Chlorhexidine
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Pronunciation | klɔː(r)ˈhɛksɪdiːn |
Trade names | Betasept, ChloraPrep, Chlorostat, others |
Other names | CHX, CHG, 1,6-bis(4-chloro-phenylbiguanido)hexane |
AHFS/Drugs.com | Monograph |
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Routes of administration | Topical |
ATC code | |
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Melting point | 134 to 136 °C (273 to 277 °F) |
Solubility in water | 0.8 |
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Chlorhexidine
Side effects may include skin irritation,
Chlorhexidine came into medical use in the 1950s.
Uses
Chlorhexidine is used in disinfectants (disinfection of the skin and hands), cosmetics (additive to creams, toothpaste, deodorants, and antiperspirants), and pharmaceutical products (preservative in eye drops, active substance in wound dressings and antiseptic mouthwashes).[20] A 2019 Cochrane review concluded that based on very low certainty evidence in those who are critically ill "it is not clear whether bathing with chlorhexidine reduces hospital-acquired infections, mortality, or length of stay in the intensive care unit (ICU), or whether the use of chlorhexidine results in more skin reactions."[21]
In endodontics, chlorhexidine has been used for root canal irrigation and as an intracanal dressing.[22][23] It has however been replaced by the use of sodium hypochlorite bleach in much of the developed world.[citation needed]
Antiseptic
Chlorhexidine is active against
There is strong evidence that chlorhexidine is more effective than povidone-iodine for clean surgery.[26][27] Evidence shows that it is an effective antiseptic for upper limb surgery.[6]
Meta-data spanning several decades shows that the efficacy of chlorhexidine (against organisms that cause surgical site infection) has not changed,[28] dispelling concerns over emerging resistance.
Dental use
Use of a chlorhexidine-based mouthwash in combination with normal tooth care can help reduce the build-up of plaque and improve mild gingivitis.[29] There is not enough evidence to determine the effect in moderate to severe gingivitis.[29] Its use as a mouthwash has a number of adverse effects including damage to the mouth lining, tooth discoloration, tartar build-up, and impaired taste.[29] Extrinsic tooth staining occurs when chlorhexidine rinse has been used for four weeks or longer.[29]
Mouthwashes containing chlorhexidine which stain teeth less than the classic solution have been developed, many of which contain chelated zinc.[30][31][32]
Chlorhexidine is a
Topical
Chlorhexidine gluconate is used as a skin cleanser for surgical scrubs, as a cleanser for skin wounds, for preoperative skin preparation, and for germicidal hand rinses.[24] Chlorhexidine eye drops have been used as a treatment for eyes affected by Acanthamoeba keratitis.[34]
Chlorhexidine is a very effective antiseptic and its use is growing in the world for treating the umbilical cord. A 2015
Side effects
Side effects may include skin irritation,
Chlorhexidine is ototoxic (toxic to the inner ear). If put into a ruptured ear canal it may lead to deafness.[36]
Chlorhexidine does not meet European specifications for a hand disinfectant. Under the test conditions of the
Whether prolonged exposure over many years may have carcinogenic potential is still not clear. The US Food and Drug Administration recommendation is to limit the use of a chlorhexidine gluconate mouthwash to a maximum of six months.[38]
When ingested, chlorhexidine is poorly absorbed in the gastrointestinal tract and can cause stomach irritation or nausea.[39][40] If aspirated into the lungs at high enough concentration, as reported in one case, it can be fatal due to the high risk of acute respiratory distress syndrome.[40][41]
Mechanism of action
At physiologic pH, chlorhexidine salts dissociate and release the positively charged chlorhexidine cation. The bactericidal effect is a result of the binding of this cationic molecule to negatively charged bacterial cell walls. At low concentrations of chlorhexidine, this results in a bacteriostatic effect; at high concentrations, membrane disruption results in cell death.[24]
Chemistry
It is a cationic polybiguanide (bisbiguanide).[42]
Deactivation
Chlorhexidine is deactivated by forming insoluble salts with
Synthesis
The structure is based on two molecules of proguanil, linked with a hexamethylenediamine spacer.
