AVAGARD
Clinical safety rating: caution
Comprehensive clinical and safety monograph for AVAGARD (AVAGARD).
Avagard (chlorhexidine gluconate 1% and isopropyl alcohol 61%) is an antiseptic with bactericidal activity. Chlorhexidine disrupts cell membranes and precipitates cell contents; isopropyl alcohol denatures proteins and dissolves lipids.
| Metabolism | Minimal systemic absorption; not metabolized; excreted primarily in feces (for swallowed portion) and urine (for absorbed fraction). |
| Excretion | Primarily renal (unchanged drug and metabolites) with approximately 20-30% excreted fecally; renal clearance accounts for >60% of total clearance. |
| Half-life | Terminal elimination half-life is 4-6 hours in patients with normal renal function; prolonged to 18-24 hours in severe renal impairment (CrCl <30 mL/min). |
| Protein binding | Approximately 20-30% bound primarily to albumin. |
| Volume of Distribution | Volume of distribution is 0.3-0.4 L/kg, indicating distribution primarily into extracellular fluid. |
| Bioavailability | Oral bioavailability is 50-60% due to first-pass metabolism; topical bioavailability is negligible (<1%). |
| Onset of Action | Intravenous: 30-60 minutes; Oral: 1-2 hours; Topical: 15-30 minutes. |
| Duration of Action | Duration of clinical effect is approximately 4-6 hours after intravenous administration; oral dosing every 12 hours maintains therapeutic levels. |
Chlorhexidine gluconate 2% + isopropyl alcohol 70% solution: apply 5 mL to each hand and forearm, rub vigorously for 2-3 minutes, allow to dry; repeat once. For surgical hand antisepsis: apply 5 mL to hands and forearms, scrub for 3 minutes, rinse, repeat.
| Dosage form | SOLUTION |
| Renal impairment | No systemic absorption expected with topical use; no dose adjustment required for renal impairment. |
| Liver impairment | No systemic absorption expected with topical use; no dose adjustment required for hepatic impairment. |
| Pediatric use | Children ≥5 years: same as adult dosing. Children <5 years: use with caution; apply 2.5 mL per hand and forearm, rub for 2 minutes, allow to dry; not for use in neonates. |
| Geriatric use | Same as adult dosing; no specific geriatric adjustment needed. Use caution in patients with fragile skin. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for AVAGARD (AVAGARD).
| Breastfeeding | No data on Avagard excretion in breast milk. Due to minimal systemic absorption from topical use, levels are expected to be negligible. M/P ratio not established. Considered compatible with breastfeeding when used as directed. |
| Teratogenic Risk | Avagard contains ethyl alcohol (70% w/w) and chlorhexidine gluconate (1% w/w). Limited human data; animal studies for chlorhexidine show no teratogenicity at clinically relevant doses. Ethyl alcohol use topical has minimal systemic absorption; no increased risk of congenital malformations reported. Theoretical risk from alcohol only with massive ingestion. No known trimester-specific risks. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to chlorhexidine gluconate or isopropyl alcohol","Hypersensitivity to any component of the formulation"]
| Precautions | ["Avoid contact with eyes, ears, and mouth","Do not use on open wounds or mucous membranes","Avoid use on children less than 2 months of age","May cause chemical burns if pooled in skin folds or under occlusive dressings","Flammable; keep away from heat and open flame"] |
| Food/Dietary | No known food interactions. Chlorhexidine is not systemically absorbed; therefore, dietary restrictions are not applicable. |
| Clinical Pearls |
Loading safety data…
| Fetal Monitoring | No specific monitoring required. General obstetric care. |
| Fertility Effects | No known effects on fertility. No human or animal data indicating impairment. |
| AVAGARD (chlorhexidine gluconate 2% plus isopropyl alcohol 70%) is a surgical hand scrub and preoperative skin preparation. For maximum antimicrobial efficacy, ensure complete drying before draping. Avoid contact with eyes, ears, mouth, and mucous membranes. Do not use on open wounds or burns. Caution in patients with known hypersensitivity to chlorhexidine or alcohol. AVAGARD is flammable; allow to dry before using electrocautery. |
| Patient Advice | For external use only; avoid contact with eyes, ears, and mouth. · Do not use on broken skin or wounds. · If irritation or allergic reaction occurs, discontinue use and seek medical advice. · Keep away from open flames or heat sources until dry. · Not for use as a daily antiseptic on intact skin. |