Furosemide with Chloral Hydrate Interaction Details
Brand Names Associated with Furosemide
- Furosemide
- Lasix®
Brand Names Associated with Chloral Hydrate
- Aquachloral®
- Chloral Hydrate
- Chloralum®
- Somnote®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 10, 2023
Interaction Effect
Cardiovascular toxicity (diaphoresis, hypertension, tachycardia)
Interaction Summary
There have been isolated cases of cardiac toxicity (ie, flushing, sweating attacks, restlessness, nausea, increase in blood pressure, and tachycardia) when IV furosemide was administered within 24 hours of chloral hydrate administration. This interaction may be more predominant in the presence of hypoalbuminemia . Therefore, concomitant use of chloral hydrate and furosemide is not recommended . In patients who require IV furosemide therapy, an alternate hypnotic drug may be preferable .
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Coadministration of IV furosemide within 24 hours of chloral hydrate administration has resulted in isolated cases of cardiac toxicity (ie, flushing, sweating attacks, restlessness, nausea, increase in blood pressure, and tachycardia). Therefore, concomitant use of chloral hydrate and furosemide is not recommended . In patients who require IV furosemide therapy, consider an alternate hypnotic drug .
Mechanism Of Interaction
Unknown
Literature Reports
A) Concomitant chloral hydrate and furosemide (IV) therapy has been reported to result in toxic effects consisting of diaphoresis, skin flushing, uneasiness and blood pressure variations . This interaction occurred in an 8-year-old patient who experienced similar adverse effects, except changes in blood pressure. The adverse effects abated in 15 to 20 minutes without intervention . This interaction may be more predominant in the presence of hypoalbuminemia. The mechanism is unclear at the present time; however, it may involve competition for protein binding sites .
B) Patients (n=5262) who received either chloral hydrate or flurazepam and furosemide over a period of 6 years were studied. The study group consisted of 43 patients who received both chloral hydrate and furosemide (chloral hydrate being administered within the previous 24 hours). The remainder of the patients were placed in control groups. Of the 43 patients in the study group, 1 patient exhibited symptoms of a drug interaction (tachycardia, increased blood pressure, diaphoresis, weakness, and nausea) immediately following IV administration of furosemide (80 mg). Chloral hydrate (500 mg orally) had been given 8 hours earlier. Two patients were evaluated as having a possible drug interaction ("being on fire", mild respiratory distress, and generalized discomfort). No patient in any of the control groups exhibited manifestations of this reaction. Until further investigations are available, the combination of IV furosemide and chloral hydrate should be administered with caution or avoided .
C) A case was reported where a 68-year-old female 12 hours status post MI who had received 80 mg of furosemide and 500 mg of chloral hydrate within a 12-hour period. The patient developed flushes, tachycardia (140 beats/min), severe diaphoresis, and a blood pressure of 169 mmHg following a second dose of furosemide. Chloral hydrate was discontinued although furosemide therapy was administered over the next 3 days without any further sequela. However, rechallenge of the patient with a 500-mg dose of chloral hydrate with IV furosemide 40 mg 8 hours later resulted in an immediate reaction similar to the previous. The data suggests that these drugs should not be administered concomitantly .
Furosemide Overview
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Furosemide is used alone or in combination with other medications to treat high blood pressure. Furosemide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease. Furosemide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.
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High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.
Chloral Hydrate Overview
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Chloral hydrate, a sedative, is used in the short-term treatment of insomnia (to help you fall asleep and stay asleep for a proper rest) and to relieve anxiety and induce sleep before surgery. It is also used after surgery for pain and to treat alcohol withdrawal.
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This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.