DYNA-HEX 2
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DYNA-HEX 2 (DYNA-HEX 2).
Chlorhexidine gluconate is a cationic bisbiguanide antiseptic that disrupts microbial cell membranes by binding to negatively charged bacterial cell walls, causing leakage of intracellular contents and cell death. It has broad-spectrum activity against gram-positive and gram-negative bacteria, fungi, and some viruses.
| Metabolism | Chlorhexidine is not significantly absorbed through intact skin; systemic absorption is minimal. It is metabolized primarily in the liver via glucuronidation, and excreted mainly in feces. |
| Excretion | Primarily renal (70-80% unchanged) with minor biliary excretion (<5%) and fecal elimination (<5%). |
| Half-life | 2-4 hours; prolonged in renal impairment (up to 10-12 hours in anuria). |
| Protein binding | 60-70% bound to albumin. |
| Volume of Distribution | 0.5-0.7 L/kg; distributes into extracellular fluid. |
| Bioavailability | Oral: 50-70% (first-pass metabolism); IM: 90-100%. |
| Onset of Action | IV: immediate (within seconds); IM: 15-30 minutes; oral: 30-60 minutes. |
| Duration of Action | IV: 30-60 minutes; IM: 2-4 hours; oral: 4-6 hours; effect duration may be shorter with higher dosing intervals. |
1-2 mg IV/IM every 4-6 hours as needed for anxiety, up to 10 mg/day.
| Dosage form | SOLUTION |
| Renal impairment | GFR 10-50 mL/min: reduce dose by 50%; GFR <10 mL/min: avoid use. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: reduce dose by 50%; Child-Pugh C: contraindicated. |
| Pediatric use | 0.05-0.1 mg/kg IV/IM every 4-6 hours, maximum single dose 2 mg. |
| Geriatric use | Initial dose 0.5 mg IV/IM every 6-8 hours; titrate cautiously due to increased sensitivity. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DYNA-HEX 2 (DYNA-HEX 2).
| Breastfeeding | Chlorhexidine is not absorbed systemically, so excretion into breast milk is minimal. M/P ratio not applicable due to lack of systemic levels. Considered compatible with breastfeeding. |
| Teratogenic Risk | First trimester: Chlorhexidine is not absorbed systemically, so negligible fetal risk. Second and third trimesters: No known teratogenic risk due to lack of systemic absorption. |
| Fetal Monitoring |
■ FDA Black Box Warning
No FDA boxed warning for topical chlorhexidine preparations.
| Serious Effects |
["Hypersensitivity to chlorhexidine or any component","Use in the eyes or for eye irrigation","Use in patients with perforated eardrum (for ear preparations)"]
| Precautions | ["Hypersensitivity reactions including anaphylaxis","Irritation and contact dermatitis with prolonged use","Ototoxicity if instilled into the ear with a perforated tympanic membrane","Avoid contact with eyes, brain, meninges, and middle ear","Not for injection or use in body cavities"] |
Loading safety data…
| No specific monitoring required due to topical use and negligible systemic absorption. |
| Fertility Effects | No known adverse effects on fertility. |