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Related Experiment Videos

[Chloral hydrate: a hypnotic best forgotten?].

J Gauillard1, S Cheref, M N Vacherontrystram

  • 1Centre Hospitalier Sainte-Anne (Service du Docteur Caroli), 1, rue Cabanis, 75014 Paris.

L'Encephale
|July 2, 2002
PubMed
Summary

Chloral hydrate, once a common sedative, is now recognized as potentially dangerous due to toxicity risks and concerns about genotoxicity and carcinogenicity. Its use is increasingly restricted, especially for insomnia in adults and the elderly.

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Area of Science:

  • Pharmacology
  • Toxicology

Context:

  • Chloral hydrate, synthesized in 1832, has a long history of use as a hypnotic and sedative agent.
  • Its application, particularly in pediatrics for sedation during procedures, declined with the emergence of newer agents.
  • Recent assessments highlight significant safety concerns, including toxicity and potential genotoxicity/carcinogenicity.

Purpose:

  • To review the historical use, pharmacological properties, and evolving safety profile of chloral hydrate.
  • To evaluate the current benefit-risk ratio of chloral hydrate, particularly for insomnia in adults and the elderly.
  • To inform clinical practice regarding the appropriate and safe use of chloral hydrate.

Summary:

  • Chloral hydrate is rapidly absorbed and metabolized to trichloroethanol (TCE) and trichloroacetic acid (TCA), with longer half-lives for metabolites.

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  • Its mechanism of action is not fully understood but involves central nervous system depression, potentially through GABA pathways.
  • Significant risks include overdose-related death, drug interactions (e.g., with alcohol), and contraindications in patients with hepatic or respiratory insufficiency.

    • Impact:

    • The reassessment of chloral hydrate's benefit-risk ratio has led to its withdrawal from various topical preparations and restricted use in pediatric sedation.
    • Concerns regarding genotoxicity and carcinogenicity have diminished its indication for insomnia, especially in older adults.
    • Clinicians must carefully consider the significant safety concerns and contraindications before prescribing chloral hydrate.