Paraldehyde (Paral)

Category:

  • Sedatives

Description:

  • DEA Schedule V Anticonvulsant

Indications:

  • Refractory seizures, status epilepticus, sedation, insomnia

  • Alcohol withdrawal, tetanus, eclampsia

Contraindications:

  • Bronchopulmonary disease, hepatic insufficiency

  • Gastroenteritis with ulceration

Precautions:

  • Pregnancy category C

  • Hepatic impairment

  • Mucous membrane irritation

Adverse Reactions (Side Effects):

  • CNS: addiction syndrome resembling alcoholism, coma, confusion dizziness, drowsiness, flushing, hallucinations, headache, seizures, stimulation

  • CV: circulatory collapse, pulmonary edema, pulmonary hemorrhage

  • GI: foul breath, hepatitis, irritation

  • HEME: agranulocytosis, hemolytic anemia, leukopenia, neutropenia, thrombocytopenia

  • RESP: respiratory depression

  • SKIN: erythema, fat necrosis, local pain, rash, sloughing

Dosage:

Administered orally, rectally, intravenously, intramuscularly

  • Adult:            

    • Seizures: 

      • IM 5-10ml; divide 10ml into 2 injections

      • IV 0.2-0.4 ml/kg in NS

    • Alcohol withdrawal: 

      • PO/PR 5-10ml, not to exceed 60ml

      • IM 5ml every 4-6 hours for 24 hours, then every 6 hours on following days, not to exceed 30ml

    • Sedation: 

      • PO/PR 4-10ml

      • IM 5ml; IV 3-5ml (emergency only)

    • Tetanus: 

      • IV 4-5ml or 12ml by gastric tube every 4 hours diluted with water; 

      • IM 5-10ml as needed

  • Child:            

    • Seizures: 

      • IM 0.15 ml/kg; PR 0.3 ml/kg every 4-6 hours or 1 ml/yr of age, not to exceed 5ml; may repeat in 1 hour as needed

      • IV 5ml/90ml NS injection; begin INF at 5 ml/hr; titrate to patient response

    • Sedation: 

      • PO/PR/IM 0.15 ml/kg

Special Considerations:

  •  Injectable form no longer commercially available

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