Chlorhexidine gluconate

Chlorhexidine gluconate is a an Antiseptic agent belonging to pharmacology class of Furan derivatives

Chlorhexidine gluconate can be used in the treatment of Seborrheic Dermatitis and Scalp psoriasis, Wound cleansing and Minor burns .It is also used to treat moderate to severe gingivitis, and for management of Associated gingival bleeding and inflammation according to the recommended dosage and frequency Under supervision of a dentist.

Chlorhexidine gluconate is Poorly absorbed from gastrointestinal tract and get excreted Via faeces (approx 90%) and urine (<1%).

The common side effects associated with Chlorhexidine gluconate include Dry mouth, taste alteration.

Chlorhexidine gluconate is available in the form of Solution, Mouthrinses, gel, spray and soaps.

The molecule is available in India, USA, Japan, Germany.

Chlorhexidine gluconate belonging to the Furan derivatives acts a Antiseptic Agent.

Chlorhexidine gluconate can be used in the treatment of Skin cleanser for preoperative skin preparation, skin wound and general skin cleanser for patients; surgical scrub and antiseptic hand rinse for healthcare personnel.

Depending on the concentration, chlorhexidine exhibits activity against gram-positive and gram-negative bacteria, facultative anaerobes, aerobes, and yeast. It also possesses antifungal and Antiseptic properties. Chlorhexidine binds to negatively charged bacterial cell walls and extramicrobial complexes, where it exerts its bactericidal effects. At low doses, this leads to a change in the osmotic balance of bacterial cells and the release of potassium and phosphorous, which has a bacteriostatic effect. Chlorhexidine concentrations that are too high cause the cytoplasmic components of the bacterial cell to precipitate and die.

Chlorhexidine gluconate is available in Solution, Mouthrinses, gel, spray and soaps.

Chlorhexidine gluconate can be used in the treatment of Seborrheic Dermatitis and Scalp psoriasis, Wound cleansing and Minor burns .It is also used to treat moderate to severe gingivitis, and for management of Associated gingival bleeding and inflammation according to the recommended dosage and frequency Under supervision of a dentist.

Chlorhexidine kills gram-positive and gram-negative bacteria by attaching cationic molecules to negatively charged bacterial cell walls and extramicrobial complexes, which causes the cytoplasmic contents of the bacterial cell wall to precipitate and cause cell death. By changing the osmotic balance of bacterial cells and causing potassium and phosphorus leakage at low concentrations, it functions as a bacteriostatic agent.

Chlorhexidine gluconate is approved for use in the following clinical indications

Antiseptic: Skin cleanser for preoperative skin preparation, skin wound and general skin cleanser for patients; surgical scrub and antiseptic hand rinse for healthcare personnel. It is also used to treat moderate to severe gingivitis, and for management of Associated gingival bleeding and inflammation according to the recommended dosage and frequency Under supervision of a dentist.

Antiseptic: Topical:

Surgical scrub: Scrub hands and forearms with ~5 mL for 3 minutes paying close attention to nails, cuticles, and interdigital spaces, and rinse thoroughly, wash for an additional 3 minutes with 5 mL, rinse, and dry thoroughly.

Health care personnel hand antiseptic: Liquid or solution: Wash with ~5 mL for 15 seconds; rinse thoroughly with water and dry

Preoperative skin preparation:

Solution: Apply liberally to surgical site and swab for at least 2 minutes. Dry with sterile towel. Repeat procedure (swab for additional 2 minutes and dry with sterile towel).

Applicator:

Dry surgical sites (e.g, abdomen, arm): Completely wet treatment area; use gentle back and forth strokes for ~30 seconds. Allow solution to air dry for ~30 seconds. If using an ignition source (e.g, electrocautery), allow solution to completely dry for a minimum of 3 minutes for hairless skin and up to 1 hour in hair; do not blot or wipe away. Note: Prior to use with electrocautery procedures, consult specific product labeling to determine if the ChloraPrep product may be used near an ignition source.

Moist surgical sites (e.g, inguinal area): Completely wet treatment area; use gentle back and forth strokes for ~2 minutes. Allow solution to air dry for ~ 1 minute. If using an ignition source (e.g, electrocautery), allow solution to completely dry for a minimum of 3 minutes for hairless skin and up to 1 hour in hair; do not blot or wipe away. Note: Prior to use with electrocautery procedures, consult specific product labeling to determine if the ChloraPrep product may be used near an ignition source.

Wound care and general skin cleansing: Rinse area with water, then apply minimum amount necessary to cover skin or wound area and wash gently. Rinse again thoroughly.

