Consumer medicine information

Chloral Hydrate Mixture

Chloral hydrate

BRAND INFORMATION

Brand name

Orion Chloral Hydrate Mixture

Active ingredient

Chloral hydrate

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Chloral Hydrate Mixture.

What is in this leaflet?

Please read this leaflet carefully before you take Chloral Hydrate Mixture.

This leaflet answers some common questions about Chloral Hydrate Mixture. It does not contain all the available information.

It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking Chloral Hydrate Mixture against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What is Chloral Hydrate Mixture used for?

The brand name of your medicine is Chloral Hydrate Mixture. The active ingredient in Chloral Hydrate Mixture is called chloral hydrate.

Chloral hydrate belongs to a group of medicines called sedatives and hypnotics. It is used short term to treat insomnia, a condition where people have difficulty sleeping. In patients with insomnia, Chloral Hydrate Mixture decreases the time it takes to fall asleep and increases the length of time spent sleeping. Chloral Hydrate Mixture is also used to calm patients down and make them sleepy before surgery. If your child is to be given chloral hydrate before a dental or medical procedure, it should only be administered at the health care facility where the procedure is to be done. This will allow the health care professional to monitor your child.

Chloral Hydrate mixture remains active in the body for many hours and may cause drowsiness the next day.

Your doctor may have prescribed Chloral Hydrate Mixture for another use. Ask your doctor if you have any questions about why Chloral Hydrate Mixture has been prescribed for you.

In general, sedatives and hypnotics such as Chloral Hydrate Mixture should be taken for short periods only (no more than 2 weeks). Continuous long term use is not recommended unless advised by your doctor. The use of Chloral Hydrate Mixture may lead to dependence on the medicine.

This medicine is only available with a doctor’s prescription.

Before you take Chloral Hydrate Mixture

Do not take if:

You must not take Chloral Hydrate Mixture if you have an allergy to:

  • Chloral hydrate
  • Any of the ingredients listed at the end of this leaflet (See “Ingredients”)

You must not take Chloral Hydrate Mixture if you have had any of the following medical conditions:

  • severe liver disease
  • severe kidney disease
  • severe heart disease
  • gastritis (inflammation of the stomach)
  • oesophagitis (inflammation of the oesophagus)
  • stomach ulcers
  • inherited blood diseases known as porphyria

Do not give this medication to children unless advised by the child’s doctor.

Do not give Chloral Hydrate Mixture to children who experience sleep apnoea, a condition which leads to temporary stops in breathing during sleep.

Do not take Chloral Hydrate Mixture after the expiry date (EXP) printed on the bottle.

Do not take Chloral Hydrate Mixture if the bottle is damaged or shows signs of tampering. Do not take Chloral Hydrate Mixture which has not been properly stored.

If the bottle of Chloral Hydrate Mixture has expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking Chloral Hydrate Mixture, talk to your doctor or pharmacist.

Tell your doctor if:

You must tell your doctor if:

  • you have had an allergic reaction to any other medicines, foods, dyes or preservatives
  • you have a history of or have a current drug or alcohol addiction
  • you are pregnant or intend to become pregnant.
    Your doctor will discuss with you the possible risks and benefits of using Chloral Hydrate Mixture during pregnancy.
  • you are breastfeeding, or wish to breastfeed.
    This medicine may pass into the breast milk and there is a possibility that your baby may be affected.
    Your doctor will discuss with you the possible risks and benefits of using Chloral Hydrate Mixture during breastfeeding.
  • you have any other medical conditions, especially the following:
    - kidney problems
    - liver diseases
    - stomach ulcers
    - breathing difficulties (e.g. asthma)
    - sleep apnoea in children, a condition which leads to temporary stops in breathing during sleep
  • you drink alcohol.
    Alcohol may increase the effects of Chloral Hydrate Mixture.

Taking other medicines:

Tell your doctor of pharmacist if you are taking any other medicines, including medicines you buy without a prescription from your pharmacy, supermarket or health food shop.

