Antiseptic Skin Clnsr(CHLORHE) (chlorhexidine gluconate)

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.

Chlorhexidine gluconate 2 and 4% solutions in a sudsing base (skin cleanser) and chlorhexidine gluconate 0.5 and 1% solutions in an alcohol base with emollients (hand rub) are applied topically to the skin and hands. These topical preparations are for external use only, and contact with the eyes, ears, or mouth should be avoided. Chlorhexidine gluconate 2 and 4% solutions in a sudsing base should not be used for preoperative skin preparation on the face or head. Dressings containing chlorhexidine gluconate 20% are applied topically at the site of vascular and nonvascular percutaneous devices.

No dosing information is available for this tab.

No dosing information is available for this tab.

There is no enhanced messaging for this drug.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

Moderate Interaction: Assess the risk to the patient and take action as needed.

Antimicrobial Topicals/Keratinocyte-Fibroblast Skin Tissue

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

MECHANISM OF ACTION: Antimicrobial topicals or dressings containing chlorhexidine, mafenide, or silver may decrease the viability of keratinocytes and fibroblasts used for wound healing in skin tissue replacement products.

CLINICAL EFFECTS: The use of antimicrobial topicals or dressings containing chlorhexidine, mafenide, or silver may disrupt the integrity of keratinocyte human skin substitutes and decrease the viability of keratinocytes and fibroblasts.

PREDISPOSING FACTORS: None determined.

PATIENT MANAGEMENT: The use of antimicrobial topicals or dressings containing chlorhexidine, mafenide, or silver is not recommended.

DISCUSSION: Mafenide acetate has been shown to reduce keratinocyte viability and disrupt the integrity of tissue-engineered human skin substitutes. In vitro data suggest silver may decrease the viability of keratinocytes and human dermal fibroblasts. Chlorhexidine has been shown to be toxic to keratinocytes and human dermal fibroblasts.(1)

There is no enhanced messaging for this drug.

There are no contraindication contraindications for this drug.

• Large open wound

There are no moderate contraindications for this drug.

There is no enhanced messaging for this drug.

Rare or Very Rare

• Anaphylaxis
• Angioedema
• Dyspnea
• Facial edema
• Hypotension
• Tachycardia
• Urticaria
• Wheezing

Rare or Very Rare

• Blistering skin
• Contact dermatitis
• Erythema
• Pruritus of skin
• Skin irritation
• Skin rash

No enhanced messaging available.

No enhanced messaging available.

Reproduction studies in rats using chlorhexidine given by gastric lavage on days 6-15 of gestation have not revealed evidence of harm to the fetus. There are no adequate and controlled studies to date using chlorhexidine gluconate in pregnant women, and the drug should be used during pregnancy only when clearly needed.

It is not known if chlorhexidine gluconate is distributed into breast milk; however, is unlikely that chlorhexidine gluconate distributes into milk following topical or intravaginal application, based on the very small amount of the drug absorbed percutaneously into maternal circulation. Although the drug is poorly absorbed from the GI tract, if chlorhexidine gluconate has been used for skin cleansing, the mother's nipples should be washed thoroughly with water prior to nursing. One neonate was reported to develop multiple episodes of bradycardia and cyanosis, with serum chlorhexidine concentrations of 11 ng/mL after oral exposure when chlorhexidine gluconate was used on the mother's breasts to prevent mastitis.

No enhanced messaging available.