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Chlorhexidine gluconate (topical): Drug information

Chlorhexidine gluconate (topical): Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Chlorhexidine gluconate (topical): Patient drug information" and "Chlorhexidine gluconate (topical): Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Betasept Surgical Scrub [OTC];
  • Biopatch Protective Disk/CHG [OTC];
  • Chlorhexidine Gluconate [OTC];
  • Dyna-Hex 2 [OTC];
  • Dyna-Hex 4 [OTC];
  • FT Antiseptic Skin Cleanser [OTC];
  • Hibiclens [OTC];
  • Tegaderm CHG Dressing [OTC] [DSC]
Pharmacologic Category
  • Antibiotic, Topical
Dosing: Adult

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

Antiseptic

Antiseptic:

Health care personnel hand antiseptic: Liquid or solution: Topical: Wash with ~5 mL for 15 seconds; rinse thoroughly with water and dry

Preoperative skin preparation:

Solution: Topical: 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): Topical: 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): Topical: 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.

Staphylococcus aureus (including methicillin-resistant) decolonization:

Note: For select patients who have recurrent S. aureus infection or warrant decolonization (eg, preoperative decolonization, patients in the ICU, patients hospitalized with central venous or midline catheters, patients colonized with methicillin-resistant S. aureus at hospital discharge) (Ref).

Liquid or Solution: Topical: Rinse entire body with water, then wash with minimum amount necessary to cover entire body daily; use in combination with nasal mupirocin. Duration of chlorhexidine is typically 5 to 14 days but may be extended in patients in the ICU and/or in patients with central venous or midline catheters (Ref). For decolonization at hospital discharge, some experts suggest a 5-day course in combination with nasal mupirocin and chlorhexidine mouthwash repeated twice monthly for 6 months (Ref).

Surgical scrub: Topical: 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.

Wound care and general skin cleansing: Topical: Rinse area with water, then apply minimum amount necessary to cover skin or wound area and wash gently. Rinse again thoroughly.

Dosing: Kidney Impairment: Adult

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

Dosing: Hepatic Impairment: Adult

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

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Chlorhexidine gluconate (topical): Pediatric drug information")

Skin cleanser for preoperative skin preparation, skin wound and general skin cleanser for patients

Skin cleanser for preoperative skin preparation, skin wound and general skin cleanser for patients: Topical:

Infants <2 months: Note: It is recommended to use with care in this population due to potential risk of dermal irritation or chemical burns. Expert suggestions are variable depending upon site and clinical scenario. Not all products may be appropriate for use in this population; refer to product specific labeling. Some experience in neonatal patients applicable to this patient population (Ref).

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).

Wound care and general skin cleansing: Rinse area with water, then apply the minimum amount of chlorhexidine necessary to cover skin or wound area and wash gently. Rinse again thoroughly.

Infants ≥2 months, Children, and Adolescents: Topical solution:

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).

Wound care and general skin cleansing: Rinse area with water, then apply the minimum amount of chlorhexidine necessary to cover skin or wound area and wash gently. Rinse again thoroughly.

Dosing: Kidney Impairment: Pediatric

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

Dosing: Hepatic Impairment: Pediatric

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

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

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

Contraindications

OTC labeling: When used for self-medication, do not use in patients hypersensitive to chlorhexidine or any component of the formulation; in contact with meninges; in genital area; electrocautery procedures (ChloraPrep); open skin wounds or as general skin cleanser (ChloraPrep).

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; do not use on lumbar puncture sites. 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).

Warnings: Additional Pediatric Considerations

Although topical chlorhexidine is widely used in many NICUs as a skin cleanser prior to procedures (eg, central venous line placement/care) (Tamma 2010), data is lacking to support use in premature infants. Manufacturer's labeling recommends using with caution in premature neonates and infants <2 months of age as chlorhexidine-containing products may cause irritation or chemical burns. A survey of US NICU chlorhexidine use reports dermal burns occurring more frequently in neonates with birth weight <1,500 g (Tamma 2010). If used for neonatal dermal site cleansing, some suggest using sterile water or normal saline to remove excess disinfectant after procedures may help avoid chemical burns (Eichenwald 2017; Nuntnarumit 2013). Several studies have noted detectable serum concentrations in neonates after chlorhexidine exposure; no correlation between serum concentration and GA, birth weight, or PNA was identified; the clinical significance is undetermined (Chapman 2013; Garland 2009).

