Chlormet
Generic Name
chlormethiazole
Manufacturer
Various generic manufacturers (AstraZeneca originally)
Country
Global, varies by manufacturer
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Description
Overview of the medicine
Chlormethiazole is a sedative-hypnotic and anticonvulsant primarily used for short-term treatment of severe alcohol withdrawal symptoms, insomnia in the elderly, and agitation.
Uses & Indications
Dosage
Adults
Alcohol withdrawal: Initially 1-2 capsules (192-384 mg) every 4-6 hours, adjusted as needed. Insomnia: 1-2 capsules (192-384 mg) at bedtime.
Elderly
Lower doses required, typically half the adult dose, due to increased sensitivity and reduced metabolism. Start with lowest effective dose.
Renal_impairment
No specific dose adjustment for mild to moderate impairment, but caution advised. Use with caution in severe renal impairment.
How to Take
Oral capsules should be swallowed whole with water. Syrup can be taken directly or diluted. IV infusion is administered slowly in a hospital setting.
Mechanism of Action
Enhances GABAergic transmission by acting at the GABA-A receptor complex, prolonging the opening of chloride channels, leading to neuronal hyperpolarization and reduced excitability.
Pharmacokinetics
Onset
30-60 minutes (oral)
Excretion
Mainly via urine as metabolites.
Half life
Approximately 4-8 hours, but varies significantly with liver function and age.
Absorption
Rapidly absorbed from the GI tract; peak plasma concentrations reached within 1-2 hours.
Metabolism
Extensively metabolized in the liver (first-pass metabolism) by glucuronidation and hydroxylation.
Side Effects
Contraindications
- Severe pulmonary insufficiency
- Acute intermittent porphyria
- Hypersensitivity to chlormethiazole
- Sleep apnea syndrome
Drug Interactions
Alcohol
Increased CNS depressant effects, severe respiratory depression, and potentially fatal.
Cimetidine
May inhibit chlormethiazole metabolism, leading to increased plasma levels and enhanced effects.
Propranolol
May increase chlormethiazole levels.
Other CNS depressants (e.g., benzodiazepines, opioids, antihistamines)
Potentiated sedative effects, increased risk of respiratory depression.
Storage
Store below 25°C, protected from light and moisture. Keep in the original packaging. Keep out of reach of children.
Overdose
Symptoms include severe respiratory depression, coma, hypotension, hypothermia, and potentially circulatory collapse. Management involves supportive care, maintaining airway, ventilation, and hemodynamic support. No specific antidote is available.
Pregnancy & Lactation
Not recommended during pregnancy due to potential for fetal harm (e.g., withdrawal symptoms in neonates). Excreted in breast milk, so caution or avoidance during lactation is advised.
Side Effects
Contraindications
- Severe pulmonary insufficiency
- Acute intermittent porphyria
- Hypersensitivity to chlormethiazole
- Sleep apnea syndrome
Drug Interactions
Alcohol
Increased CNS depressant effects, severe respiratory depression, and potentially fatal.
Cimetidine
May inhibit chlormethiazole metabolism, leading to increased plasma levels and enhanced effects.
Propranolol
May increase chlormethiazole levels.
Other CNS depressants (e.g., benzodiazepines, opioids, antihistamines)
Potentiated sedative effects, increased risk of respiratory depression.
Storage
Store below 25°C, protected from light and moisture. Keep in the original packaging. Keep out of reach of children.
Overdose
Symptoms include severe respiratory depression, coma, hypotension, hypothermia, and potentially circulatory collapse. Management involves supportive care, maintaining airway, ventilation, and hemodynamic support. No specific antidote is available.
Pregnancy & Lactation
Not recommended during pregnancy due to potential for fetal harm (e.g., withdrawal symptoms in neonates). Excreted in breast milk, so caution or avoidance during lactation is advised.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date, refer to product packaging for exact expiry.
Availability
Pharmacies, Hospitals
Approval Status
Approved in various countries for specific indications
Patent Status
Expired
Clinical Trials
Numerous clinical trials have established its efficacy in severe alcohol withdrawal and agitation. Research continues to explore its role in specific patient populations and compare its safety profile with newer agents.
Lab Monitoring
- Liver function tests (especially with long-term use or hepatic impairment)
- Respiratory rate monitoring (especially in elderly or with concomitant CNS depressants)
Doctor Notes
- Strictly for short-term use (usually <2 weeks) due to dependence potential.
- Careful monitoring required for respiratory function, especially in elderly, those with respiratory compromise, or when co-administered with other CNS depressants.
- Consider alternative therapies where possible for insomnia to avoid dependence and side effects.
- Always taper off slowly to avoid severe withdrawal symptoms, particularly in alcohol-dependent patients.
- Assess for risk of abuse before prescribing.
Patient Guidelines
- Do not exceed the prescribed dose or duration of treatment.
- Avoid alcohol and other CNS depressants while taking this medicine.
- Inform your doctor about all other medications and medical conditions you have.
- Do not stop taking this medicine suddenly without consulting your doctor, especially if used for alcohol withdrawal, to avoid severe withdrawal symptoms.
Missed Dose Advice
If a dose is missed, take it as soon as remembered unless it's almost time for the next dose. Do not double the dose.
Driving Precautions
Chlormethiazole may cause drowsiness, dizziness, and impaired concentration and coordination. Patients should be advised not to drive or operate machinery until they know how the drug affects them and are certain they can perform such tasks safely.
Lifestyle Advice
- Maintain a regular sleep schedule if using for insomnia.
- Avoid operating heavy machinery or driving if experiencing drowsiness or dizziness.
- Limit caffeine intake.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.
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