PERIOGARD
Clinical safety rating
cautionComprehensive clinical and safety monograph for PERIOGARD (PERIOGARD).
Chlorhexidine gluconate is a cationic bisbiguanide that disrupts microbial cell membrane integrity, leading to leakage of intracellular contents and cell death. It exhibits broad-spectrum antimicrobial activity against gram-positive and gram-negative bacteria, fungi, and viruses.
| Metabolism | Chlorhexidine is not significantly absorbed systemically following oral topical application; minimal metabolism occurs in the liver, with primary excretion via feces. |
| Excretion | Primarily renal (70-80% unchanged via glomerular filtration); minor biliary/fecal (20-30%). |
| Half-life | 6-7 hours (prolonged in renal impairment; no dosage adjustment for topical oral use). |
| Protein binding | Very low (10-18%), primarily to serum proteins (albumin). |
| Volume of Distribution | 0.2-0.3 L/kg (minimal systemic distribution, consistent with poor absorption from oral topical use). |
| Bioavailability | Topical oral (mouthwash): <1% (minimal systemic absorption). |
| Onset of Action | Topical oral (mouthwash): 30 minutes to 1 hour for reduction of oral bacterial load. |
| Duration of Action | Topical oral: 12 hours (sustained antimicrobial effect with twice-daily use). |
| Molecular Weight | 505.48 |
15 mL chlorhexidine gluconate 0.12% oral rinse twice daily for 30 seconds and expectorate.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required; negligible systemic absorption. |
| Liver impairment | No dose adjustment required; negligible hepatic metabolism. |
| Pediatric use | Not recommended for children under 18 years due to safety and efficacy data lacking. |
| Geriatric use | No specific dose adjustment; use with caution if dysphagia or aspiration risk present. |
| 1st trimester | Chlorhexidine gluconate 0.12% mouthrinse is considered low risk; systemic absorption negligible (<1%). No known association with fetal malformations, but data limited. Use only if clearly needed. |
| 2nd trimester | Low risk; negligible systemic absorption. May be used as needed for periodontal health. |
| 3rd trimester | Low risk; avoid prolonged or frequent use near term due to theoretical risk of neonatal hypotonia from rare systemic absorption. |
Clinical note
Comprehensive clinical and safety monograph for PERIOGARD (PERIOGARD).
| Placental transfer | Minimal; chlorhexidine has low systemic bioavailability (<1% after oral rinse) and negligible placental transfer. |
| Breastfeeding | Chlorhexidine is poorly absorbed orally (<1%) and unlikely to reach significant levels in breast milk. Use is considered compatible with breastfeeding. Avoid excessive ingestion. |
| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Periogard (chlorhexidine gluconate oral rinse) has not been studied in pregnant women. Animal reproduction studies have not been conducted. Based on limited systemic absorption, risk to fetus is considered low. However, due to insufficient data, use in pregnancy is generally avoided, especially during first trimester, unless clearly needed. |
| Fetal Monitoring | No specific maternal or fetal monitoring required due to minimal systemic exposure. Routine prenatal care is sufficient. |
| Fertility Effects | No known effects on fertility based on available data. Chlorhexidine has not been studied for reproductive impact in humans. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Hypersensitivity to chlorhexidine or any component
| Precautions | Avoid contact with eyes, ears, and mucous membranes; may cause staining of teeth, tongue, and dental restorations; hypoesthesia of tongue may occur; anaphylaxis and serious allergic reactions reported; use with caution in patients with known hypersensitivity; not for use in children under 6 years. |
| Food/Dietary | Avoid food, beverages, and other oral care products (e.g., toothpaste) for 30 minutes after rinsing to prevent inactivation. Specifically, sodium lauryl sulfate in toothpaste can reduce efficacy. There are no known direct food interactions with chlorhexidine rinse beyond timing of use. |
| Clinical Pearls | PERIOGARD (chlorhexidine gluconate 0.12%) oral rinse is used as an adjunct to periodontal treatment. It is most effective when used 30 minutes after brushing to avoid inactivation by sodium lauryl sulfate in toothpaste. Patients should be advised to avoid eating or drinking for 30 minutes after rinsing. The most common side effect is extrinsic tooth staining, which can often be removed by dental prophylaxis. Rinsing with 15 mL for 30 seconds twice daily is typical. Do not swallow; if accidental ingestion occurs, consider potential for alcohol toxicity (contains 11.6% alcohol). |
| Patient Advice | Use exactly as directed: 15 mL (1 tablespoon) for 30 seconds twice daily after brushing. · Do not swallow the rinse; spit it out after use. · Avoid eating, drinking, or rinsing with other mouthwashes for at least 30 minutes after use. · Temporary taste alteration or numbness of the tongue may occur initially. · May cause brown staining of teeth, tongue, or dental restorations; regular dental cleaning can remove stains. · Do not dilute the solution; use full strength. · If you have mouth ulcerations or oral surgery, consult your dentist before use. · Keep out of reach of children. |
Loading safety data…