Dosage Forms: US

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

Liquid, External:

Generic: 2% (118 mL [DSC])

Miscellaneous, External:

Biopatch Protective Disk/CHG: (Dressing) (10 ea)

Tegaderm CHG Dressing: (Dressing) (1 ea [DSC])

Pad, External:

Generic: 2% (2 ea, 6 ea)

Solution, External:

Betasept Surgical Scrub: 4% (118 mL, 237 mL, 473 mL, 946 mL)

Chlorhexidine Gluconate: 2% (118 mL) [latex free; contains isopropyl alcohol]

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

Dyna-Hex 4: 4% (118 mL, 473 mL) [contains isopropyl alcohol]

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

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

Generic: 4% (118 mL, 236 mL, 237 mL [DSC], 473 mL, 946 mL [DSC], 3800 mL [DSC])

Generic Equivalent Available: US

May be product dependent

Pricing: US

Misc (Biopatch Protective Disk/CHG External)

(Dressing) (per each): $8.83

Solution (Betasept Surgical Scrub External)

4% (per mL): $0.04

Solution (Chlorhexidine Gluconate External)

4% (per mL): $0.04

Solution (Dyna-Hex 2 External)

2% (per mL): $0.01

Solution (Dyna-Hex 4 External)

4% (per mL): $0.04

Solution (Hibiclens External)

4% (per mL): $0.03

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

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.

Administration: Pediatric

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.

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

Medication Safety Issues
Pediatric patients: High-risk medication:

KIDs List: Chlorhexidine, when used in very low birthweight neonates, is identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be used with caution due to risk of chemical burns (strong recommendation; low quality of evidence) (PPA [Meyers 2020]).

Metabolism/Transport Effects

None known.

Drug Interactions

There are no known significant interactions.

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.

Breastfeeding Considerations

It is not known if chlorhexidine is excreted in breast milk.

Mechanism of Action

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.

Pharmacokinetics (Adult Data Unless Noted)

