Chlorhexidine Gluconate Oral Rinse is indicated for use between dental visits as part of a professional program for the treatment of gingivitis as characterized by redness and swelling of the gingivae, including gingival bleeding upon probing. Chlorhexidine Gluconate Oral Rinse has not been tested among patients with acute necrotizing ulcerative gingivitis (ANUG). For patients having coexisting gingivitis and peri...
Dosage and administration
Chlorhexidine Gluconate Oral Rinse therapy should be initiated directly following a dental prophylaxis. Patients using Chlorhexidine Gluconate Oral Rinse should be reevaluated and given a thorough prophylaxis at intervals no longer than six months. Recommended use is twice daily oral rinsing for 30 seconds, morning and evening after toothbrushing. Usual dosage is 15 mL of undiluted Chlorhexidine Gluconate Oral Rin...
Chlorhexidine Gluconate is an oral rinse containing
0.12% chlorhexidine gluconate (1,1
1-hexamethylene
bis[5-(p-chlorophenyl) biguanide] di-D-gluconate) in a base containing
water, 11.6% alcohol, glycerin, PEG-40 sorbitan diisostearate, flavor,
sodium saccharin, and FD&C Blue No. 1. Chlorhexidine Gluconate
is a near-neutral solution (pH range 5-7). Chlorhexidine Gluconate
is a salt of chlorhexidine and gluconic acid. Its chemical structure
is:
Chlorhexidine Gluconate Structure
CLINICAL PHARMACOLOGY
CLINICAL PHARMACOLOGY SECTION
Chlorhexidine Gluconate Oral Rinse
provides antimicrobial activity during oral rinsing. The clinical
significance of Chlorhexidine Gluconate Oral Rinse’s antimicrobial
activities is not clear. Microbiological sampling of plaque has shown
a general reduction of counts of certain assayed bacteria, both aerobic
and anaerobic, ranging from 54-97% through six months use.
Use of Chlorhexidine Gluconate
Oral Rinse in a six month clinical study did not result in any significant
changes in bacterial resistance, overgrowth of potentially opportunistic
organisms or other adverse changes in the oral microbial ecosystem.
Three months after Chlorhexidine Gluconate Oral Rinse was discontinued,
the number of bacteria in plaque had returned to baseline levels and
resistance of plaque bacteria to chlorhexidine gluconate was equal
to that at baseline.
PHARMACOKINETICS
PHARMACOKINETICS SECTION
Pharmacokinetic studies with Chlorhexidine Gluconate Oral Rinse indicate approximately 30% of the active ingredient, chlorhexidine gluconate, is retained in the oral cavity following rinsing. This retained drug is slowly released in the oral fluids. Studies conducted on human subjects and animals demonstrate chlorhexidine gluconate is poorly absorbed from the gastrointestinal tract. The mean plasma level of chlorhexidine gluconate reached a peak of 0.206 mcg/g in humans 30 minutes after they ingested a 300 mg dose of the drug. Detectable levels of chlorhexidine gluconate were not present in the plasma of these subjects 12 hours after the compound was administered. Excretion of chlorhexidine gluconate occurred primarily through the feces (~90%). Less than 1% of the chlorhexidine gluconate ingested by these subjects was excreted in the urine.
INDICATIONS AND USAGE
INDICATIONS & USAGE SECTION
Chlorhexidine Gluconate
Oral Rinse is indicated for use between dental visits as part of a
professional program for the treatment of gingivitis as characterized
by redness and swelling of the gingivae, including gingival bleeding
upon probing. Chlorhexidine Gluconate Oral Rinse has not been tested
among patients with acute necrotizing ulcerative gingivitis (ANUG).
For patients having coexisting gingivitis and periodontitis, see
PRECAUTIONS.
CONTRAINDICATIONS
CONTRAINDICATIONS SECTION
Chlorhexidine Gluconate Oral Rinse should not
be used by persons who are known to be hypersensitive to chlorhexidine
gluconate or other formula ingredients.
WARNINGS
WARNINGS SECTION
The effect of Chlorhexidine Gluconate Oral Rinse
on periodontitis has not been determined. An increase in supragingival
calculus was noted in clinical testing in Chlorhexidine Gluconate
Oral Rinse users compared with control users. It is not known if Chlorhexidine
Gluconate Oral Rinse use results in an increase in subgingival calculus.
Calculus deposits should be removed by a dental prophylaxis at intervals
not greater than six months. Anaphylaxis, as well as serious allergic
reactions, have been reported during postmarketing use with dental
products containing chlorhexidine, see
CONTRAINDICATIONS.
PRECAUTIONS
PRECAUTIONS SECTION
GENERAL
GENERAL PRECAUTIONS SECTION
For patients having coexisting gingivitis and periodontitis,
the presence or absence of gingival inflammation following treatment
with Chlorhexidine Gluconate Oral Rinse should not be used as a major
indicator of underlying periodontitis.
Chlorhexidine Gluconate Oral Rinse can cause staining of
oral surfaces, such as tooth surfaces, restorations, and the dorsum
of the tongue. Not all patients will experience a visually significant
increase in toothstaining. In clinical testing, 56% of Chlorhexidine
Gluconate Oral Rinse users exhibited a measurable increase in facial
anterior stain, compared to 35% of control users after six months;
15% of Chlorhexidine Gluconate Oral Rinse users developed what was
judged to be heavy stain, compared to 1% of control users after six
months. Stain will be more pronounced in patients who have heavier
accumulations of unremoved plaque. Stain resulting from use of Chlorhexidine
Gluconate Oral Rinse does not adversely affect health of the gingivae
or other oral tissues. Stain can be removed from most tooth surfaces
by conventional professional prophylactic techniques. Additional time
may be required to complete the prophylaxis. Discretion should be
used when prescribing to patients with anterior facial restorations
with rough surfaces or margins. If natural stain cannot be removed
from these surfaces by a dental prophylaxis, patients should be excluded
from Chlorhexidine Gluconate Oral Rinse treatment if permanent discoloration
is unacceptable. Stain in these areas may be difficult to remove by
dental prophylaxis and on rare occasions may necessitate replacement
of these restorations.
Some patients may experience an alteration in taste perception
while undergoing treatment with Chlorhexidine Gluconate Oral Rinse.
Rare instances of permanent taste alteration following Chlorhexidine
Gluconate Oral Rinse use have been reported via post-marketing product
surveillance.
PREGNANCY: TERATOGENIC EFFECTS
TERATOGENIC EFFECTS SECTION
Pregnancy
Category B. Reproduction Studies have been performed in rats and rabbits
at chlorhexidine gluconate doses up to 300 mg/kg/day and 40 mg/kg/day
respectively, and have not revealed evidence of harm to fetus. However,
adequate and well-controlled studies in pregnant women have not been
done. Because animal reproduction studies are not always predictive
of human response, this drug should be used during pregnancy only
if clearly needed.
NURSING MOTHERS
NURSING MOTHERS SECTION
It is not known whether this drug
is excreted in human milk. Because many drugs are excreted in human
milk, caution should be exercised when Chlorhexidine Gluconate Oral
Rinse is administered to nursing women. In parturition and lactation
studies with rats, no evidence of impaired parturition or of toxic
effects to suckling pups was observed when chlorhexidine gluconate
was administered to dams at doses that were over 100 times greater
than that which would result from a person’s ingesting 30 mL of Chlorhexidine
Gluconate Oral Rinse per day.
PEDIATRIC USE
PEDIATRIC USE SECTION
Clinical effectiveness
and safety of Chlorhexidine Gluconate Oral Rinse have not been established
in children under the age of 18.
CARCINOGENESIS, MUTAGENESIS, AND IMPAIRMENT OF FERTILITY
CARCINOGENESIS & MUTAGENESIS & IMPAIRMENT OF FERTILITY SECTION
In a drinking water study in rats, carcinogenic effects were
not observed at doses up to 38 mg/kg/day. Mutagenic effects were not
observed in two mammalian
in vivo mutagenesis studies
with chlorhexidine gluconate. The highest doses of chlorhexidine used
in a mouse dominant-lethal assay and a hamster cytogenetics test were
1000 mg/kg/day and 250 mg/kg/day, respectively. No evidence of impaired
fertility was observed in rats at doses up to 100 mg/kg/day.
ADVERSE REACTIONS
ADVERSE REACTIONS SECTION
The most common side effects associated with chlorhexidine gluconate oral rinses are: 1) an increase in staining of teeth and other oral surfaces; 2) an increase in calculus formation; and 3) an alteration in taste perception; see
WARNINGS and
PRECAUTIONS. Oral irritation and local allergy-type symptoms have been spontaneously reported as side effects associated with use of chlorhexidine gluconate rinse. The following oral mucosal side effects were reported during placebo-controlled adult clinical trials: aphthous ulcer, grossly obvious gingivitis, trauma, ulceration, erythema, desquamation, coated tongue, keratinization, geographic tongue, mucocele, and short frenum. Each occurred at a frequency of less than 1%. Among post marketing reports, the most frequently reported oral mucosal symptoms associated with Chlorhexidine Gluconate Oral Rinse are stomatitis, gingivitis, glossitis, ulcer, dry mouth, hypesthesia, glossal edema, and paresthesia. Minor irritation and superficial desquamation of the oral mucosa have been noted in patients using Chlorhexidine Gluconate Oral Rinse. There have been cases of parotid gland swelling and inflammation of the salivary glands (sialadenitis) reported in patients using Chlorhexidine Gluconate Oral Rinse.
