Pronunciation:

(klor HEKS i deen GLOO koe nate)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Orphan drug: Peridex®: Oral mucositis with cytoreductive therapy when used for patients undergoing bone marrow transplant

Use - 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

Pregnancy Risk Factor:

Contraindications:

Warnings/Precautions:

Oral: Staining of oral surfaces (mucosa, teeth, tooth restorations, dorsum of tongue) may occur; 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.

Topical: For topical use only. Keep out of eyes and ears. May stain fabric. There have been case reports of anaphylaxis following chlorhexidine disinfection. Not for preoperative preparation of face or head; avoid contact with meninges.

Adverse Reactions:

Oral:

>10%: 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, dyspnea

Topical: Skin erythema and roughness, dryness, sensitization, allergic reactions

Overdosage/Toxicology:

Drug Interactions:

Stability:

Avagard™: Avoid excessive heat. Ethanol-containing products are flammable; keep away from flames or fire. Hand lotions and gel hand sanitizers are incompatible. The thickeners used in these products (eg, carbomer) react to form an insoluble salt and cause loss of antibacterial action.

Mechanism of Action:

Pharmacodynamics/Kinetics:

Topical hand sanitizer (Avagard™): Duration of antimicrobial protection: 6 hours

Oral rinse (Peridex®, PerioGard®):

Absorption: ~30% retained in the oral cavity following rinsing and slowly released into oral fluids; poorly absorbed

Time to peak, plasma: Oral rinse: Detectable levels not present after 12 hours

Excretion: Feces (~90%); urine (<1%)

Dosage:

Oral rinse (Peridex®, PerioGard®):

Floss and brush teeth, completely rinse toothpaste from mouth and swish 15 mL (one capful) undiluted oral rinse around in mouth for 30 seconds, then expectorate. Caution patient not to swallow the medicine and instruct not to eat for 2-3 hours after treatment. (Cap on bottle measures 15 mL.)

Treatment of gingivitis: Oral prophylaxis: Swish for 30 seconds with 15 mL chlorhexidine, then expectorate; repeat twice daily (morning and evening). Patient should have a re-evaluation followed by a dental prophylaxis every 6 months.

Periodontal chip: One chip is inserted into a periodontal pocket with a probing pocket depth 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 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. 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.

Cleanser:

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

Hand sanitizer (Avagard™): Dispense 1 pumpful in palm of one hand; dip fingertips of opposite hand into solution and work it under nails. Spread remainder evenly over hand and just above elbow, covering all surfaces. Repeat on other hand. Dispense another pumpful in each hand and reapply to each hand up to the wrist. Allow to dry before gloving.

Hand wash: Wash for 15 seconds and rinse

Hand rinse: Rub 15 seconds and rinse

Administration:

Hand sanitizer (Avagard™): To facilitate drying, continue rubbing hand prep into hands until dry.

Periodontal chip insertion: 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.

Topical: Keep out of eyes, ears, and mouth. Do not routinely apply to wounds which involve more than superficial layers of skin.

Patient Education:

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

Periodontal chip: Avoid dental floss at the site of the chip insertion for 10 days after placement because flossing might dislodge the chip.

Topical: For external use only.

Nursing Implications:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

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

Liquid, topical [surgical scrub]:

Avagard™: 1% (500 mL) [contains ethyl alcohol and moisturizers]

BactoShield® CHG: 2% (120 mL, 480 mL, 750 mL, 1000 mL, 3800 mL); 4% (120 mL, 480 mL, 750 mL, 1000 mL, 3800 mL) [contains isopropyl alcohol]

Betasept®: 4% (120 mL, 240 mL, 480 mL, 960 mL, 3840 mL) [contains isopropyl alcohol]

ChloraPrep®: 2% (0.67 mL, 1.5 mL, 3 mL, 10.5 mL) [contains isopropyl alcohol 70%; prefilled applicator]

Chlorostat®: 2% (360 mL, 3840 mL) [contains isopropyl alcohol]

Dyna-Hex: 2% (120 mL, 960 mL, 3840 mL); 4% (120 mL, 960 mL, 3840 mL)

Hibiclens®: 4% (15 mL, 120 mL, 240 mL, 480 mL, 960 mL, 3840 mL) [contains isopropyl alcohol]

Operand® Chlorhexidine Gluconate: 2% (120 mL); 4% (120 mL, 240 mL, 480 mL, 960 mL, 3840 mL) [contains isopropyl alcohol]

Liquid, oral rinse: 0.12% (480 mL)

Peridex®: 0.12% (480 mL) [contains alcohol 11.6%]

PerioGard®: 0.12% (480 mL) [contains alcohol 11.6%; mint flavor]

Liquid, topical: Hibistat®: 0.5% (240 mL, 480 mL) [contains isopropyl alcohol]

Pad [prep pad]: Hibistat®: 0.5% (50s) [contains isopropyl alcohol]

Sponge/Brush (BactoShield® CHG, Hibiclens®): 4% per sponge/brush [contains isopropyl alcohol]

International Brand Names: