Are there any FDA-approved chloral hydrate drugs?
There are no FDA-approved drug products that contain chloral hydrate. As mentioned above, the firms commercially manufacturing and distributing drug products containing chloral hydrate without FDA-approval voluntarily removed their products from the market in 2012.
When was chloral hydrate used?
It was widely used recreationally and prescribed [further explanation needed] in the late 19th century. Chloral hydrate is soluble in both water and ethanol, readily forming concentrated solutions. A solution of chloral hydrate in ethanol called "knockout drops" was used to prepare a Mickey Finn.
How long should I take chloral hydrate?
Chloral hydrate should be given only for a short time. This medicine may become less effective after 1 or 2 weeks of use. To use as a sedative, chloral hydrate is usually taken 3 times per day after meals. To treat alcohol or drug withdrawal, chloral hydrate is usually taken every 6 hours. Follow your doctor's dosing instructions very carefully.
What is chloral hydrate and what are the effects?
This form of chloral hydrate is used in drug-facilitated sexual assault, or "date rape". What are the effects? Chloral hydrate takes effect in about 30 minutes and will induce sleep in about an hour. What are the dangers? A toxic dose produces severe respiratory depression and very low blood pressure.
When was chloral hydrate banned?
There are no FDA-approved drug products that contain chloral hydrate. As mentioned above, the firms commercially manufacturing and distributing drug products containing chloral hydrate without FDA-approval voluntarily removed their products from the market in 2012.
Is chloral hydrate used anymore?
Chloral hydrate is no longer available in the United States.
What replaced chloral hydrate?
Chloral hydrate is used for the short-term treatment of insomnia and as a sedative before minor medical or dental treatment. It was largely displaced in the mid-20th century by barbiturates and subsequently by benzodiazepines.
What is the street name for chloral hydrate?
Liquid chloral hydrate may be created from commonly-available household products. Street names for chloral hydrate include “Mickey Finn” and “Knockout Drops.”
What does chloral hydrate do to your brain?
Chloral hydrate is a central nervous system depressant and is one of the oldest sedatives (discovered in 1832). It is well absorbed orally as well as rectally and rapidly metabolised into the active metabolite trichloroethanol, which is responsible for its hypnotic and sedative effects.
What are the long term effects of chloral hydrate?
Long-term use may cause serious stomach problems (gastritis) or kidney problems. Tell your doctor right away if any of these serious side effects occur: vomit that looks like coffee grounds, difficult/painful swallowing, black/tarry stools, severe stomach/abdominal pain, change in the amount of urine.
What is the common name of chloral?
Chloral, also known as trichloroacetaldehyde or trichloroethanal, is the organic compound with the formula Cl3CCHO. This aldehyde is a colourless oily liquid that is soluble in a wide range of solvents. It reacts with water to form chloral hydrate, a once widely used sedative and hypnotic substance.
How much chloral hydrate is lethal?
Although the dose considered to be fatal for CH is about 10 g, fatalities have been documented with ingestion of as little as 4 g and the recovery of a patient following ingestion of 30 g CH was also reported.
What does chloral hydrate smell like?
(Nordt 2014) Chloral hydrate is also directly nephrotoxic and can cause hepatitis. A fruity or pear like smell on the breath is classic.
What's in a Mickey Finn?
In slang, a Mickey Finn (or simply a Mickey) is a drink laced with a incapacitating agent, particularly chloral hydrate, given to someone without their knowledge with the intent to incapacitate them or "knock them out"; hence the colloquial name knockout drops.
Why do they call it a Mickey Finn?
A Mickey Finn is a drugged alcoholic drink given to someone without them knowing. It's named for a late 19th-century bartender and pickpocket who was notorious for drugging people's drinks. Giving someone a Mickey Finn is sometimes called “slipping a mickey.”
Is chloral hydrate still available in Canada?
Based on the most recent data, most commercial chloral hydrate is imported into Canada although a small quantity is manufactured in the country.
How much chloral hydrate is lethal?
Although the dose considered to be fatal for CH is about 10 g, fatalities have been documented with ingestion of as little as 4 g and the recovery of a patient following ingestion of 30 g CH was also reported.
Is chloral hydrate and insomnia the same thing?
What is this medicine? CHLORAL HYDRATE (klor al HI drate) is used for the short-term treatment of insomnia. This medicine may also be used to decrease anxiety or make you sleep before a procedure or test.
What is the common name of chloral?
Chloral, also known as trichloroacetaldehyde or trichloroethanal, is the organic compound with the formula Cl3CCHO. This aldehyde is a colourless oily liquid that is soluble in a wide range of solvents. It reacts with water to form chloral hydrate, a once widely used sedative and hypnotic substance.