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

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Curasept | Elugel;
  • (AR) Argentina: Clorhexidina | Digluconato de Clorhexidina | Elugel | Odontogel colutorio | Perio aid intensive care | Periogard | Pervinox clorhexidina | Plac Out Colutorio | Prevenplac;
  • (AU) Australia: Curasept | First Aid Cream | Microshield | Obstetric care | Rivacol chlorhexidine mouthwash;
  • (BD) Bangladesh: Germicord | Germisol | Hexicord | Oral c | Winsol | Xisol;
  • (BE) Belgium: Dentio | Hibitane;
  • (BR) Brazil: Anti septico clo | Assepmed | Asseptcare | Asseptic | Chlorclear | Clorexid star | Clorexidina | Ferisept | Hibitane | Indahex | Kuratop | Marclohrex | Merthioclean | Merthiocort | Mertiocure | Mertisept | Metiotrat | Noplak sem alcool | Panvel clorex | Perioassept | Periodont | Periokin | Perioplak | Periotrat | Riohex | Riohex gard | Saracorte | Septmax;
  • (CH) Switzerland: Chlorhexidine faure | Dentohexin | Hibiscrub | Hibitane | Lifo-scrub | Meridol Perio Chlorhexidin | Plak out;
  • (CI) Côte d'Ivoire: Hexidine mouthwash | Hexigel | Sanidyl;
  • (CL) Chile: Bucoseptil | Dichlorexan | Elugel | Periogard;
  • (CN) China: Chlorhexidine gluconate antibacterial | Dilute chlorhexidine gluconate | Healso;
  • (CO) Colombia: Aseptidina | Baccidine | Bacter | Boncida | Clinhexidina | Clorgivin | Freedine | Hexitec | Kin gingival | Meta clor | Periogard | Vioxin | Wescohex;
  • (DE) Germany: Chlorhexamed | Chx | Cidegol c | Corsodyl | Dynexidin | Hibiscrub | Lemocin cx | Meridol med CHX | Paroex;
  • (DO) Dominican Republic: Clorexcrub | Clorhexidina | Clorhexidina Lacer | Dermiscrub | Diorbis | Elugel | Euroclorex | Hidradex | Periogard;
  • (EC) Ecuador: Antisek | Antisek bano seco | Clorhexin | Encident professional advanced clorhexidina | Gluconato de clorhexidina | Jabon de gluconato de clorhexidina | Linushexidina | Linushexidina al | Lirahexidina | Lirahexidina acuosa | Lirahexidina hidroalcoholica | Merthiopara | Septlon scrub | Solucion de clorhexidina;
  • (EE) Estonia: Corsodyl | Perio Aid | Periokin;
  • (EG) Egypt: Antiseptol | Elugel | Septivon;
  • (ES) Spain: Bohmclorh | Furaseptic | Lacer | Normosept;
  • (ET) Ethiopia: Chlorhexidine | Galscrub;
  • (FR) France: Adontex | Aquaseptic | Baseal | Biorgasept | Chlorhexidine arrow | Chlorhexidine arrow conseil | Chlorhexidine biogaran | Chlorhexidine mylan | Eludrilperio | Gluconate de chlorhexidine cristers | Mercurochrome solution antibacterienne | Merfene | Paroex | Prexidine | Septidose;
  • (GB) United Kingdom: Cepton | Chlorohex | Eczmol | Hibitane obstetric | Perio kin | Periogard | Prevase | Savlon burns & scalds;
  • (GR) Greece: C sept pro | Chlorel | Hibiscrub | Hibitane | Paroex | Periogard;
  • (HK) Hong Kong: Breathxidine | Cedium | Chlorhexidine | Comfordyl | Hexidine mouthwash | Jmp Chlorhexidine Gluconate | Microshield | Oralxidine | Scanlin | Sterets unisept;
  • (HR) Croatia: Curasept;
  • (ID) Indonesia: Minosep | Periokin | Progina care;
  • (IE) Ireland: Acriflex | Corsodyl mint | Curasept | Hibiscrub | Perio kin;
  • (IL) Israel: Dentamist gargle | Tarodent;
  • (IN) India: Ad x | Amgargl | Bludent | Chlorofresh | Clodin | Clohex | Dent x | Eludril | Elugel | Freshdew | Gb safe | Glycoseptol c | Guard oral rinse | Hexalor | Hexi plus | Hexiat | Hexiclear | Hexiday | Hexifresh | Hexil | Heximac | Hexin | Hexiwin total | Hexona | Hexun | O2 fresh mw | Phoxidine | Rexidin | Rinzin | Sensa relief | Trogyl denta;
