Methylnaltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Drug reference
Chloral hydrate
Benzodiazepine · Hypnotic
Also known as chloral betaine
BenzodiazepineHypnotic
CDSCO approvedSchedule H
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Avoid.
FDA category + note
Top interactionssee all 12 →
- MethylnaltrexoneSevereTextbookG&G 14e
- NalmefeneSevereTextbookG&G 14e
- NaloxoneSevereTextbookG&G 14e
- NaltrexoneSevereTextbookG&G 14e
Mechanism
Chloral hydrate is rapidly reduced by hepatic alcohol dehydrogenase to its active metabolite trichloroethanol, which exerts barbiturate-like effects on GABA-A receptor chloride channels. Unlike benzodiazepines, trichloroethanol directly enhances chloride conductance rather than allosterically modulating GABA binding, producing dose-dependent sedation and hypnosis with a narrow therapeutic window between anxiolysis and excessive CNS depression.
Indications
Insomnia (short-term use)Treat patients with paradoxical reactions to benzodiazepines
Dosing
- Adult
- Oral solution: 430–860 mg once daily with water or milk at bedtime. Tablets: 1–2 tablets, alternatively 414–828 mg once daily with water or milk at bedtime.
- Renal adjustment
- Avoid in severe impairment.
- Hepatic adjustment
- Avoid in marked impairment.
- Geriatric
- Reduce dose in frail elderly. Consider dose reduction in the elderly with hepatic impairment.
- Max dose
- 2 g per day
Pharmacokinetics
Metabolism
Chloral hydrate is primarily reduced, and is converted to trichloroethanol.
Contraindications
- Acute porphyrias
- gastritis
- severe cardiac disease
- marked hepatic impairment
- severe renal impairment
Side effects
Common
Agitationallergic dermatitisataxiaconfusiondrug use disordersgastrointestinal discomfortgastrointestinal disordersheadacheinjuryketonuriaDrowsiness
Serious
- Delirium (more common on abrupt discontinuation)
- Kidney injury
Pregnancy & lactation
Pregnancy
Avoid.
Lactation
Risk of sedation in infant—avoid.
Drug interactions
Nalmefene
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naloxone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Naltrexone
Severe
Textbook
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: G&G 14e
Other Cns Depressants
Severe
Textbook
Typically fatal if combined in overdose.
Use with extreme caution; avoid if possible.
Source: G&G 14e
Alfentanil
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Benzhydrocodone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Buprenorphine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Codeine
Severe
Database
Increased rates of accidental overdose and death.
Caution is advised, especially for patients with a history of drug abuse.
Source: DDInter
Dextropropoxyphene
Severe
Database
Drug interaction classified as: synergy, metabolism
Source: DDInter
Dihydrocodeine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Other Benzodiazepine drugs
Ask House about Chloral hydrate
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung·Verified: 2026-05-10 · House clinical team