How long does chloral hydrate last?
Chloral hydrate is rapidly converted to an active metabolite (trichloroethanol) responsible for its sedative properties, which has a half-life at therapeutic doses of up to 66 hours in neonates, 28-40 hours in infants, 8-12 hours in children, and much longer following an overdose. 2,7. No reversal agent.
How long did it take for a 15-month-old to vomit after taking chloral hydrate?
Within 25 minutes of receiving the drug, the child vomited, became obtunded, and developed stridor, periods of apnea, and cyanosis. The child improved after an oral airway was established and oxygen was administered. She was transferred to the ED, monitored for 12 hours, and then discharged.
Is chloral hydrate bitter?
Large volume per dose. Chloral hydrate is very bitter tasting and requires a large volume per dose. Poor palatability has necessitated administration via a nasogastric tube at times. 9 In addition, compounded chloral hydrate is difficult to concentrate, leading to even larger volumes per dose than the previously available commercial formulation. 5 This can lead to vomiting or spitting out of unquantifiable amounts of the dose.
Can chloral hydrate be absorbed with food?
Irritating gastric effects. Nordt et al. notes that chloral hydrate is more rapidly absorbed with food; fasting before a procedure where chloral hydrate is used for sedation is not recommended since it can delay the drug’s onset, leading to sedation failures. 2 However, gastric irritation has led to vomiting, which can result in aspiration of the stomach contents.
Does chloral hydrate have a narrow therapeutic index?
Narrow therapeutic index. Chloral hydrate has a relatively narrow therapeutic index, which can increase the risk of adverse effects when higher therapeutic doses or overdoses are administered. 2
Is chloral hydrate FDA approved?
There are no FDA-approved drug products that contain chloral hydrate. As mentioned above, the firms commercially manufacturing and distributing drug products containing chloral hydrate without FDA-approval voluntarily removed their products from the market in 2012. We were thinking about removing chloral hydrate from our lists of high-alert medications but have not done so given the unknown frequency of prescribing and compounding the drug. There have also been worrisome, more recent adverse events associated with the drug as reported in the news media and professional literature. Chloral hydrate has a US Pharmacopeial Convention (USP) monograph so pharmacists can compound it under section 503A (individual prescription) of the Federal Food, Drug, and Cosmetic (FD&C Act), but it can’t be compounded under 503B (outsourcing facilities) because it is NOT on FDA’s list of bulk drug substances.
Can you compound chloral hydrate?
Chloral hydrate has a US Pharmacopeial Convention (USP) monograph so pharmacists can compound it under section 503A (individual prescription) of the Federal Food, Drug, and Cosmetic (FD&C Act), but it can’t be compounded under 503B (outsourcing facilities) because it is NOT on FDA’s list of bulk drug substances.
How long does chloral hydrate take to work?
When administered orally, the average time to peak sedation is approximately 30 minutes, with a recovery time of an additional 1 to 2 hours.3,4 Residual motor imbalance and agitation may persist for several hours beyond this. 5 Rectal administration is erratically absorbed and therefore not recommended.
What happens if you take chloral hydrate?
Chloral hydrate is irritating to the GI tract, resulting in nausea, vomiting, and hemorrhagic gastritis. It may also rarely cause gastric and intestinal necrosis, which could lead to perforation and stricture formation. The major cause of death is believed to be secondary to cardiac dysrhythmias. Chloral hydrate and its metabolites can decrease myocardial contractility, shorten the refractory period, and increase sensitivity to catecholamines. Serious dysrhythmias can include ventricular fibrillation, ventricular tachycardia, and torsades de pointes. Respiratory failure can develop as a result of therapeutic use. As expected, patients can develop significant CNS depressions. Interestingly, case reports of seizure activity and a paradoxical central stimulant reaction has been reported.
What is chloral hydrate used for?
Chloral hydrate, which was synthesized by Justus Liebig in 1832, continues to be used for sleep disorders and for sedation before surgery or radiology, especially in children (1). As an alternative to the benzodiazepines, it has essentially similar properties and problems, but is associated with perhaps rather more frequent gastrointestinal disturbances, up to 7% in one large sample of children. Chloral hydrate had a reputation for safety, which has been challenged by data that suggest that it and short-acting barbiturates are particularly lethal when taken in overdose (2). Liver damage and cardiac toxicity, consistent with the chemical similarities between trichloroethanol, chloroform, and alcohol, can occur.
Can chloral hydrate cause respiratory depression?
