Is Chloral Hydrate safe while breastfeeding?
Here is what LactMed, the Drugs and Lactation Database published by the U.S. National Institute of Child Health and Human Development (NICHD), reports about Chloral Hydrate. The text below is quoted from that source — it is not our own verdict.
Summary of use during breastfeeding
Short-term or occasional use of chloral hydrate during breastfeeding is unlikely to adversely affect the breastfed infant, especially if the infant is older than 2 months. Because the active metabolite of chloral hydrate has a long half-life, other sedative-hypnotics are preferred for long-term use during breastfeeding, especially while nursing a neonate or preterm infant. Monitor the infant for sedation, poor feeding and poor weight gain.
Effects on the breastfed infant
An old review article states that if an infant is breastfed within 45 minutes of a maternal dose of chloral hydrate while she is taking 1.5 grams twice daily, the infant will fall into a prolonged, restless sleep.[3]
A single maternal rectal dose of 1.3 grams chloral hydrate in 50 women was stated to not adversely affect their breastfed newborn infants.[1]
Minimal morning sedation occurred in a 5-month-old breastfed infant whose mother was taking 1.3 grams of dichloralphenazone (equivalent to about 1 gram of chloral hydrate) every evening plus chlorpromazine 100 mg 3 times daily. The infant's overall development was said to be normal at 3 months of age.[2]
Effects on milk supply
Relevant published information was not found as of the revision date.
Levels in milk
Maternal Levels. In a study of 50 women who were given 1.3 grams of chloral hydrate rectally on day 3 postpartum, peak chloral hydrate milk levels of about 10 mg/L occurred within the first hour and fluctuated between 6 and 10 mg/L for 10 hours after the dose. Milk levels of the active metabolite, trichloroethanol, reached a peak of about 40 mg/L at 45 minutes after the dose and gradually decreased to about 12 mg/L over the next 23 hours.[1]
After 1.3 grams of dichloralphenazone daily dichloralphenazone (equivalent to about 1 gram of chloral hydrate), milk trichloroethanol levels were found to range from 1.3 to 3.2 mg/L in one woman.[2]
Infant Levels. After a 1.3 gram maternal dose of dichloralphenazone (equivalent to about 1 gram of chloral hydrate), trichloroethanol was detected in the breastfed infant's plasma 21 hours later.[2]
Alternatives LactMed lists
Source: Drugs and Lactation Database (LactMed), National Institute of Child Health and Human Development (NICHD), via NCBI Bookshelf, record “Chloral Hydrate” (LM431). LactMed on NCBI Bookshelf. LactMed is a registered trademark of the U.S. Department of Health and Human Services.
Educational summary of an authoritative source — not medical advice. Never start, stop, or change a medicine while breastfeeding without confirming with your doctor.