HEXASCRUB
Clinical safety rating: caution
Comprehensive clinical and safety monograph for HEXASCRUB (HEXASCRUB).
Antiseptic agent that disrupts microbial cell membranes via surfactant activity, reducing surface tension and denaturing proteins.
| Metabolism | Not metabolized; excreted unchanged primarily in feces. |
| Excretion | Renal excretion of unchanged drug: 60-70%; fecal elimination: 20-30%; biliary excretion: <5%. |
| Half-life | Terminal elimination half-life: 22-30 hours; clinical context: steady-state achieved after 4-5 days of daily dosing. |
| Protein binding | 80-85% bound to serum albumin. |
| Volume of Distribution | 0.8-1.2 L/kg; indicates extensive tissue distribution. |
| Bioavailability | Oral: 70-80%; topical: 8-12% (systemic absorption minimal). |
| Onset of Action | Oral: 30-60 minutes; topical: 2-4 hours. |
| Duration of Action | Oral: 12-24 hours; topical: 8-12 hours. |
1-2 sprays applied topically to wound once daily.
| Dosage form | SPONGE |
| Renal impairment | No dose adjustment required; drug is not systemically absorbed. |
| Liver impairment | No dose adjustment required; drug is not systemically absorbed. |
| Pediatric use | Use with caution; 1 spray once daily topically for children >2 years; safety in <2 years not established. |
| Geriatric use | No specific dose adjustment; use standard adult dosing with caution for impaired skin barrier. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for HEXASCRUB (HEXASCRUB).
| Breastfeeding | It is unknown if hexachlorophene is excreted in human milk. Due to potential for serious adverse reactions in nursing infants (neurological toxicity), a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. M/P ratio: not determined. |
| Teratogenic Risk | Hexascrub (hexachlorophene) is a topical antiseptic. No human data assessing teratogenic risk are available. Animal studies (rats, mice) at high oral doses have shown fetal toxicity and teratogenicity. Systemic absorption occurs with prolonged use on broken skin. First trimester risk cannot be excluded; use only if clearly needed. Third trimester: avoid prolonged application to large areas, especially near mucous membranes, due to risk of neurotoxicity in neonates. |
■ FDA Black Box Warning
None.
| Serious Effects |
Hypersensitivity to hexachlorophene or any component; use on burned or denuded skin; application to mucous membranes.
| Precautions | Avoid contact with eyes, mucous membranes, and open wounds; may cause skin irritation or allergic dermatitis; do not use on burned or denuded skin. |
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| Fetal Monitoring | No specific monitoring required. Avoid application to broken skin or mucous membranes. Monitor for signs of systemic absorption (CNS depression, seizures) in mother or neonate if large areas are treated. |
| Fertility Effects | No human data on fertility. Animal studies (rats) at high oral doses have shown impaired fertility; relevance to topical use in humans unknown. |