In particular, tell your doctor if you are taking any of the following:

  • Any medicines used to prevent clotting of the blood (e.g. Coumadin®, Marevan®)
  • Benzodiazepines and other medicines used to treat anxiety or to help you sleep
  • Strong pain killers e.g. morphine
  • Medicines used to control depression or mood swings
  • Antipsychotic medicines, used to treat mental illnesses
  • Medicines used to treat hayfever, coughs and colds
  • Alcohol
  • Frusemide, a medicine to treat high blood pressure and other heart conditions

Some medicines may affect the way other medicines work. They may also react with Chloral Hydrate Mixture resulting in untoward or sometimes dangerous side effects. Your doctor or pharmacist will be able to tell you which medicines are safe to take with Chloral Hydrate Mixture.

This list is not exhaustive. Your doctor or pharmacist has more information on medicines to be careful with or to avoid while taking Chloral Hydrate Mixture.

In future, before you start to take any other medicines, tell your doctor or pharmacist that you are taking Chloral Hydrate Mixture.

How do I take Chloral Hydrate Mixture?

Follow your doctor’s instructions about how to take Chloral Hydrate Mixture.

Read the directions label of your Chloral Hydrate Mixture carefully. If you have any concerns about how to take Chloral Hydrate Mixture, talk to your doctor or pharmacist.

How much to take:

The usual adult dose is 5 - 10 mL taken 15 - 30 minutes before bedtime.

You should not take more than 20 mL a day.

If you have kidney or liver disease, or are elderly, your doctor may start you on a lower dose to prevent untoward side effects.

Your doctor or pharmacist will tell you how much Chloral Hydrate Mixture you will need to take each day.

Smaller doses are used in children. If Chloral Hydrate Mixture has been prescribed for a child, your doctor or pharmacist will tell you what the dose for your child is. It is important that you give your child the correct dose.

How to take it:

Shake the bottle well and accurately measure the dose with a medicine measure.

Shaking the bottle and using a medicine measure will make sure that you get the correct dose. You can buy a medicine measure from your pharmacist. Mix the dose with water, ginger ale, or fruit juice before you take it. Mixing with a drink can help reduce the risk of stomach upset.

How long to take it for:

Do not take Chloral Hydrate Mixture for longer than your doctor says.

Usually, Chloral Hydrate Mixture should be taken for short periods only (no more than 2 weeks). Continuous long term use is not recommended unless advised by your doctor. The use of Chloral Hydrate Mixture may lead to dependence on the medicine within two weeks of use. If you are concerned that you may be dependent talk to your doctor.

Continue to take Chloral Hydrate Mixture until your doctor tells you to stop.

If you forget to take it:

If it is almost time for your next dose, skip the dose you missed and take your next dose when you are meant to.

Otherwise, take it as soon as you remember, and then go back to taking your medicine as you would normally.

Do not try and make up for the dose that you missed by taking more than one dose at a time. This may increase the chance of you getting an unwanted side effect.

If you are not sure what to do, ask your doctor or pharmacist.

If you have trouble remembering to take you medicine, ask your pharmacist for some hints.

What do I do if I take too much? (Overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at your nearest hospital, if you think that you or anyone else may have taken too much Chloral Hydrate Mixture. Do this, even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

If you are not sure what to do, contact your doctor or pharmacist.

Keep telephone numbers for these places handy.

Signs of overdose include feeling dizzy or feeling faint, drowsiness, confusion, breathing difficulties, irregular heart beats and coma.

While you are taking Chloral Hydrate Mixture

Things you must do:

Tell your doctor if, for any reason, you have not taken your medicine exactly as directed.

Otherwise, your doctor may think that it was not working as it should and change your treatment unnecessarily.

Tell your doctor if you feel the mixture is not helping your condition.

Tell your doctor immediately if you become pregnant while taking Chloral Hydrate Mixture.

Tell any other doctors, dentists, and pharmacists who are treating you that you are taking Chloral Hydrate Mixture.

If you are about to be started on any new medicines, remind you doctor, dentist or pharmacist that you are taking Chloral Hydrate Mixture.

Visit your doctor regularly.

Your doctor needs to check your progress and see whether you need to keep taking Chloral Hydrate Mixture.

Things you must not do:

Do not take Chloral Hydrate Mixture for a longer time than your doctor has prescribed.

Chloral Hydrate Mixture should only be taken for short periods (no more than 2 weeks) unless otherwise advised by your doctor.

Do not suddenly stop taking Chloral Hydrate Mixture or lower the dose without first checking with your doctor.

Stopping this medicine suddenly may cause some unwanted side effects. Your doctor will explain how you should slowly reduce your dose of Chloral Hydrate Mixture before you can stop taking it completely.

Do not let yourself run out of medicine over the weekend or on holidays.

Do not give this medicine to anyone else, even if his or her symptoms seem similar to yours.

Do not use Chloral Hydrate Mixture to treat any other complaints unless your doctor says to.

Things to be careful of:

Be careful driving or operating machinery until you know how Chloral Hydrate Mixture affects you.

As with other sedatives and hypnotic medicines, Chloral Hydrate Mixture may cause drowsiness in some people. Make sure you know how you react to Chloral Hydrate Mixture before you drive a car, operate machinery, or do anything else that could be dangerous.

Be careful when drinking alcohol while taking Chloral Hydrate Mixture.

Combining Chloral Hydrate Mixture and alcohol can make you more sleepy, dizzy or lightheaded.

Your doctor may suggest that you avoid alcohol or reduce the amount of alcohol you drink while you are taking Chloral Hydrate Mixture.

What are the side effects?

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Chloral Hydrate Mixture, even if the problem is not listed below. Like other medicines, Chloral Hydrate Mixture can sometimes cause unwanted side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects. If you get any unwanted side effects, tell your doctor or pharmacist.

Tell your doctor if you notice any of the following that are troublesome or ongoing, and they worry you:

  • nausea, vomiting
  • diarrhoea, flatulence
  • unpleasant taste in the mouth
  • drowsiness, tiredness (sometimes lasting the next morning)
  • dizziness, lightheadedness
  • unsteadiness
  • headache, hangover feeling
  • unpleasant dreams
  • sweet smelling urine

Tell your doctor immediately or go to Accident and Emergency at your nearest hospital if you notice any of the following:

  • sudden signs of allergy such as a rash, itching or hives on the skin; swelling of the face, lips, tongue or other parts of the body; wheezing or troubled breathing
  • breathing difficulty
  • excitement
  • confusion, lack of concentration
  • hallucinations or delusions
  • paranoid behaviour

These may be serious side effects. You may need urgent medical attention. Serious side effects are rare.

Your doctor or pharmacist will have more information. Your doctor or pharmacist should discuss the possible side effects of Chloral Hydrate Mixture with you.

This is not a complete list of all possible side effects. Others may occur in some people and there may be some side effects not yet known.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

How do I store Chloral Hydrate Mixture?

Storage:

Chloral Hydrate Mixture should be stored in a safe place where children cannot reach it A locked cupboard at least one-and-a-half meters above the ground is a good place to store medicines.

Keep you Chloral Hydrate Mixture in its bottle until it is time to take it.

Chloral Hydrate Mixture should be stored below 25°C and kept away from light.

Do not leave Chloral Hydrate Mixture in the car or on windowsills. Do not store medicines in the bathroom or near a sink. Heat and dampness can destroy some medicines.

Disposal:

If your doctor tells you to stop taking Chloral Hydrate Mixture, ask you pharmacist what to do with any mixture that is left over.

Product Description

What it looks like:

Chloral Hydrate Mixture 1g/10mL is a clear, colourless syrupy liquid. It comes in 200mL bottles.

Ingredients:

Active Ingredient: Chloral hydrate 100mg per mL

Inactive Ingredients:

  • Sucrose
  • Citric acid
  • Sodium citrate
  • Saccharin sodium
  • Glycerol
  • Methyl hydroxybenzoate
  • Ethanol
  • Propylene glycol
  • Natural Peppermint Flavour 7-7686
  • Water – purified

What other information should I know?