Despite a wide margin of safety, chloral hydrate can cause airway obstruction and respiratory depression, especially at higher doses (75 to 100 mg/kg).3, 5, 7, 9, 10, 12, The incidence was 0.6% in one large series. 3 There is not a known dosage threshold of chloral hydrate below which this potential complication can be consistently avoided, 9,12 and accordingly standard interactive and mechanical monitoring precautions apply to chloral hydrate as they do to other PSA agents.
Does chloral hydrate increase warfarin?
Another metabolite of chloral hydrate, trichloroacetic acid, may increase free warfarin plasma concentrations by interfering with its protein binding (normally 98% to 99%). Sedation with benzodiazepine regimens is a recommended alternative.
Does chloral hydrate affect alcohol?
Chloral hydrate causes a summation of effects with other CNS depressants. However, the combination of chloral hydrate with alcohol is thought to produce a potentiation drug interaction through an alteration of alcohol metabolism. Chloral hydrate and its primary metabolite, trichloroethanol, competitively inhibit alcohol-metabolizing dehydrogenases, elevating alcohol blood concentrations (see Table 11-3 ). This combination, known colloquially as a “Mickey Finn” or “knock-out drops,” can induce severe alcohol intoxication with stupor, coma, or death. The interaction is significant because it induces greater than additive effects and may result in a potentially life-threatening CNS depression. The dental indications for chloral hydrate are almost exclusively in pediatric sedation, and alcohol is usually not a concomitantly administered drug.
Does chloral hydrate cause depression?
As one might expect, chloral hydrate produces increased CNS depression when administer ed with other sedatives. The therapeutic advantage of this drug interaction is that it allows practitioners to decrease the dose of both CNS depressants and limit the side effects of the individual drugs. This is the rationale for a multidrug technique for pediatric sedation using chloral hydrate, meperidine, and hydroxyzine in combination. Similarly, nitrous oxide administration in conjunction with chloral hydrate deepens the level of sedation. The likelihood of oversedation and respiratory compromise increases when these drug combinations are utilized.
What is chloral hydrate used for?
This form of chloral hydrate is used in drug-facilitated sexual assault, or "date rape".
Is chloral hydrate addictive?
It is not considered an addictive drug like cocaine, heroin or alcohol because it does not produce the same compulsive drug-seeking behavior. However, like addictive drugs, chloral hydrate produces greater tolerance in some users who take the drug repeatedly.
What is chloral hydrate?
Chloral hydrate is a sedative, also called a hypnotic. Chloral hydrate slows the activity of your central nervous system. This medicine has both fast-acting and long-lasting sedative effects.
How long does it take for chloral hydrate to work?
To treat insomnia, take the medicine 15 to 30 minutes before your normal bedtime. Chloral hydrate should be given only for a short time. This medicine may become less effective after 1 or 2 weeks of use.
What should I discuss with my health care provider before taking chloral hydrate?
You should not use chloral hydrate if you are allergic to it, or if you have:
What should I avoid while taking chloral hydrate?
Do not drink alcohol. Dangerous side effects or death can occur when alcohol is combined with chloral hydrate.
What other drugs will affect chloral hydrate?
Ask your doctor before taking chloral hydrate with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.
Why is chloral hydrate given before surgery?
It is sometimes given before a surgery to help you relax. Chloral hydrate may also be used to treat alcohol withdrawal symptoms, or to relieve anxiety caused by withdrawal from certain drugs such as barbiturates or narcotic medicine. Chloral hydrate may also be used for purposes not listed in this medication guide.
What to do if you don't feel better with chloral hydrate?
Call your doctor if your symptoms do not improve, or if they get worse while using chloral hydrate.
Deltaweb Newbie
I got a prescription today for 1000mg chloral hydrate. but when i went to the drugstore to get it filled i was told that they think they have discontinued the drug. However it was just this drugstore chain. I'm going to try to get it filled at 2 other pharmacies tommorow.
Booty love Silver Member
that what they gave my 4 year old last Monday when he went to the dentist for his cavities. it fucked him up big time, I had never heard of it until then. may ask what you were prescribed it for?
Deltaweb Newbie
After a long list of sleeping meds over about 2 years they prescribed me this for insomnia.
zedletter Mercury Member
Wow chloral hydrate, thats old... I remember they used it in that book and then there were none from 1939, I can't believe they still use that stuff.
Millie Platt Silver Member
i get this stuff in australia. i'd say it's just as, if not more effective than many hypnotic benzos and z-drugs. although it is rarely prescribed. i'm lucky my doctor gives it to me and my pharmacy usually has to order it in for me overnight.
What is the name of the company that discontinued Cytoxan?
