Drug reference

Chlorhexidine gluconate

Topical/oral antiseptic (cationic bisbiguanide) · Topical disinfection

Also known as HIBITANE PLUS, HIBISCRUB, HIBITANE OBSTETRIC, HIBI LIQUID HAND RUB+, Cepton, ChloraPrep

START

Pre-op skin: 2% in alcohol, allow to dry; mouth: 0.12% 15 mL BID rinse

TYPICAL MAX

Topical to application area as protocol

STOP IF

Hypersensitivity / anaphylaxis or contact dermatitis

WATCH

Avoid eye/middle ear/meninges; let alcohol dry before drapes

CDSCO approvedOTCATC D08AC02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 18s · seconds
PEAK: 6min · local
t½: 36s · not absorbed
DURATION: 6h · reservoir

EXCRETION

Mainly faecal; minimal systemic

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Topical use considered safe.

FDA category + note

Mechanism

Cationic bisbiguanide that binds negatively charged bacterial cell walls and disrupts membrane permeability; broad-spectrum bactericidal (Gram-positive > Gram-negative), some fungi/enveloped viruses; persistent skin substantivity (6 h reservoir).

Indications

Surgical hand/skin antisepsis (4% scrub)Pre-operative skin preparation (2% in alcohol)Oral antiseptic (0.12–0.2% mouthwash) for gingivitis/peri-implantVaginal cleansingWound irrigation (low concentration)Bathing (2% wipes — ICU CLABSI prevention)

Dosing

Adult: Skin: 4% scrub for surgical hand prep; 2% alcohol for surgical site. Mouth: 15 mL of 0.12% twice daily ×30 s rinse. Bathing: 2% wipes daily in ICU.
Pediatric: Avoid ≥2% products on premature/term neonates (chemical burn risk); use diluted formulations.
Renal adjustment: No adjustment (topical).
Hepatic adjustment: No adjustment.
Geriatric: Standard topical use.
Max dose: Topical to application area; routine dosing

Pharmacokinetics

Onset

Bactericidal within seconds; reservoir effect 6 h

Peak effect

Local — immediate

Duration

Sustained reservoir effect ~6 h

Half-life

Not applicable (negligible systemic absorption)

Bioavailability

Negligible systemic

Protein binding

Not applicable

Metabolism

Not metabolised systemically

Excretion

Mainly faecal (any swallowed); minimal renal

Contraindications

Use on / in / near the middle ear or meninges (ototoxicity/neurotoxicity)
Use on eyes (corneal damage)
Severe hypersensitivity (anaphylaxis reported)
Use in spinal/epidural anaesthesia field with alcohol still wet

Side effects

Common

Local skin irritationTooth/restoration staining (mouthwash)Taste alterationTongue discoloration

Serious

Severe hypersensitivity / anaphylaxis (rare)
Chemical burns (high concentration on neonatal skin)
Ototoxicity if used in middle ear
Corneal injury

Pregnancy & lactation

Pregnancy

Topical use considered safe.

Lactation

Compatible (topical/local; rinse nipple before feeding if used).

Drug interactions

Anionic Surfactants (e.g., Soaps, Detergents)

Moderate

Database

Reduced antimicrobial efficacy of chlorhexidine gluconate when used concurrently with common soaps or detergents for skin cleansing prior to surgical procedures or wound care.

Ensure that skin is thoroughly rinsed with water to remove all traces of anionic soaps or detergents before applying chlorhexidine gluconate. Use chlorhexidine-compatible cleansers if available.

Anionic Surfactants

Moderate

Database

Anionic-cationic neutralisation

Rinse soap before chlorhexidine

Source: Kimi deep-research + Cla

Sodium Lauryl Sulfate

Moderate

Database

Reduced antimicrobial efficacy of chlorhexidine gluconate when used concurrently with toothpastes or mouthwashes containing sodium lauryl sulfate.

Advise patients to rinse thoroughly with water between using sodium lauryl sulfate-containing products and chlorhexidine gluconate. Ideally, separate administration by at least 30 minutes, or use an SLS-free toothpaste/mouthwash.

Cetrimide

Mild

Database

Potential for reduced antimicrobial efficacy if mixed directly in certain formulations. Not a systemic interaction.

Avoid direct mixing of concentrated solutions. In clinical practice, they are rarely used simultaneously in a way that would cause significant interaction.

Fluoride (in Toothpastes/mouthwashes)

Mild

Database

Reduced anticaries effect of fluoride or reduced antimicrobial effect of chlorhexidine if used immediately sequentially without rinsing. Not a systemic interaction.

Advise patients to rinse thoroughly with water between using fluoride-containing products and chlorhexidine gluconate. Separate administration by at least 30 minutes.

Fluoride Toothpaste

Mild

Database

Possible inactivation

Separate mouthwash and brushing by ≥30 min

Source: Kimi deep-research + Cla

Iodine Based Antiseptics

Mild

Database

May potentiate skin reactions

Avoid layering

Source: Kimi deep-research + Cla

Povidone Iodine

Mild

Database

While not a strong interaction, some sources suggest a theoretical reduction in efficacy if mixed directly or applied immediately after one another without rinsing. No significant systemic interaction.

Generally, it's best to avoid direct mixing. If sequential application is necessary, ensure the area is dry between applications or rinse with water if practical. Often used as alternative antiseptics rather than concurrently.

Tap Water

Mild

Database

Hard-water cations may reduce activity

Use distilled for sensitive applications

Source: Kimi deep-research + Cla

Tetracycline

Mild

Database

Reduced antibacterial effect (in vitro)

Separate rinse

Source: Kimi deep-research + Cla