Solution

• Dose Adjustment in Pediatric patient:

Skin cleanser for preoperative skin preparation, skin wound and general skin cleanser for patients: Topical:

Infants <2 months: Note: It is recommended to use with care in this population due to potential risk of dermal irritation or chemical burns. Expert suggestions are variable depending upon site and clinical scenario. Not all products may be appropriate for use in this population; refer to product specific labeling. Some experience in neonatal patients applicable to this patient population.

Preoperative skin preparation: Solution: Apply liberally to surgical site and swab for at least 2 minutes. Dry with sterile towel. Repeat procedure (swab for additional 2 minutes and dry with sterile towel).

Wound care and general skin cleansing: Rinse area with water, then apply the minimum amount of chlorhexidine necessary to cover skin or wound area and wash gently. Rinse again thoroughly.

Infants ≥2 months, Children, and Adolescents: Topical solution:

Preoperative skin preparation: Solution: Apply liberally to surgical site and swab for at least 2 minutes. Dry with sterile towel. Repeat procedure (swab for additional 2 minutes and dry with sterile towel).

Wound care and general skin cleansing: Rinse area with water, then apply the minimum amount of chlorhexidine necessary to cover skin or wound area and wash gently. Rinse again thoroughly.

The dietary restriction should be individualized as per patient requirements.

Chlorhexidine gluconate may be contraindicated in the following conditions:

Hypersensitivity.

The treating physician must closely monitor the patient and keep pharmacovigilance as follows

Concerns related to adverse effects:

• Hypersensitivity reactions: Serious allergic reactions, including anaphylaxis, have been reported.

Dosage form specific issues:

• Topical: For topical use only. Keep out of eyes, ears, and the mouth; if contact occurs, rinse with cold water immediately; permanent eye injury may result if agent enters and remains in the eye. Deafness has been reported following instillation in the middle ear through perforated ear drums. Avoid applying to wounds that involve more than the superficial skin layers. Avoid repeated use as general skin cleansing of large surfaces (unless necessary for condition). Not for preoperative preparation of face or head; do not use on lumbar puncture sites. Solutions may be flammable (products may contain alcohol); avoid exposure to open flame and/or ignition source (eg, electrocautery) until completely dry; avoid application to hairy areas which may significantly delay drying time. Use with caution in children <2 months of age due to potential for increased absorption, and risk of irritation or chemical burns. May cause staining of fabrics (brown stain) due to a chemical reaction between chlorhexidine gluconate bound to fabric and chlorine (if sufficient chlorine is present from certain laundry detergents used during laundering process).

Other warnings/precautions:

• Appropriate use: Topical: When used as a topical antiseptic, improper use may lead to product contamination. Although infrequent, product contamination has been associated with reports of localized and systemic infections. To reduce the risk of infection, ensure antiseptic products are used according to the labeled instructions; avoid diluting products after opening; and apply single-use containers only one time to one patient and discard any unused solution.

There is no sufficient scientific evidence traceable regarding use and safety of chlorhexidine gluconate in concurrent use with alcohol.

There is no sufficient scientific evidence traceable regarding use and safety of chlorhexidine gluconate in breast feeding.

There is no sufficient scientific evidence traceable regarding use and safety of chlorhexidine gluconate in pregnancy.

There is no sufficient scientific evidence traceable regarding use and safety of chlorhexidine gluconate in concurrent use with any particular food.

The adverse reactions related to Chlorhexidine gluconate can be categorized as:

Common Adverse effects: Dry mouth, taste alteration, Dermatitis, pruritus

Less Common Adverse effects: Erythema, Eczema, Rash, Urticaria, Skin irritation, Blisters.

Rare Adverse effects: Anaphylactic shock

The common side of Chlorhexidine gluconate include the following

Burns on skin and mucous membranes (w/ white eschar), pain.

Pharmacodynamic:

Chlorhexidine kills gram-positive and gram-negative bacteria by attaching cationic molecules to negatively charged bacterial cell walls and extramicrobial complexes, precipitating the cytoplasmic contents of the bacterial cell wall, and causing cell death. It functions as a bacteriostatic at low concentrations by changing the osmotic balance of bacterial cells and causing potassium and phosphorus leaks.

Pharmacokinetics:

Absorption: Poorly absorbed from gastrointestinal tract.

1. https://www.uptodate.com/contents/Chlorhexidine gluconate-drug-information?search=Chlorhexidine gluconate&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1#F154338
2. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/022352s017lbl.pdf
3. https://www.medicaid.nv.gov/Downloads/provider/Chlorhexidine gluconate_2015-1215.pdf
4. https://www.mims.com/india/drug/info/Chlorhexidine gluconate?type=full&mtype=generic#mechanism-of-action