If you have diabetes and use urine test strips to test your sugar levels, speak to your doctor or pharmacist about which test strips to use.

Chloral Hydrate Mixture may interfere with urine test strips which use copper sulphate. This may lead to false results with some urine test strips.

Speak to your doctor or pharmacist if you are not sure which test to use.

Where to go to for further information

Pharmaceutical companies are not in a position to give people an individual diagnosis or medical advice. Your doctor or pharmacist is the best person to give you advice on the treatment of your condition.

Sponsor

Chloral Hydrate Mixture is supplied in Australia by:

Orion Laboratories Pty Ltd T/A
Perrigo Australia
25-29 Delawney Road
Balcatta WA 6021

Australian Registration Number:
AUST R 42850

This leaflet was prepared in September 2003

Date of last amendment: 19 May 2020

END OF CONSUMER MEDICINE INFORMATION

Published by MIMS July 2020

BRAND INFORMATION

Brand name

Orion Chloral Hydrate Mixture

Active ingredient

Chloral hydrate

Schedule

S4

 

1 Name of Medicine

Chloral hydrate.

2 Qualitative and Quantitative Composition

The active ingredient of Chloral Hydrate Mixture is chloral hydrate 1 g/10 mL.
Excipients with known effect: sucrose, sodium citrate, saccharin sodium, methyl hydroxybenzoate, ethanol.
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Chloral Hydrate Mixture 1 g/10 mL is a clear, colourless, syrupy liquid in a 200 mL bottle.

4 Clinical Particulars

4.1 Therapeutic Indications

Chloral Hydrate Mixture is indicated preoperatively to produce sedation. It is also indicated for short-term (not more than 2 weeks) use as a hypnotic to assist in sleep disorders.

4.2 Dose and Method of Administration

The dosage of chloral hydrate must be individualised for each patient.
Generally Chloral Hydrate Mixture should be well diluted with water or another liquid (e.g. fruit juice, ginger ale) prior to administering. Gastric irritation may be minimised by diluting the mixture before administering.

Adults.

The usual hypnotic dose is 500 mg to 1 g given 15-30 minutes before bedtime, or when used as a preoperative medication, 30 minutes before surgery.
The maximum daily dose in adults should not exceed 2 g.

Children.

Sedatives should be administered preoperatively to children only at the health facility, where appropriate monitoring can be instituted (see Section 4.4 Special Warnings and Precautions for Use). Monitoring must continue until the child's level of consciousness has returned to a state that meets the approved discharge criteria.
Particular care must be taken in calculating and administering the proper dose appropriate to the age and weight of paediatric patients.
The usual hypnotic dose is 30 to 50 mg/kg or 1.5 g/m2 with a maximum single dose of 1 g (10 mL).
As premedication, children have been given chloral hydrate in a dose of 20 to 50 mg/kg, to a maximum single dose of 1 g.

Hepatic or renal impairment.

The dosage in these patients may need to be reduced (see Section 4.3 Contraindications; Section 4.4 Special Warnings and Precautions for Use).

Elderly or debilitated.

The dosage in these patients may need to be reduced (see Section 4.4 Special Warnings and Precautions for Use).

4.3 Contraindications

Chloral hydrate is contraindicated in patients with:
marked hepatic or renal impairment;
severe cardiac disease;
gastritis, oesophagitis or gastric or duodenal ulcers;
porphyrias;
previous history of a hypersensitivity reaction to chloral hydrate itself, or to any of the excipients contained in the mixture.
Chloral hydrate is also contraindicated for sedation of children with obstructive sleep apnoea, due to the risk of life threatening respiratory obstruction.

4.4 Special Warnings and Precautions for Use

Alertness.

Chloral hydrate may impair mental and/or physical abilities, and may cause drowsiness which may persist the next day. Patients should therefore be cautioned about performing activities requiring mental alertness or physical coordination (e.g. operating machinery or driving).

