Talk:Paraldehyde

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''Injection. Paraldehyde is no longer given by injection since this can be very painful and lead to sterile abscesses, nerve damage, and tissue necrosis.''

India was using intramuscular paraldehyde for status epilepticus in 2000. Nigeria was doing this around 1998. Who was it, exactly, that no longer injects it at all? The United Kingdom? Would you mind clarifying this?--Rmky87 22:52, 17 January 2006 (UTC)


 * Thanks very much for reviewing this. You are right and I think that sentence over-simplifies the situation. There is a difference between intravenous and intramuscular in the risk and advice. The former seems to be pretty universally discouraged but presumably was done in the past and might still be done somewhere. To quote from the New Zealand data sheet:


 * Intramuscular administration of paraldehyde is extremely painful and has produced sterile skin abscesses, sloughing of skin, fat necrosis, and muscular irritation. Severe and permanent nerve damage has occurred when paraldehyde was injected intramuscularly too close to nerve trunks; care must be taken when administered by the intramuscular route.


 * Intravenous administration of paraldehyde is not recommended as it has caused pulmonary oedema, pulmonary haemorrhage, dilatation of the right side of the heart, circulatory collapse, thrombophlebitis, respiratory distress and cyanosis.


 * The NZ data sheet describes its use as an intramuscular injection. The manufacturer's Austrailian patient info leaflet also describes the IM route. There is a letter in the Indian journal you quoted earlier positively recommending IM injection of paraldehyde in neonates.


 * The UK sources I have (BNF 50 and BNF for Children 2005) both only list the rectal route for administration. The product comes in an ampoule for injection but this is mixed with saline or oil to form an enema.


 * The American source (Drugs.com) lists the oral and rectal route for the US and Canada but parenteral for Canada only. However, this drug information sheet is old (Revised: 03/19/1993) so I'd prefer to find a more up-to-date source. The book Aicardi's Epilepsy in Children (ISBN 0781726980) page 258 says "Intravenous paraldehyde solution is no longer commercially available in the United States".


 * I'll rewrite this bit in the article when I get a moment. However, feel free to go ahead and fix it.--Colin 23:21, 18 January 2006 (UTC)

''It was included in some cough medicines as an expectorant (though this may have relied on the placebo effect: if it tastes horrible then it must be good for you). ''
 * This is not a very good explanation of the placebo effect. Placebos need not taste bad. --Littenberg 21:06, 18 March 2006 (UTC)