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.risperidoneMonitor Closely (1)chloral hydrate and risperidone both increase sedation. Use Caution/Monitor.sageMinor (1)chloral hydrate and sage both increase sedation. Minor/Significance Unknown.salmeterolMonitor Closely (1)chloral hydrate increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.scullcapMonitor Closely (1)chloral hydrate and scullcap both increase sedation. Use Caution/Monitor.secobarbitalMonitor Closely (1)secobarbital and chloral hydrate both increase sedation. Use Caution/Monitor.selinexorSerious - Use Alternative (1)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.sevofluraneMonitor Closely (1)sevoflurane and chloral hydrate both increase sedation. Use Caution/Monitor.shepherd's purseMonitor Closely (1)chloral hydrate and shepherd's purse both increase sedation. Use Caution/Monitor.Siberian ginsengMinor (1)Siberian ginseng increases effects of chloral hydrate by pharmacodynamic synergism. Minor/Significance Unknown. May enhance CNS depression.sodium oxybateContraindicated (1)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.sufentanilMonitor Closely (1)chloral hydrate and sufentanil both increase sedation. Use Caution/Monitor.sufentanil SLSerious - Use Alternative (1)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.tapentadolMonitor Closely (1)chloral hydrate and tapentadol both increase sedation. Use Caution/Monitor.temazepamMonitor Closely (1)temazepam and chloral hydrate both increase sedation. Use Caution/Monitor.terbutalineMonitor Closely (1)chloral hydrate increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.thioridazineMonitor Closely (1)chloral hydrate and thioridazine both increase sedation. Use Caution/Monitor.thiothixeneMonitor Closely (1)chloral hydrate and thiothixene both increase sedation. Use Caution/Monitor.topiramateMonitor Closely (1)chloral hydrate and topiramate both increase sedation. Modify Therapy/Monitor Closely.tramadolMonitor Closely (1)chloral hydrate and tramadol both increase sedation. Use Caution/Monitor.trazodoneMonitor Closely (1)chloral hydrate and trazodone both increase sedation. Use Caution/Monitor.triazolamMonitor Closely (1)triazolam and chloral hydrate both increase sedation. Use Caution/Monitor.triclofosMonitor Closely (1)chloral hydrate and triclofos both increase sedation. Use Caution/Monitor.trifluoperazineMonitor Closely (1)chloral hydrate and trifluoperazine both increase sedation. Use Caution/Monitor.trimipramineMonitor Closely (1)chloral hydrate and trimipramine both increase sedation. Use Caution/Monitor.triprolidineMonitor Closely (1)triprolidine and chloral hydrate both increase sedation. Use Caution/Monitor.valerianMonitor Closely (1)valerian increases effects of chloral hydrate by pharmacodynamic synergism. Use Caution/Monitor. May enhance CNS depression.Serious - Use Alternative (1)valerian and chloral hydrate both increase sedation. Avoid or Use Alternate Drug.warfarinMonitor Closely (1)chloral hydrate increases effects of warfarin by unspecified interaction mechanism. Use Caution/Monitor.xylometazolineMonitor Closely (1)chloral hydrate increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.yohimbineMonitor Closely (1)chloral hydrate increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.ziconotideMonitor Closely (1)chloral hydrate and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)chloral hydrate and ziprasidone both increase sedation. Use Caution/Monitor.zotepineMonitor Closely (1)chloral hydrate and zotepine both increase sedation. Use Caution/Monitor. 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 Inform healthcare providers when taking this medication, including doctors, nurses, pharmacists, and dentists With long-term use, this medication may be habit-forming When used nightly for more than a few weeks, medication may not work as well to help sleep problems as patient may develop tolerance; only administer for a short time; if sleep problems last, talk to healthcare professional If taking this medication on a regular basis patient may experience withdrawal symptoms if discontinued abruptly; do not discontinue medication abruptly without calling doctor; patient should inform healthcare professional if experiencing bad effects Avoid operating heavy machinery, including driving and doing other tasks or actions that require alertness when taking this medication; may experience drowsiness the day after taking this medication; avoid these tasks or actions until feeling fully awake Avoid alcohol while taking this medication; do not take after drinking alcohol on the evening or before bed Talk with healthcare professional before using other drugs and natural products that slow actions This medication may affect certain lab tests; inform all healthcare providers and lab workers about taking this medication If 65 or older, use medication with care; medication may cause more side effects Pregnancy Inform healthcare professional if pregnant or plan on getting pregnant Lactation Inform healthcare professional if breastfeeding; may need to discuss benefits and risks to the mother and the babyPregnancy 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. 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 No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions 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. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. OR Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription. 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