609-897-2412Bristol-Myers Squibb Company has made a decision to discontinue Cytoxan (cyclophosphamide) 25mg and 50mg tablets. Alternate products continue to be available from other companies.
When did 888-825-5249 expire?
888-825-5249Stelazine was discontinued and withdrawn from the market. The final lots were distributed by GSK August 2003 and the final expiry date of all products in the marketplace is no later than January 31, 2004.
What is the NDA for PULMICORT?
The introduction of PULMICORT FLEXHALER (budesonide inhalation powder, 90 & 180 mcg), NDA 21-949, will be accompanied by the phasing out of PULMICORT TURBUHALER so as to minimize confusion in the marketplace.
When did Lexxel tablets stop being made?
LEXXEL Tablets will be discontinued on July 31, 2008. AstraZeneca has no further plans to manufacture or distribute LEXXEL (enalapril maleate-felodipine ER) Tablets after July 31, 2008.
When will Serevent be discontinued?
GSK anticipates that SEREVENT Inhalation Aerosol will no longer be available starting in June 2003.
When did Fortovase 200 mg stop?
Fortovase 200 mg capsules will be discontinued by February 15, 2006. Please see attached DHP letter for additional information.
Is Lundbeck discontinuing mebaral?
Lundbeck is aware of the difficult situation that some patients may face with regard to the upcoming Mebaral discontinuation. The company thoroughly evaluated all avenues for keeping Mebaral available to patients, but ultimately concluded that no matter what steps we took, patients would be forced to transition to a new therapy. Due to the limited remaining Mebaral supply, we encourage patients to work with their physician to transition to alternative therapies rather than starting a new course of therapy with Mebaral. For more information or with questions, Lundbeck’s medical information team can be reached at 866-402-8520.
Older Chloral Hydrate Adverse Events
Compounded Chloral Hydrate
- Since 2010, ISMP has not received additional reports of errors involving pediatric sedation with chloral hydrate, which we assumed was due in large part to the 2012 discontinuation of the only remaining commercially available chloral hydrate products (oral solution by Pharmaceutical Associates, oral capsules by Breckenridge) in the US, for business...
More Recent Chloral Hydrate Adverse Events
- In June 2014, Nordt et al. published three cases of pediatric chloral hydrate overdoses, one a fatality, that occurred in the outpatient setting following procedural sedation.2These patients were all seen in the ED within a 4-month period, alerting the authors to a potential public safety issue. The first case involved a 4-year-old girl for whom a dentist had prescribed 900 mg (70 mg/kg) of …
Other Issues with Chloral Hydrate
- In addition to the risk of respiratory depression associated with most sedatives used for pediatric sedation, chloral hydrate carries several other risks worthy of mention: Resedation after discharge. Chloral hydrate can result in prolonged sedation or resedation with effects persisting beyond 24 hours in children of all ages, including those who have demonstrated resolution of se…
Comparison to Other Pediatric Sedation Agents
- Chloral hydrate has been a drug of choice for pediatric sedation in some facilities due to its low cost.5 However, in regards to efficacy, there are conflicting studies regarding which sedation agent is best. Numerous studies suggest there are many other effective sedative agents with more predictable pharmacokinetic profiles than chloral hydrate, including oral or intranasal mida…
Seeking Your Input
- The risks of adverse events and the potential for compounding errors associated with chloral hydrate are concerning. Thus, the literature is replete with recommendations to use a safer alternative agent instead of chloral hydrate when sedating pediatric patients.2,4,6,7,10-12,18-19 However, the evidence regarding efficacy of chloral hydrate and alternative sedatives is confli…
References
- Stern KW, Gauvreau K, Geva T, Benavidez OJ. The impact of procedural sedation on diagnostic errors in pediatric echocardiography. J Am Soc Echocardiogr. 2014;27(9):949-55.
- Nordt SP, Rangan C, Hardmaslani M, Clark RF, Wendler C, Valente M. Pediatric chloral hydrate poisonings and death following outpatient procedural sedation. J Med Toxicol. 2014;10(2):219-22.
- Stern KW, Gauvreau K, Geva T, Benavidez OJ. The impact of procedural sedation on diagnostic errors in pediatric echocardiography. J Am Soc Echocardiogr. 2014;27(9):949-55.
- Nordt SP, Rangan C, Hardmaslani M, Clark RF, Wendler C, Valente M. Pediatric chloral hydrate poisonings and death following outpatient procedural sedation. J Med Toxicol. 2014;10(2):219-22.
- American Society of Health-System Pharmacists. Chloral hydrate oral solution and capsules. Drugs No Longer Available Bulletin. November 5, 2012.
- Cote CJ, Wilson S; American Academy of Pediatrics; American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for dia...
