chlorhexidine digluconate: clinical use

Prescribing considerations

• Confirm the indication and formulation because mouthwash, gel and periodontal inserts have different licensed roles and administration requirements.
• Ask about previous reactions to chlorhexidine-containing products or coated devices.
• Account for toothpaste incompatibility when counselling about mouthwash or gel.
• The adult-only periodontal insert is placed after mechanical debridement and biodegrades in situ. Its current eMC entry is marked discontinued.

Contraindications and cautions

• Hypersensitivity to chlorhexidine digluconate or any formulation excipient.
• Do not administer chlorhexidine-containing products where there is a possible history of chlorhexidine allergy.
• Avoid the periodontal insert during pregnancy and do not administer it during breastfeeding.

Monitoring

• Assess clinical response and oral hygiene; routine laboratory monitoring is not required.
• Review persistent oral irritation, mucosal peeling, swelling, parotid swelling or troublesome staining.
• After periodontal-insert placement, assess severe pain, swelling, bleeding or signs of local infection.
• Document chlorhexidine allergy clearly because it may be present in other medicines and medical devices.

Clinical pharmacology

Chlorhexidine is a cationic, membrane-active antiseptic active against many Gram-positive and Gram-negative organisms and yeasts. It binds strongly to oral tissues and is poorly absorbed; the periodontal insert provides local sustained release from a gelatin matrix.

Formulation and product differences

• Mouthwash is an oromucosal solution for rinsing and spitting out.
• Dental gel may be brushed onto teeth or applied directly to oral tissue and is not rinsed away immediately.
• The biodegradable periodontal insert is professionally placed into periodontal pockets and is not for self-administration.
• The selected mouthwash and gel contain macrogolglycerol hydroxystearate, which may cause skin reactions; their other excipients differ.

Gel

Route: Cutaneous

Strengths: 1% w/w

Mouthwash

Route: Oromucosal

Strengths: 0.2%, 0.2% w/v