Dependence.

Tolerance to chloral hydrate may develop and dependence may occur. Chloral hydrate should therefore be used with caution in patients who are mentally depressed, have suicidal tendencies, or a history of drug or alcohol abuse.
Tolerance and psychologic dependence may develop by the second week of continued therapy. Individuals dependent on chloral hydrate may take large dosages of the drug, and fatalities have occurred.

Withdrawal.

Withdrawal symptoms, similar to those of barbiturates, can occur if chloral hydrate is stopped abruptly. These symptoms can include delirium tremens (sometimes fatal) and hallucinations. Prolonged administration and abrupt withdrawal of chloral hydrate should therefore be avoided to prevent precipitation of withdrawal symptoms.
Dependent persons should be hospitalised and the drug withdrawn slowly.

Chronic toxicity.

Prolonged administration of chloral hydrate may result in adverse reactions including gastritis, skin eruptions or parenchymatous renal damage.

Porphyria.

Chloral hydrate should not be used in patients with porphyria (see Section 4.3 Contraindications). The drug has been reported to precipitate attacks of acute intermittent porphyria.

Respiratory disease.

As with all sedatives, chloral hydrate should be used with caution in those with respiratory insufficiency.

Sleep apnoea.

Children with sleep apnoea, particularly obstructive sleep apnoea with tonsillar hypertrophy, could be at risk of life threatening respiratory obstruction if chloral hydrate is used for sedation (see Section 4.3 Contraindications).

Gastric irritation.

Chloral hydrate is irritating to the skin and mucous membranes. Gastric irritation may be minimised by diluting the oral solution with water or other liquids.

Carcinogenicity, mutagenicity.

Data on the long-term safety of chloral hydrate are incomplete. Long-term use of chloral hydrate is not recommended.

Use in hepatic and renal impairment.

The dose of chloral hydrate may need to be reduced.

Use in the elderly.

The dose of chloral hydrate may need to be reduced in the elderly due to age related decreases in both hepatic and renal function (also see Section 4.3 Contraindications). Delirium may occur when chloral hydrate is used in conjunction with psychotropic or cholinergic drugs.

Paediatric use.

Deaths have occurred prior to or following diagnostic procedures, particularly in paediatric patients, after chloral hydrate was administered to induce sedation before the procedure. Chloral hydrate should be administered only at the health care facility, where appropriate monitoring can be instituted. Monitoring must continue until the child meets appropriate discharge criteria. In addition, particular care must be taken in calculating and administering the proper dose appropriate to the age and weight of paediatric patients.
The half-life of trichloroethanol, an active metabolite of chloral hydrate, is prolonged in neonates. Repeated administration in infants and children may lead to accumulation of metabolites and thereby increase the potential for excessive CNS depression, predispose neonates to conjugated and nonconjugated hyperbilirubinaemia, decrease albumin binding of bilirubin and contribute to metabolic acidosis. Chloral Hydrate Mixture is not recommended in infants and children when repetitive dosing would be necessary.

Effects on laboratory tests.

Chloral hydrate may interfere with tests for urinary glucose which use copper sulphate, such as Clinitest. Urinary glucose tests which utilise glucose oxidase, such as Clinistix, are not affected, and should be used when patients are receiving chloral hydrate.
Chloral hydrate may also interfere with fluorometric tests for determining urine catecholamines. Chloral hydrate should not be used for 48 hours preceding the test.
Tests for determining 17-hydroxycorticosteroids, such as Reddy, Jenkins and Thorn procedure, may also be affected by chloral hydrate.

4.5 Interactions with Other Medicines and Other Forms of Interactions

CNS depressants.

