Chloral hydrate abuse

Unlike benzodiazepines, buspirone is not associated with sedative or abuse problems, but some clinicians have observed that bus-pirone s anxiolytic properties do not appear to be as potent as those of benzodiazepines, particularly in patients who have previously received a benzodiazepine. Because buspirone is not sedating and has no psychomotor effects, it has a distinct advantage over benzodiazepines when optimal alertness and motor performance are necessary. Response to buspirone occurs in approximately 2-4 weeks. Buspirone does not show cross-tolerance with benzodiazepines and other sedative or hypnotic drugs such as alcohol, barbiturates, and chloral hydrate. Therefore, buspirone does not suppress benzodiazepine withdrawal symptoms. In anxious patients who are taking a benzodiazepine and who require a switch to buspirone, the benzodiazepine must be tapered gradually to avoid withdrawal symptoms, despite the fact that the patient is receiving buspirone. 

Schedule IV Substances with low abuse potential for example, some barbiturate compounds, chloral hydrate, and benzodiazepine derivatives. 

Schedule IV - This class represents medications considered to be of low abuse potential with the possibility of limited dependence especially when compared to the previous schedules. Examples are phenobarbital, chloral hydrate, the benzodiazepine tranquilizers, propoxyphene and meprobamate (all are sedatives). 

Drugs in this category have an accepted medical use and a relatively low potential for abuse compared to Schedule 3. Use may lead to limited physical dependence or psychological dependence. Many drugs in this category are hypnotic (sleep-inducing) or anesthetic in effect. Phenobarbital, barbital, and chloral hydrate are examples. 

The drugs in Schedule IV have a relatively low abuse potential and risk for psychological or physical dependence relative to those listed in Schedule in and include such drugs as barbital, phenobarbital, methylphe-nobarbital, chloral betaine (Beta Chlor), chloral hydrate, ethchlorvynol (Placidyl), ethinamate (Valmid), meprobamate (Equanil, Miltown), paraldehyde, methohexital, fenfluramine, diethyipropion, phentermine, chlor-diazepoxide (Librium), diazepam (Valium), oxazepam (Serax), clorazepate (Tranxene), flurazepam (Dalmane), clonazepam (Clonopin), prazepam (Verstran), lorazepam (Ativan), mebutamate, and dextropropoxyphene (Dar-von). 

Chloral hydrate was widely used as a sleeping medication and anticonvulsant before other drugs became available, but it is not prescribed very often now. — Abusers sometimes combine it with alcohol, thus increasing the depressant effect and resulting in a potentially dangerous knockout potion known as a Mickey Finn. 

Another downer, chloral hydrate, is the oldest sleeping drug still in medical use. Although rare today, abuse of it was not uncommon in the last century. Slipped into alcoholic drinks, it was the notorious "Mickey Finn" or "knockout drops" used to drug unsuspecting people into unconsciousness in order to rob or shanghai them. 

Chloral hydrate, clomethiazole and barbiturates also enhance GABA function but at high doses have the additional capacity directly to open the membrane chloride channel (see Figure 19.4) this may lead to potentially lethal respiratory depression and explains their low therapeutic ratio. These drugs also have a propensity for abuse/misuse and are very much second-line treatments. 

Nonbarbiturate sedative-hypnotics have a similar mechanism of action as barbiturates and have high potential for tolerance, abuse, dependence, overdose, and withdrawal reactions. Chloral hydrate is still commonly used today due to its efficacy as a short-term sedative hypnotic and low cost. Chloral hydrate should not be used in patients with severe renal, hepatic, or cardiac disease. 

Chloral hydrate is used as a sedative-hypnotic agent. It is also a drug of abuse. 

Chloral hydrate is normally used today as a sleeping pill only if a person cannot take other sleeping pills called benzodiazepines. It is marketed under the brand name Noctec. The drug comes in liquid or capsule form and may be swallowed or inserted into the rectum. Chloral hydrate is listed on Schedule IV of the Controlled Substances Act, which means that it has a legitimate medical use even though it may be abused. 

IV Medical use low abuse potential Benzodiazepines, chloral hydrate, meprobamate, weak opioid agonists, zolpidem, zaleplon... 

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