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