Additive CNS depression may occur when chloral hydrate is administered concomitantly with other CNS depressants such as alcohol, antihistamines, barbiturates, opiates, antipsychotics, tricyclic antidepressants and other sedatives.
Delirium may occur, especially in the elderly, when chloral hydrate is used in conjunction with psychotropic or anticholinergic drugs.
In addition, patients receiving chloral hydrate may develop a vasodilation reaction characterised by tachycardia, palpitations, facial flushing and dysphoria after ingesting alcohol. If chloral hydrate is used concomitantly with other depressant drugs including alcohol, caution should be used to avoid overdosage.

Coumarin anticoagulants.

Chloral hydrate may produce a transient increase in the hypoprothrombinaemic response to warfarin. Trichloroacetic acid, a major metabolite of chloral hydrate, appears to displace warfarin bound plasma proteins, resulting in a transient increase in unbound plasma warfarin concentrations.
Chloral hydrate should therefore be used with caution in patients receiving warfarin or other oral anticoagulants. Even though the interaction between chloral hydrate and warfarin does not usually cause adverse effects, it is preferable to use hypnotic drugs that do not appear to interact with anticoagulants.
When chloral hydrate is given to a patient receiving an oral anticoagulant, the patient should be monitored for excessive hypoprothrombinaemia during the first several days of chloral hydrate therapy. The long-term coadministration of the 2 drugs probably does not increase the risk of bleeding significantly.

Intravenous frusemide.

A hypermetabolic state, apparently due to displacement of thyroid hormones from their binding proteins, has been reported in patients given intravenous (IV) frusemide subsequent to chloral hydrate. Symptoms reported included diaphoresis, flushes, variable blood pressure including hypertension and uneasiness. Therefore, it may be preferable to use an alternative hypnotic drug in patients who require IV frusemide.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

Data on the long-term safety of chloral hydrate are incomplete. Long-term use of chloral hydrate is not recommended.
(Category A)
Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed. Chloral hydrate should be used in pregnancy only when clearly needed.
Chloral hydrate crosses the placenta, and chronic use during pregnancy may cause withdrawal symptoms in the neonate.
Chloral hydrate is distributed into breast milk and may lead to sedation in breastfed infants.

4.7 Effects on Ability to Drive and Use Machines

This medication may cause drowsiness. If affected do not drive a vehicle or operate machinery. Avoid alcohol.

4.8 Adverse Effects (Undesirable Effects)

Below are some of the reactions that have been reported.

Gastrointestinal.

The most frequent adverse effects of chloral hydrate is gastric irritation in the form of nausea and vomiting. Diarrhoea, flatulence, unpleasant taste and abdominal distension occur less frequently.

Central nervous system.

Residual sedation or hangover occurs infrequently following usual hypnotic doses. Occasionally, patients may become somnambulistic, disoriented, incoherent and display paranoid behaviour. Rarely, paradoxical excitement, hallucinations, nightmares, delirium, staggering gait, ataxia, lightheadedness, headache, vertigo, dizziness, drowsiness, and confusion have occurred.

Dermatological.

Cutaneous reactions to chloral hydrate are not common but have included scarlatiniform or erythamatous rash, urticaria, angioedema, purpura, eczema, bullous lesions, and erythema multiforme.

Haematological.

Leukopenia and eosinophilia have occasionally been reported. Chloral hydrate has also been reported to precipitate attacks of acute intermittent porphyria (see Section 4.4 Special Warnings and Precautions for Use).

Miscellaneous.

Ketonuria has been reported rarely with chloral hydrate.
Additional effects including coma, hypotension, hypothermia, respiratory depression and cardiac arrhythmias have occurred with high doses (see Section 4.9 Overdose).

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

Symptoms.

The symptoms of overdosage with chloral hydrate resemble barbiturate overdose. Significant toxicity usually develops within 2 to 3 hours of ingestion. Symptoms include coma, hypotension, hypothermia, respiratory depression and cardiac arrhythmias. Miosis, vomiting, and muscle flaccidity may also occur. Oesophageal stricture, gastric necrosis and perforation, and GI haemorrhage have also been reported. Hepatic and renal function may be impaired and may result in transient jaundice and/or albuminuria. Renal tubular toxicity may occur between 2 and 5 days following ingestion.
Death may result from respiratory failure, cardiac arrest or hypotension.
Significant toxicity has occurred in children with ingestion of 1.5 g. The lethal oral dose of chloral hydrate in adults is about 10 g, however, ingestion of 4 g has caused death and some patients have survived ingestion of as much as 30 g.

