Clomethiazole

Clomethiazole - is available as capsules (192 mg) and syrup (250 mg/5 ml), but no longer available as a 0.8% solution for IV use. One capsule is equivalent to 5 ml syrup. The capsule contains 192 mg clomethiazole (base) while the syrup contains 250 mg clomethiazole edisilate per 5 ml. The difference in weight is due to the inactive edisilate group.

Uses:
Alcohol withdrawal
Restlessness and agitation

Contraindications:
Alcohol-dependent patients who continue to drink

Administration:
1 capsule = 5 ml syrup
• Alcohol withdrawal
Oral: Day 1, 9–12 capsules in 3–4 divided doses
      Day 2, 6–8 capsules in 3–4 divided doses
      Day 3, 4–6 capsules in 3–4 divided doses
      Then gradually reduce over days 4–6
      Do not treat for 9 days
• Restlessness and agitation
Oral: 1 capsule 3 times daily

How not to use clomethiazole:
Prolonged use (risk of dependence)
Abrupt withdrawal

Adverse effects:
Increased nasopharyngeal and bronchial secretions
Conjunctival irritation
Headache

Cautions:
Concurrent use of other CNS depressants will produce excessive sedation
Cardiac and respiratory disease – confusion may indicate hypoxia
Hepatic impairment – sedation can mask hepatic coma
Renal impairment

Organ failure:
Hepatic: reduced clearance with accumulation. Can precipitate coma
Renal: increase cerebral sensitivity