  • (IQ) Iraq: Chloro gluconate;
  • (IT) Italy: Broxo din | Clorexidina sanitas | Clorosan | Forhans clexidin | Neomercurocromo bianco | Neoxene | Plakout active;
  • (JO) Jordan: Avohex | Claradine | Curasept | Eimasept;
  • (JP) Japan: Benclosid | Clegen | Hexizac | Hibiscrub | Hibitane | Maskin or | Maskin w | Microshield | Rapotec | Stericlon;
  • (KE) Kenya: Chlorhexidine | Clinica | Hexidine | Hexigel | Hexon | Hibiscrub | Hibitane | Klincord | Maxidine | Oss tane | Saniquad m | Umbipro;
  • (KR) Korea, Republic of: Alpha hexidine gargle sungkwang | Alphahexidine | Arlico Chlorhexidine | Ch oral | E.b pyeon | Green chlorhexidine | Green hexidine | Green hexidine brush | Green hexidine cleansing solution | Green hexidine solution | Hexamedin | Hexi r | Hexichlen brush | Hexiclean | Hexident | Hexidex | Hexiol | Hexitan | Microshield | Osstem chlorhexidine | Pusclean | Sungkwang chlorhexidine gluconate | Sungkwang hexichlren | Ulticle | Ultz;
  • (KW) Kuwait: Claradine | Clorasept | Corsodyl | Elugel | Zordyl;
  • (LU) Luxembourg: Chlorhexamed;
  • (LV) Latvia: Elugel;
  • (MA) Morocco: Parolex;
  • (MY) Malaysia: Biopatch | Chlorhex | Cololo sp | Gynepro | Hexidine | Hexigel | Juyanko | Microshield | Oradex everyday | Periogard | Sanidyl | Surgibath | Surgiscrub | Unirins cg;
  • (NG) Nigeria: Chlorhexidine | Chlorxy g | Cordcare | Emxidine | Hexigel | Umblicare;
  • (NL) Netherlands: Corsodyl | Hibiscrub | Sterilon;
  • (NO) Norway: Hibiscrub | Hibitane;
  • (NZ) New Zealand: Obstetric;
  • (OM) Oman: Hydrex Surgical Scrub | Zygel;
  • (PE) Peru: Clorhexidina | Dentodex | Hexidine ava;
  • (PH) Philippines: Biopatch | Hyclens | Hyclens gargle | Hyclens OB | Orahex | Sorexidine;
  • (PK) Pakistan: Cordiclean | Coreclean | Loxidin | Orahex | Sepidyl | Umbilica;
  • (PL) Poland: Hydrex s | Oralsept;
  • (PR) Puerto Rico: Acclean | Hibiclens | Paroex | Rugby antiseptic skin cleanser;
  • (PT) Portugal: Elugel | Hibitane | Lifo-scrub;
  • (PY) Paraguay: Bacterida | Bioampix | Dermanios scrub | Odontol plac | Riohex;
  • (QA) Qatar: BactoShield | ChloraPrep Clear | ChloraPrep Orange | ChloraPrep Scrub Orange | ChloraPrep Scrub Teal | Eczmol | Hibiclens | Hibiscrub | Hibitane | Hydrex | Hydrex Pink | Scrub Stat 4 | Sterets Unisept;
  • (RO) Romania: Corsodyl mint | Periogard;
  • (RU) Russian Federation: Amident | Bioaseptic | Chlorhexidin | Chlorhexidine | Chlorhexidine bigluconate | Chlorhexidine c | Elugel;
  • (SA) Saudi Arabia: Avohex | Cida stat | Clorasept | Orax | Periokin | Zordyl;
  • (SG) Singapore: Biopatch | Elugel | Hexodane mouthwash | Hexodane obstetric | Joycare antiseptic | Orasol | Orasyl green | Unirins cg;
  • (SL) Sierra Leone: Emxidine | Umbipro;
  • (TH) Thailand: Desmanol g | Hexene skin cleanser | Hexidine | Prepskin aqua;
  • (TN) Tunisia: Baseal | Hexident;
  • (TR) Turkey: Oroheks;
  • (TW) Taiwan: Aqua easy antiseptic solution | Delegerm | Easy antiseptic cleansing solution | Kilgerm | Parmason | Perioxidin | Safederm antiseptic;
  • (UA) Ukraine: Chlorhexidin | Chlorhexidin kr | Chlorhexidine;
  • (UG) Uganda: Ago scrub | Chlorhexidine | Hexidine | Renscrub | Saniquad m | Umbi gel | Umbipro;
  • (VE) Venezuela, Bolivarian Republic of: Periogard;
  • (VN) Viet Nam: Medoral;
  • (ZA) South Africa: Bioscrub | Biotaine | Curasept | D germ | Steriscrub;
  • (ZM) Zambia: Corsodyl;
  • (ZW) Zimbabwe: Corsodyl
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