Chlorhexidine Gluconate eentPronunciation
Class: Anti-infectives, Miscellaneous
Chemical Name: N,N″-Bis(4-chlorophenyl)-3,12-diimino- 2,4,11,13-tetraazatetradecanediimidamide di-d-gluconate
Molecular Formula: C22H30Cl2N10•2C6H12O7
CAS Number: 18472-51-0
Brands: Peridex, PerioChip, PerioGard
Uses for Chlorhexidine Gluconate
Reduction of pocket depth in the treatment of adult periodontitis; adjunct to scaling and root planing procedures.3
Prevention of Dental Caries
Prevention of dental plaque and dental caries† when conventional oral hygiene measures are difficult or impossible, such as in patients with fractured jaws, periodontal surgery, or orthodontic treatments and in patients with seizure disorders, rheumatoid arthritis, mental retardation, and cerebral palsy.8 33 34 44
Mucositis and Other Oral Complications in Individuals with Altered Immunocompetence
Used to decrease incidence and severity of mucositis† and other oral complications† in patients with altered immunocompetence, including those undergoing bone marrow transplantation,10 11 14 20 21 radiation therapy,15 21 38 or chemotherapy.12 13 15 19 20 21 38
Also has been used as adjunct to surgical debridement, plaque removal, and systemic anti-infectives in treatment of linear gingival erythema†, necrotizing ulcerative gingivitis†, and necrotizing ulcerative periodontitis† in immunocompromised individuals, including patients with HIV infection.88 89
Oropharyngeal Decontamination in Critically Ill Patients
For oral hygiene and oropharyngeal decontamination in an attempt to decrease the incidence of nosocomial respiratory tract infections in critically ill patients†, including immunocompromised patients and those undergoing mechanical ventilation or heart surgery.19 21 39 85 86
Chlorhexidine Gluconate Dosage and Administration
Oral, Topical Use Only
Immediately prior to initiation of treatment, the patient should receive professional dental prophylaxis.1 2 Patients should then be reevaluated and receive a thorough dental prophylaxis throughout treatment at intervals not exceeding 6 months.1 2
Pellets are inserted into periodontal pockets by a dental health-care provider and are not meant for self-administration.3
Isolate periodontal pocket and dry surrounding area prior to insertion.3 Grasp flat end of pellet with forceps and insert (curved end first) into periodontal pocket to its maximum depth.3 Place a single pellet into each periodontal pocket that has a probing depth of ≥5 mm.3 Consult manufacturer’s information for details.1
Pellets will biodegrade within the periodontal pockets and do not need to be manually removed.3
Oral, Topical Use Only
A new pellet should be inserted every 3 months into pockets that continue to have a probing depth of ≥5 mm.3
Consider other treatment options (e.g., combination therapy, surgical intervention) if periodontal pockets with a probing depth of ≥5 mm do not respond within 9–12 months.79
Up to 8 pellets during a single visit.3
Cautions for Chlorhexidine Gluconate
Staining of Oral Surfaces
Efficacy of topical oral solution in periodontitis has not been fully determined to date.1 2 If used as a mouthwash or rinse in patients with coexisting gingivitis and periodontitis, the presence or absence of gingival inflammation following treatment should not be used as a major indicator of underlying periodontitis.1 2
Effectiveness of pellets for subgingival administration in acutely abscessed periodontal pockets has not been established.3
Management of patients with periodontal disease should include consideration of potentially contributing medical disorders, such as cancer, diabetes, and compromised immune function.3
Some mild to moderate sensitivity is normal during the first week after placement of a subgingival pellet; however, dentist should be promptly notified if pain, swelling, or other problems occur.3
Insufficient experience in patients ≥65 years of age to determine whether safety and efficacy of chlorhexidine gluconate pellets (PerioChip) for the treatment of periodontitis in geriatric patients differ from safety and efficacy in younger adults.3 However, clinical experience to date has not identified differences in responses between these populations.3
Common Adverse Effects
Interactions for Chlorhexidine Gluconate
Chlorhexidine Gluconate Pharmacokinetics
Following use of mouthwash or rinse, approximately 30% of the drug is retained in the oral cavity,1 2 5 8 34 bound to phosphate groups principally on coatings of mucous membrane surfaces;8 gradually released into oral fluids1 2 5 8 34 for up to 24 hours.8
Following subgingival administration of biodegradable pellet, drug is released into periodontal pocket.3 50 40% is released during first 24 hours and remainder is released in linear manner over 7–10 days.3
Oral, Topical Use Only
Actions and Spectrum
Cationic compound;3 5 8 adsorbed onto negatively-charged cell surfaces of susceptible organisms, with specific and strong adsorption to certain phosphate-containing compounds.8 33 34 Integrity of the cell membrane is disrupted, resulting in increased permeability.8 33 34
Binds to negatively charged surfaces within the oral cavity, including hydroxyapatite of tooth enamel, pellicle on tooth surface, oral mucosa, salivary glycoproteins, and bacteria and extracellular polysaccharides of bacterial origin;5 8 33 34 provides a persistent bacteriostatic effect at tooth surface.8 33 34
Antiplaque effects when applied topically in oral cavity involve immediate bacteriostatic or bactericidal effects on salivary bacteria and bacteria adhering to tooth surface as well as persistent antibacterial effects at tooth surface that prevent plaque from forming;34 however, antiplaque effects do not result in efficient removal of plaque that has already formed.34
Active against some aerobic and anaerobic gram-positive and gram-negative bacteria.8 22 33 54 55 56 57 60 Also has some activity against Chlamydia trachomatis,74 certain fungi,8 33 42 49 59 and certain viruses,33 53 but is inactive against mycobacteria.71
Advice to Patients
Pellets are not meant for self-administration; only qualified oral health-care professionals familiar with the administration of subgingival chlorhexidine gluconate pellets should administer the drug.3
Importance of not using dental floss for 10 days following administration of the subgingival pellet.3
Notify dentist promptly if a pellet is dislodged or if pain, swelling, or other problems occur.3
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1
Importance of informing patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
Oral (Topical Use Only)
Chlorhexidine Gluconate Oral Rinse
Actavis, Apotex, Butler, Hi-Tech, Morton Grove, Novex, Teva
AHFS DI Essentials. © Copyright 2016, Selected Revisions July 1, 2006. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
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