidone

              chloral hydrate and paliperidone both increase sedation. Use Caution/Monitor.

            • papaveretum

              chloral hydrate and papaveretum both increase sedation. Use Caution/Monitor.

            • papaverine

              chloral hydrate and papaverine both increase sedation. Use Caution/Monitor.

            • passion flower

              passion flower increases effects of chloral hydrate by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • pentazocine

              chloral hydrate and pentazocine both increase sedation. Use Caution/Monitor.

            • pentobarbital

              pentobarbital and chloral hydrate both increase sedation. Use Caution/Monitor.

            • perphenazine

              chloral hydrate and perphenazine both increase sedation. Use Caution/Monitor.

            • phendimetrazine

              chloral hydrate increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenobarbital

              phenobarbital and chloral hydrate both increase sedation. Use Caution/Monitor.

            • phentermine

              chloral hydrate increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine

              chloral hydrate increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenylephrine PO

              chloral hydrate increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • pholcodine

              chloral hydrate and pholcodine both increase sedation. Use Caution/Monitor.

            • pimozide

              chloral hydrate and pimozide both increase sedation. Use Caution/Monitor.

            • pirbuterol

              chloral hydrate increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pregabalin

              pregabalin, chloral hydrate. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

            • primidone

              primidone and chloral hydrate both increase sedation. Use Caution/Monitor.

            • prochlorperazine

              chloral hydrate and prochlorperazine both increase sedation. Use Caution/Monitor.

            • promethazine

              promethazine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • propofol

              propofol and chloral hydrate both increase sedation. Use Caution/Monitor.

            • propylhexedrine

              chloral hydrate increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • protriptyline

              chloral hydrate and protriptyline both increase sedation. Use Caution/Monitor.

            • quazepam

              quazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • quetiapine

              chloral hydrate and quetiapine both increase sedation. Use Caution/Monitor.

            • ramelteon

              chloral hydrate and ramelteon both increase sedation. Use Caution/Monitor.

            • remimazolam

              remimazolam, chloral hydrate. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely. Coadministration may result in profound sedation, respiratory depression, coma, and/or death. Continuously monitor vital signs during sedation and recovery period if coadministered. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics.

            • risperidone

              chloral hydrate and risperidone both increase sedation. Use Caution/Monitor.

            • salmeterol

              chloral hydrate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              chloral hydrate and scullcap both increase sedation. Use Caution/Monitor.

            • secobarbital

              secobarbital and chloral hydrate both increase sedation. Use Caution/Monitor.

            • sevoflurane

              sevoflurane and chloral hydrate both increase sedation. Use Caution/Monitor.

            • shepherd's purse

              chloral hydrate and shepherd's purse both increase sedation. Use Caution/Monitor.

            • sufentanil

              chloral hydrate and sufentanil both increase sedation. Use Caution/Monitor.

            • tapentadol

              chloral hydrate and tapentadol both increase sedation. Use Caution/Monitor.

            • temazepam

              temazepam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • terbutaline

              chloral hydrate increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • thioridazine

              chloral hydrate and thioridazine both increase sedation. Use Caution/Monitor.

            • thiothixene

              chloral hydrate and thiothixene both increase sedation. Use Caution/Monitor.

            • topiramate

              chloral hydrate and topiramate both increase sedation. Modify Therapy/Monitor Closely.

            • tramadol

              chloral hydrate and tramadol both increase sedation. Use Caution/Monitor.

            • trazodone

              chloral hydrate and trazodone both increase sedation. Use Caution/Monitor.

            • triazolam

              triazolam and chloral hydrate both increase sedation. Use Caution/Monitor.

            • triclofos

              chloral hydrate and triclofos both increase sedation. Use Caution/Monitor.

            • trifluoperazine

              chloral hydrate and trifluoperazine both increase sedation. Use Caution/Monitor.

            • trimipramine

              chloral hydrate and trimipramine both increase sedation. Use Caution/Monitor.

            • triprolidine

              triprolidine and chloral hydrate both increase sedation. Use Caution/Monitor.

            • valerian

              valerian increases effects of chloral hydrate by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.

            • xylometazoline

              chloral hydrate increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • yohimbine

              chloral hydrate increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziconotide

              chloral hydrate and ziconotide both increase sedation. Use Caution/Monitor.

            • ziprasidone

              chloral hydrate and ziprasidone both increase sedation. Use Caution/Monitor.

            • zotepine

              chloral hydrate and zotepine both increase sedation. Use Caution/Monitor.

            Minor (6)

            • ashwagandha

              ashwagandha increases effects of chloral hydrate by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

            • brimonidine

              brimonidine increases effects of chloral hydrate by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

            • eucalyptus

              chloral hydrate and eucalyptus both increase sedation. Minor/Significance Unknown.

            • nettle

              nettle increases effects of chloral hydrate by pharmacodynamic synergism. Minor/Significance Unknown. (High dose nettle; theoretical interaction) May enhance CNS depression.

            • sage

              chloral hydrate and sage both increase sedation. Minor/Significance Unknown.

            • Siberian ginseng

              Siberian ginseng increases effects of chloral hydrate by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.

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            Warnings

            Contraindications

            Hypersensitivity/idiosyncrasy to chloral derivatives

            Marked renal, hepatic impairment; severe cardiac disease; gastritis & ulcers

            Cautions

            Potential toxic dose <6 years old: 50 mg/kg

            Use with caution in porphyria

            Use caution in long term care patients, elderly, and neonates

            Use not recommended for >2 weeks

            Abrupt discontinuation may cause withdrawal symptoms

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: small amount secreted into breast milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Unknown; produces central nervous system depression

            Absorption

            Onset: 30-60 min

            Duration: 4-8 hr

            Peak plasma levels: 7-10 mcg/mL

            Metabolism

            Metabolized by alcohol dehydrogenase, glucuronidation

            Metabolites: trichloroethanol

            Elimination

            Half-life: 8-11 hr (active metabolite)

            Excretion: Mostly in urine; some feces

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            Code Definition
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            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.