4.7.1.1 Hypnotics, sedatives and anxiolytics

Kent and Medway Melatonin Guidance

Melatonin Prescribing Checklist for Clinicians

The paediatric indication for chloral hydrate (for children aged 2 years and older) and cloral (previously chloral) betaine (children aged 12 years and older) has been restricted to short-term treatment (maximum 2 weeks) of severe insomnia only when the child or adolescent has a suspected or definite neurodevelopmental disorder and when the insomnia is interfering with normal daily life.
Chloral hydrate and cloral betaine should only be used when other therapies (behavioural and pharmacological) have failed.

Where a patient is currently receiving regular, long-term chloral hydrate for the management of insomnia:

• They should be reviewed by a relevant specialist and a plan made for discontinuation of the drug. Due to risks associated with sudden cessation of chloral hydrate, this will usually require a gradual, controlled discontinuation. Do not stop abruptly if patients have been taking the drug regularly for over 2 weeks.
• Alternative pharmacological or non-pharmacological treatments may be required. Consider referring to a local sleep service where appropriate and available.

Please see MHRA Drug Safety Update (here) and the position statement "Off label use of Chloral Hydrate in the Management of Intrusive Movement and Motor Disorders in Children and Young People" (here). It should only be used under the supervision of a named consultant with appropriate experience.