No

Antibiotic, Oral Rinse; Antibiotic, Topical

Dental:

Antibacterial dental rinse; chlorhexidine is active against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast

Chip, for periodontal pocket insertion; indicated as an adjunct to scaling and root planing procedures for reduction of pocket depth in patients with adult periodontitis; may be used as part of a periodontal maintenance program

Medical: Skin cleanser for surgical scrub, cleanser for skin wounds, germicidal hand rinse, and as antibacterial dental rinse. Chlorhexidine is active against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast.

B

Known hypersensitivity to chlorhexidine gluconate

Staining of oral surfaces, tooth restorations, and dorsum of tongue may occur; keep out of eyes and ears; for topical use only; there have been case reports of anaphylaxis following chlorhexidine disinfection

>10%: Oral: Increase of tartar on teeth, changes in taste. Staining of oral surfaces (mucosa, teeth, dorsum of tongue) may be visible as soon as 1 week after therapy begins and is more pronounced when there is a heavy accumulation of unremoved plaque and when teeth fillings have rough surfaces. Stain does not have a clinically adverse effect but because removal may not be possible, patient with frontal restoration should be advised of the potential permanency of the stain.

1% to 10%: Gastrointestinal: Tongue irritation, oral irritation

<1%: Facial edema, nasal congestion, shortness of breath

Symptoms of oral overdose include gastric distress, nausea, or signs of alcohol intoxication

No data reported

Store at room temperature

The bactericidal effect of chlorhexidine is a result of the binding of this cationic molecule to negatively charged bacterial cell walls and extramicrobial complexes. At low concentrations, this causes an alteration of bacterial cell osmotic equilibrium and leakage of potassium and phosphorous resulting in a bacteriostatic effect. At high concentrations of chlorhexidine, the cytoplasmic contents of the bacterial cell precipitate and result in cell death.

Absorption: ~30% of chlorhexidine is retained in the oral cavity following rinsing and is slowly released into the oral fluids; chlorhexidine is poorly absorbed from the GI tract

Serum concentrations: Detectable levels are not present in the plasma 12 hours after administration

Elimination: Primarily through the feces (approximately 90%); <1% excreted in the urine

Adults:

Precede use of solution by flossing and brushing teeth; completely rinse toothpaste from mouth. Swish 15 mL undiluted oral rinse around in mouth for 30 seconds, then expectorate. Caution patient not to swallow the medicine. Avoid eating for 2-3 hours after treatment. (The cap on bottle of oral rinse is a measure for 15 mL.)

When used as a treatment of gingivitis, the regimen begins with oral prophylaxis. Patient treats mouth with 15 mL chlorhexidine, swishes for 30 seconds, then expectorates. This is repeated twice daily (morning and evening). Patient should have a re-evaluation followed by a dental prophylaxis every 6 months.

Cleanser:

Surgical scrub: Scrub 3 minutes and rinse thoroughly, wash for an additional 3 minutes

Hand wash: Wash for 15 seconds and rinse

Hand rinse: Rub 15 seconds and rinse

Periodontal chip: Adults: One chip is inserted into a periodontal pocket with a probing pocket depth greater than or equal to 5 mm. Up to 8 chips may be inserted in a single visit. Treatment is recommended every 3 months in pockets with a remaining depth greater than or equal to 5 mm. If dislodgment occurs 7 days or more after placement, the subject is considered to have had the full course of treatment. If dislodgment occurs within 48 hours, a new chip should be inserted.

Insertion of periodontal chip: Pocket should be isolated and surrounding area dried prior to chip insertion. The chip should be grasped using forceps with the rounded edges away from the forceps. The chip should be inserted into the periodontal pocket to its maximum depth. It may be maneuvered into position using the tips of the forceps or a flat instrument. The chip biodegrades completely and does not need to be removed. Patients should avoid dental floss at the site of PerioChip® insertion for 10 days after placement because flossing might dislodge the chip.

Insertion of periodontal chip: Pocket should be isolated and surrounding area dried prior to chip insertion. The chip should be grasped using forceps with the rounded edges away from the forceps. The chip should be inserted into the periodontal pocket to its maximum depth. It may be maneuvered into position using the tips of the forceps or a flat instrument. The chip biodegrades completely and does not need to be removed.

No information available to require special precautions

Swelling of face has been reported

Oral rinse: Do not swallow, do not rinse after use; may cause reduced taste perception which is reversible; may cause discoloration of teeth

Topical administration is for external use only

Inform patient that reduced taste perception during treatment is reversible with discontinuation of chlorhexidine

Chip, for periodontal pocket insertion (PerioChip®): 2.5 mg

Foam, topical, with isopropyl alcohol 4% (BactoShield®): 4% (180 mL)

Liquid, topical, with isopropyl alcohol 4%:

Dyna-Hex® Skin Cleanser: 2% (120 mL, 240 mL, 480 mL, 960 mL, 4000 mL); 4% (120 mL, 240 mL, 480 mL, 4000 mL)

BactoShield® 2: 2% (960 mL)

BactoShield®, Betasept®, Exidine® Skin Cleanser, Hibiclens® Skin Cleanser: 4% (15 mL, 120 mL, 240 mL, 480 mL, 960 mL, 4000 mL)

Rinse:

Oral (mint flavor) (Peridex®, PerioGard®): 0.12% with alcohol 11.6% (480 mL)

Topical (Hibistat® Hand Rinse): 0.5% with isopropyl alcohol 70% (120 mL, 240 mL)

Sponge/Brush (Hibiclens®): 4% with isopropyl alcohol 4% (22 mL)

Wipes (Hibistat®): 0.5% (50s)

al-Tannir MA and Goodman HS, "A Review of Chlorhexidine and Its Use in Special Populations," Spec Care Dentist, 1994, 14(3):116-22.

Emerson D and Pierce C, "A Case of a Single Ingestion of 4% Hibiclens®," Vet Hum Toxicol, 1988, 30(6):583.

Ferretti GA, Brown AT, Raybould TP, et al, "Oral Antimicrobial Agents - Chlorhexidine," NCI Monogr, 1990, 9:51-5.

Greenstein G, Berman C, and Jaffin R, "Chlorhexidine. An Adjunct to Periodontal Therapy," J Periodontol, 1986, 57(6):370-7.

Johnson BT, "Uses of Chlorhexidine in Dentistry," Gen Dent, 1995, 43(2):126-32, 134-40.

Massano G, Ciocatto E, Rosabianca C, et al, "Striking Aminotransferase Rise After Chlorhexidine Self-Poisoning," Lancet, 1982, 1(8266):289.

Quinn MW and Bini RM, "Bradycardia Associated With Chlorhexidine Spray," Arch Dis Child, 1989, 64(6):892-3.

Yong D, Parker FC, and Foran SM, "Severe Allergic Reactions and Intra-Urethral Chlorhexidine Gluconate," Med J Aust, 1995, 162(5):257-8.

Yusof ZA, "Chlorhexidine Mouthwash: A Review of Its Pharmacological Activity, Clinical Effects, Uses and Abuses," Dent J Malays, 1988, 10(1):9-16.