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Chlorhexidine Gluconate (Topical)

Medically reviewed on Sep 10, 2018

Pronunciation

(klor HEKS i deen GLOO koe nate)

Index Terms

  • 3M Avagard [OTC]
  • CHG

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Liquid, External:

Betasept Surgical Scrub: 4% (118 mL, 237 mL, 473 mL, 946 mL, 3780 mL [DSC])

Hibiclens: 4% (15 mL, 118 mL, 236 mL, 473 mL, 946 mL, 3790 mL) [contains fd&c red #40, isopropyl alcohol]

Generic: 2% (118 mL); 4% (118 mL, 237 mL, 473 mL, 946 mL, 3800 mL)

Miscellaneous, External:

Tegaderm CHG Dressing: (Dressing) (1 ea)

Pad, External:

Generic: 2% (2 ea, 6 ea)

Solution, External:

Antiseptic Skin Cleanser: 4% (118 mL, 237 mL [DSC]) [dye free; contains isopropyl alcohol]

ChloraPrep One Step: 2% (3 mL [DSC], 10.5 mL [DSC]) [latex free]

Dyna-Hex 2: 2% (473 mL) [contains isopropyl alcohol]

Dyna-Hex 4: 4% (118 mL) [contains isopropyl alcohol]

Brand Names: U.S.

  • Antiseptic Skin Cleanser [OTC]
  • Betasept Surgical Scrub [OTC]
  • ChloraPrep One Step [OTC] [DSC]
  • Dyna-Hex 2 [OTC]
  • Dyna-Hex 4 [OTC]
  • Hibiclens [OTC]
  • Tegaderm CHG Dressing [OTC]

Pharmacologic Category

  • Antibiotic, Topical

Pharmacology

Chlorhexidine has activity against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast; it is both bacteriostatic and bactericidal, depending on its concentration. 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

Topical: Neonates: Detectable serum concentrations have been noted following topical chlorhexidine administration (Chapman 2013; Cowen 1979; Garland 2009)

Use: Labeled 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

Contraindications

Hypersensitivity to chlorhexidine or any component of the formulation

Dosing: Adult

Note: General dosing guidelines provided; refer to specific product labeling for dosing instructions.

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 (ChloraPrep One-Step):

Dry surgical sites (eg, 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 (eg, 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 (eg, 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 (eg, 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.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling.

Administration

Topical: Keep out of eyes, ears, and mouth. Do not routinely apply to wounds which involve more than superficial layers of skin. Avoid contact with meninges (ie, do not use on lumbar puncture sites). Solutions may be flammable (may contain alcohol); consult specific product labeling to determine if product may be used with electrocautery procedures; if product can be used near an ignition source (eg, cautery, laser), avoid exposure to open flame and/or ignition source until completely dry; avoid application to hairy areas which may significantly delay drying time. When using the ChloraPrep applicator, do not touch sponge. Hold applicator sponge down and pinch wings of applicator once to activate ampul and release antiseptic.

Storage

Store at room temperature. Alcohol-containing topical products are flammable; keep away from flames or fire.

Drug Interactions

There are no known significant interactions.

Test Interactions

If chlorhexidine is used as a disinfectant before midstream urine collection, a false-positive urine protein may result (when using dipstick method based upon a pH indicator color change).

Adverse Reactions

Dermatologic: Allergic sensitization, erythema, hypersensitivity reaction, rough skin, xeroderma

<1%, postmarketing, and/or case reports: Anaphylaxis (Health Canada May 2016), dyspnea, facial edema, nasal congestion

Warnings/Precautions

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; avoid contact with meninges (do not use on lumbar puncture sites). Avoid applying to genital areas; generalized allergic reactions, irritation, and sensitivity have been reported. 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 (FDA Drug Safety Communication 2013).

Pregnancy Considerations

No reports of adverse effects in newborns have been reported, even though chlorhexidine is commonly used during labor and in the neonate. Moreover, only very small amounts of disinfectant reach the maternal circulation and the fetus.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience dryness or itching. Have patient report immediately to prescriber skin irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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