Is Chloral Hydrate safe while breastfeeding?

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

• Zaleplon
• Zolpidem