Chlorhexidine gluconate is an antiseptic drug that is effective against Bacteria and Fungi. It is used to treat the following conditions:

• As antimicrobial oral rinse for the treatment of Gingivitis.

• As Adjunctive therapy (dental chip) to scaling and root planning procedures to reduce pocket depth in patients with periodontitis

• Off-Label Use of Chlorhexidine Gluconate in Adults:

  • As adjunctive therapy in the treatment of medication-related osteonecrosis of the jaw (MRONJ).
  • For Oropharyngeal decontamination to reduce the risk of ventilator-associated or hospital-acquired pneumonia in Cardiac surgical patients and mechanically ventilated patients

Chlorhexidine Dose in Adults

Chlorhexidine use in Gingivitis:

• Oral Rinse:
  • Swish for 30 seconds with one capful or 15 mLof undiluted oral rinses twice daily after toothbrushing. Expectorate after oral rinses.
  • It should be initiated immediately after dental prophylaxis.

Use in Periodontitis:

• Periodontal chip:
  • One chip is inserted into a periodontal pocket with a depth of more than 5 mm.
  • Up to 8 chips may be inserted in a single visit.
  • Treatment is recommended every three months in pockets with a remaining depth of 5 mm or more
  • If dislodgment occurs seven days or more after placement, full treatment should be considered.
  • If dislodgment occurs within two days, a new chip should be inserted.

Off-label use in the treatment of Oropharyngeal decontamination to reduce the risk of hospital-acquired or ventilator-associated pneumonia:

• Cardiac surgical patients:
  • 15 mL swished and gargled or applied to intubated patients by swabbing the oral cavity for 30 seconds twice a day.
  • Therapy should be initiated preoperatively and continued postoperatively for ten days or until extubation.
  • Avoid food or drink for thirty minutes after rinsing.

Chlorhexidine Dose in Childrens

Chlorhexidine use in Gingivitis:

• Children older than 8 years and Adolescents:
  • Oral rinse (0.12%):
    • Swish one capful or 15 ml for 30 seconds twice daily after toothbrushing and then expectorate.

Pregnancy Risk Factor B

• Because it is poorly absorbed by the gastrointestinal tract, there have been no adverse effects in pregnant women.
• Pregnant females have not been tested on the use of periodontal chips.
• Pregnancy with Chlorhexidine It is safe to use in lactating women, as it is not absorbed through the GI tract.

Chlorhexidine Dose in Kidney Disease:

The manufacturer does not recommend any dose adjustment in patients with Renal disease.

Chlorhexidine Dose in Liver Disease:

The manufacturer does not recommend any dose adjustment in patients with liver disease.

Common Side Effects of Chlorhexidine gluconate include:

• Gastrointestinal:
  • Toothache
• Respiratory:
  • Upper respiratory tract infection
  • Sinusitis

Less Common Side Effects Of Chlorhexidine gluconate inlcude:

• Gastrointestinal:
  • Gingival hyperplasia
  • Aphthous stomatitis
• Neuromuscular & skeletal:
  • Arthritis
  • Tendonitis
• Respiratory:
  • Bronchitis
  • Pharyngitis

Frequency not defined:

• Dermatologic:
  • Cellulitis
• Gastrointestinal:
  • Dental discoloration with oral rinse
  • Dental discomfort
  • Increased tartar formation
  • Mouth discoloration
• Infection:
  • Abscess

Contraindication to Chlorhexidine gluconate include:

• Allergy reactions to chlorhexidine and any component of the formulation

Warnings and Precautions

• Hypersensitivity reactions
  • Anaphylaxis and severe allergic reactions may occur.
• Oral Rinse
  • Although it is possible for oral surfaces to become stained, this does not necessarily mean that the oral health of other tissues or gingival health will be affected.
  • Every six months, dental prophylaxis should be done to remove dental calculus.
  • It has been reported that it can alter the taste buds.
• Periodontal chip
  • Cellulitis and abscesses have been seen with adjunctive chip placement.
  • Patients with periodontal disease or concomitant conditions like cancer or diabetes should not use it.
  • It is not recommended to use in the treatment of acute periodontal infection or abscess pockets.

Monitor:

None required

How to administer Chlorhexidine gluconate:

• When used as Oral Rinse:
  • Swish, rinse and expectorate after rinsing
  • It should not be swallowed.
  • Use chlorhexidine in the morning and evening after brushing teeth and do not immediately rinse with other mouthwashes, water, eat, or brush teeth.
• Periodontal chip insertion:
  • The Pocket should be isolated and the surrounding area dried before the chip insertion.
  • The chip should be held and inserted into the pocket to its maximum depth using forceps with the rounded edges away from the forceps.
  • Removal of the chip is not required as it is biodegradable.
  • Patients should avoid dental floss for 10 days as flossing might dislodge the chip.

Mechanism of action of Chlorhexidine gluconate:

• Chlorhexidine, an antiseptic solution, has bactericidal as well as bacteriostatic properties depending upon its concentration.
• It is active against both gram-positive as well as gram-negative organisms.
• Chlorhexidine, a cationic molecule that binds to negatively charged bacterial cell walls, results in its bactericidal properties.
• Low concentrations of potassium and/or phosphorous can alter the bacterial cell osmotic equilibrium, leading to a bacteriostatic reaction.
• High concentrations of cytoplasmic content in bacterial cells can cause cell death.

Absorption:

• Oral Rinse:
  • It is poorly absorbed from the gastrointestinal tract after oral administration
• Periodontal chip:
  • Chlorhexidine is released from chip in a biphasic manner.
  • About 40% is released within the first 24 hours, the remainder is released over 7 - 10 days.
  • Plasma levels are undetectable following the insertion of up to 4 chips.

It is Excreted primarily in the feces.

Chlorhexidine international brands:

• APO-Chlorhexidine
• Chlorhexidine Alcohol Free
• DentiCare Rinse
• GUM Paroex Oral Rinse
• Oro Clear
• Oro-Clense
• Perichlor
• Peridex
• Periogard
• X-Pur Chlorhexidine
• A'Fresh
• Afresho
• Alpha-Hexidine Sungkwang Gargle
• Amident
• Antiseptol
• Atoseptal
• B-Mouthwash
• Bacto Scrub
• Baxil
• Benodent CLX
• Bucoglobin Gel Dental
• Bucoseptil
• Chlohexin Gargle
• Chlorasept
• Chlorhexil
• Cidegol C
• Clear Mouthwash
• Clohex
• Coglu
• Collunovar
• Corsodyl
• Corsodyl
• Mint
• Deratin
• Dynexan Proaktiv
• Eburos
• Elgydium
• Eludrilperio
• Elugel
• Everguard
• Fresh Breath
• Health Mouthwash
• Hexabir
• Hexamedal
• Hexidine
• Hexidine Mouth Wash
• Hexidine Mouthwash
• Hexisept
• Hexitol
• Medilixin
• Odontol Plac
• Oracare
• Oradex
• Orahex
• Oraklean
• Oral-C
• Oralgene
• Oralon
• Oralon Dental Gel
• Oralxidine
• Oraxine
• Paroex
• Perio-Aid
• Periochip
• Periokin Gel
• Prexidine
• Prodent Plac
• Qualikin
• Savacol Mouth and Throat Rinse
• Scrub Stat 4
• Septofort
• Sorexidine
• Tarodent
• Ya Nuo
• Zordyl

Chlorhexidine brands in Pakistan: