Chlorhexidine Gluconate topical

Absorption

Bioavailability

Poorly absorbed from GI tract4 or percutaneously following topical application to skin.1 4 5

Low concentrations appear to be absorbed systemically following intravaginal† administration.71

Adsorbed onto outer layers of skin following topical application to intact skin, resulting in a persistent (residual) antimicrobial effect.1 5 6 14

In pregnant women who received a 2% solution intravaginally† as a vaginal wash during labor, concentrations ranging from 0.01–0.083 mcg/mL were detected in the blood (limits of detection 0.01 mcg/mL) of approximately 33% of these women.71

Serum concentrations of 11 ng/mL reported in a neonate after oral exposure when chlorhexidine gluconate was used on the nursing mother’s nipples to prevent mastitis.74

Special Populations

Possible systemic absorption when topical preparations used as skin cleansers in neonates or infants.4 5 12 13

Distribution

Extent

Not known whether chlorhexidine crosses the placenta or is distributed into milk.a

Elimination

Elimination Route

If absorbed percutaneously following topical application to the skin, appears to be mainly excreted unchanged in feces.5

• Bacteriostatic or bactericidal in action, depending on concentration attained at site and susceptibility of organism.5 15

• Cationic compound;5 6 adsorbed onto negatively charged cell surfaces of susceptible organisms, with specific and strong adsorption to certain phosphate-containing compounds.5 6 Integrity of the cell membrane is disrupted, resulting in increased permeability.5 6

• Active against some aerobic and anaerobic gram-positive and gram-negative bacteria.1 2 4 5 6 102 Also has some activity against Chlamydia trachomatis,77 certain fungi,4 5 6 and certain viruses,4 5 52 but inactive against mycobacteria48 and generally inactive against bacterial spores.15

Pending revision, the material in this section should be considered in light of more recently available information in the MedWatch notification at the beginning of this monograph.

• Importance of avoiding contact with eyes, ears, and mouth.1 2 78 107 108 If ocular contact occurs, rinse eye promptly and thoroughly with water to prevent irreversible injury.1 2 60 78 107 108

• Avoid exposure to excessive heat (i.e., >40°C) with alcohol-based preparations (Hibistat, Avagard); keep away from flames or devices that may generate an electric spark.2 108

• Importance of discontinuing drug and informing clinician if an allergic or hypersensitivity reaction occurs.1 2 108

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.71 93

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1 2 108

• Importance of informing patients of other important precautionary information. (See Cautions.)1 2 108

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.

• Tell all of your health care providers that you take chlorhexidine gluconate topical. This includes your doctors, nurses, pharmacists, and dentists.
• Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using this medicine while you are pregnant.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.
• Protect clothing and fabrics from staining.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Very bad skin irritation.

Consult your pharmacist.

Consult your pharmacist.

Keep a list of all your medications with you, and share the list with your doctor and pharmacist.