Treatment.

General symptomatic and supportive treatment, including maintenance of airway, assisted respiration, oxygen administration, and maintaining body temperature and circulation, should be administered as appropriate. Continuous cardiac monitoring is important, especially in patients with predisposing cardiac disease.
Activated charcoal has been recommended within one hour of ingestion, provided the airway can be protected. Haemodialysis reportedly enhances the elimination of trichloroethanol.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

Chloral hydrate is a hypnotic and sedative with CNS depressant properties similar to barbiturates.

5.1 Pharmacodynamic Properties

Mechanism of action.

The mechanism of action of the drug is not completely known, however the CNS depressant effects of chloral hydrate are believed to be mainly due to the active metabolite trichloroethanol.

5.2 Pharmacokinetic Properties

Absorption.

Chloral hydrate is rapidly absorbed from the gastrointestinal tract and starts to act within 30 minutes of oral administration. The duration of action is for between 4-8 hours. Plasma concentrations of chloral hydrate (or the major metabolite trichloroethanol) required for sedative or hypnotic effects are unknown.

Distribution.

Chloral hydrate is widely distributed throughout the body, as is the active metabolite trichloroethanol. Both have been detected in the CSF, umbilical cord blood, fetal blood and amniotic fluid. The active metabolite is 70% to 80% protein bound. Following therapeutic doses of chloral hydrate, only small amounts of the clinically active metabolite are distributed into breast milk.

Metabolism.

Chloral hydrate is rapidly metabolised by the liver, erythrocytes and other tissues to form trichloroethanol (an active metabolite). The reduction of chloral hydrate to trichloroethanol is catalysed by alcohol dehydrogenase and other enzymes. The plasma half-life of trichloroethanol is about 4-12 hours. This is increased to 1-2 days in neonates. A small but variable amount of chloral hydrate and a larger portion of trichloroethanol are oxidised to trichloroacetic acid (an inactive metabolite) in the liver and kidneys. Trichloroethanol may also be conjugated to form trichlorethanol glucuronide, another inactive metabolite.

Excretion.

The metabolites of chloral hydrate are slowly excreted in the urine. Some metabolites may also be excreted into the bile and faeces. Chloral hydrate is not excreted in the urine unchanged. The quantities of metabolites excreted in the urine may vary between individuals, as well as in the same individual on different days.

5.3 Preclinical Safety Data

Genotoxicity.

See Section 4.4 Special Warnings and Precautions for Use.

Carcinogenicity.

See Section 4.4 Special Warnings and Precautions for Use.

6 Pharmaceutical Particulars

6.1 List of Excipients

Sucrose, citric acid, sodium citrate, saccharin sodium, glycerol, methyl hydroxybenzoate, ethanol, propylene glycol, natural peppermint flavour 07-7686, purified water.

6.2 Incompatibilities

See Section 4.5 Interactions with Other Medicines and Other Forms of Interactions.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C. Protect from light.

6.5 Nature and Contents of Container

Chloral Hydrate Mixture comes in a 200 mL bottle.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

6.7 Physicochemical Properties

Chemical structure.

Chloral hydrate is a 2,2,2- trichloroethane-1,1-diol.
C2H3Cl3O2. MW = 165.4.
Chloral hydrate occurs as colourless, transparent crystals with an aromatic, penetrating, and slightly acrid odour. It is very soluble in water and freely soluble in alcohol. A 10% solution in water has a pH of 3.5 to 5.5. Chloral hydrate volatises slowly on exposure to air and should be stored in airtight containers.

CAS number.

302-17-0.

7 Medicine Schedule (Poisons Standard)

Schedule 4 (Prescription Only Medicine).

Summary Table of Changes