OVERDOSAGE
OVERDOSAGE SECTION
Ingestion of 1 or 2 ounces of Chlorhexidine Gluconate
Oral Rinse by a small child (~10 kg body weight) might result in gastric
distress, including nausea, or signs of alcohol intoxication. Medical
attention should be sought if more than 4 ounces of Chlorhexidine
Gluconate Oral Rinse is ingested by a small child or if signs of alcohol
intoxication develop.
DOSAGE AND ADMINISTRATION
DOSAGE & ADMINISTRATION SECTION
Chlorhexidine
Gluconate Oral Rinse therapy should be initiated directly following
a dental prophylaxis. Patients using Chlorhexidine Gluconate Oral
Rinse should be reevaluated and given a thorough prophylaxis at intervals
no longer than six months. Recommended use is twice daily oral rinsing
for 30 seconds, morning and evening after toothbrushing. Usual dosage
is 15 mL of undiluted Chlorhexidine Gluconate Oral Rinse. Patients
should be instructed to not rinse with water, or other mouthwashes,
brush teeth, or eat immediately after using Chlorhexidine Gluconate
Oral Rinse. Chlorhexidine Gluconate Oral Rinse is not intended for
ingestion and should be expectorated after rinsing.
HOW SUPPLIED
HOW SUPPLIED SECTION
Chlorhexidine Gluconate Oral Rinse
is supplied as a blue liquid in single dose 0.5 fluid ounce (15mL)
amber plastic bottles with child-resistant dispensing closures.
STORE at 20°C to 25°C (68°F to 77°F), excursions permitted to 15°C
to 30°C (59°F to 86°F) [See USP controlled room temperature].
SPL PATIENT PACKAGE INSERT SECTION
Rx only. KEEP OUT OF REACH OF CHILDREN.
WHAT TO EXPECT WHEN USING CHLORHEXIDINE GLUCONATE ORAL RINSE Your dentist has prescribed Chlorhexidine Gluconate Oral Rinse to treat your gingivitis, to help reduce the redness, and swelling of your gums, and also to help you control any gum bleeding. Use Chlorhexidine Gluconate Oral Rinse regularly, as directed by your dentist, in addition to daily brushing. Spit out after use. Chlorhexidine Gluconate Oral Rinse should not be swallowed.
If you develop allergic symptoms such as skin rash, itch, generalized swelling, breathing difficulties, light headedness, rapid heart rate, upset stomach or diarrhea, seek medical attention immediately. Chlorhexidine Gluconate Oral Rinse should not be used by persons who have a sensitivity to it or its components.
Chlorhexidine Gluconate Oral Rinse may cause some tooth discoloration, or increase in tartar (calculus) formation, particularly in areas where stain and tartar usually form. It is important to see your dentist for removal of any stain or tartar at least every six months or more frequently if your dentist advises.
Both stain and tartar can be removed by your dentist or hygienist. Chlorhexidine Gluconate Oral Rinse may cause permanent discoloration of some front-tooth fillings.
To minimize discoloration, you should brush and floss daily, emphasizing areas which begin to discolor.
Chlorhexidine Gluconate Oral Rinse may taste bitter to some patients and can affect how foods and beverages taste. This will become less noticeable in most cases with continued use of Chlorhexidine Gluconate Oral Rinse.
To avoid taste interference, rinse with Chlorhexidine Gluconate Oral Rinse
after meals. Do not rinse with water or other mouthwashes immediately after rinsing with Chlorhexidine Gluconate Oral Rinse.
If you have any questions or comments about Chlorhexidine Gluconate Oral Rinse, contact your dentist or pharmacist.
Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
INGREDIENTS: 0.12% chlorhexidine gluconate in a base containing water, 11.6% alcohol, glycerin, PEG-40 sorbitan diisostearate, flavor, sodium saccharin, and FD&C Blue No. 1.
STORE at 20°C to 25°C (68°F to 77°F), excursions permitted to 15°C to 30°C (59°F to 86°F) [See USP controlled room temperature].
Manufactured for: Sage Products LLC
Cary, IL 60013
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