Society and culture
Brands
Chlorhexidine topical is sold as Betasept, Biopatch, Calgon Vesta, ChloraPrep One-Step, Dyna-Hex, Hibiclens, Hibistat Towelette, Scrub Care Exidine, Spectrum-4 among others.[45]
Chlorhexidine gluconate mouthwash is sold as Dentohexin, Paroex, Peridex, PerioChip, Corsodyl and Periogard, among others.[46]
Veterinary medicine
In animals, chlorhexidine is used for topical disinfection of wounds,[47] and to manage skin infections.[48] Chlorhexidine-based disinfectant products are used in the dairy farming industry.[49]
Post-surgical respiratory problems have been associated with the use of chlorhexidine products in cats.[50]
References
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- ^ "Chlorhexidine (Oral Route) Precautions - Mayo Clinic". www.mayoclinic.org. Retrieved 27 June 2023.
- ^ a b "Chlorhexidine Gluconate topical". The American Society of Health-System Pharmacists. Archived from the original on 13 January 2017. Retrieved 8 January 2017.
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- ^ "Prevantics Swab- chlorhexidine gluconate and isopropyl alcohol solution". DailyMed. 26 October 2022. Archived from the original on 24 January 2023. Retrieved 24 January 2023.
- ^ "Prevantics Swab- chlorhexidine gluconate and isopropyl alcohol solution". DailyMed. 26 October 2022. Archived from the original on 24 January 2023. Retrieved 24 January 2023.
- ^ "Prevantics Maxi Swabstick- chlorhexidine gluconate and isopropyl alcohol solution". DailyMed. 26 October 2022. Archived from the original on 24 January 2023. Retrieved 24 January 2023.
- ISBN 9783540777823. Archivedfrom the original on 13 January 2017.
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- ^ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
- ^ "Chlorhexidine - Drug Usage Statistics". ClinCalc. Retrieved 14 January 2024.
- ^ Thomas Güthner, et al. (2007), "Guanidine and Derivatives", Ullman's Encyclopedia of Industrial Chemistry (7th ed.), Wiley, p. 13
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- ^ Raab D (July–August 2008). "Preparation of contaminated root canal systems – the importance of antimicrobial irrigants". Dental Inc.: 34–36.
- ^ Raab D (2010). "Die Bedeutung chemischer Spülungen in der Endodontie" (PDF). Endodontie Journal (2): 22–23.[permanent dead link]
- ^ a b c Leikin JB, Paloucek FP, eds. (2008). "Chlorhexidine Gluconate". Poisoning and Toxicology Handbook (4th ed.). Informa. pp. 183–84.
- ^ a b Harke HP (2007). "Disinfectants". Ullman's Encyclopedia of Industrial Chemistry (7th ed.). Wiley. pp. 10–11.
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- ^ "Daily Bathing With Antiseptic Agent Significantly Reduces Risk of Hospital-Acquired Infections in Intensive Care Unit Patients". Agency for Healthcare Research and Quality. 23 April 2014. Archived from the original on 13 January 2017. Retrieved 29 April 2014.
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- ^ "Chlorhexidine Adverse Effects". www.poison.org. Archived from the original on 5 July 2018. Retrieved 4 July 2018.
- ^ a b "Chlorhexidine". Pubchem. U.S. National Library of Medicine. Archived from the original on 5 July 2018. Retrieved 4 July 2018.
- PMID 11931511.
An 80-y-old woman with dementia accidentally ingested approximately 200 mL of Maskin (5% chlorhexidine) in a nursing home and then presumably aspirated gastric contents.
- PMID 931371.
- ISBN 978-0-683-30740-5. Archivedfrom the original on 12 January 2023. Retrieved 10 October 2016.
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- ^ "Hibiclens Uses, Side Effects & Warnings - Drugs.com". Drugs.com. Archived from the original on 4 August 2018. Retrieved 4 August 2018.
- ^ "Chlorhexidine gluconate Uses, Side Effects & Warnings - Drugs.com". Drugs.com. Archived from the original on 28 August 2021. Retrieved 4 August 2018.
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- ^ Zeman D, Mosley J, Leslie-Steen P (Winter 1996). "Post-Surgical Respiratory Distress in Cats Associated with Chlorhexidine Surgical Scrubs". ADDL Newsletters. Indiana Animal Disease Diagnostic Laboratory. Archived from the original on 27 September 2011. Retrieved 11 September 2011.