The Basics
What is Chlorhexidine?
Used to treat gingivitis.
Brand names for Chlorhexidine
Peridex
How Chlorhexidine is classified
Anti-Infective Agents – Local, Antibacterial Agents, Disinfectants, Mouthwashes
Chlorhexidine During Pregnancy
Chlorhexidine pregnancy category
Category BNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Chlorhexidine while pregnant
Reproduction studies have been performed in rats and rabbits at chlorhexidine gluconate doses up to 300mg/kg/day and 40mg/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.
Taking Chlorhexidine While Breastfeeding
What are recommendations for lactation if you're taking Chlorhexidine?
Chlorhexidine has been used vaginally or topically on the abdomen or perineum prior to delivery to prevent infection. No toxicity has been reported in breastfed infants and it has clearly less toxicity compared to povidone-iodine in these situations. Topical application of chlorhexidine to the breast before and after nursing did not appear to adversely affect the breastfed infants in one study. Use of chlorhexidine oral rinse by a nursing mother is unlikely to adversely affect her infant.
Maternal / infant drug levels
Chlorhexidine has been used vaginally or topically on the abdomen or perineum prior to delivery to prevent infection. No toxicity has been reported in breastfed infants and it has clearly less toxicity compared to povidone-iodine in these situations. Topical application of chlorhexidine to the breast before and after nursing did not appear to adversely affect the breastfed infants in one study. Use of chlorhexidine oral rinse by a nursing mother is unlikely to adversely affect her infant.
Possible effects of Chlorhexidine on milk supply
A randomized study compared 0.2% chlorhexidine in alcohol to distilled water as a spray to the breast in 200 mothers who were nursing newborns. The mothers sprayed their breasts with the liquid before and after each feeding. Mothers and infants were assessed at discharge and weekly thereafter. Discomfort and nipple trauma were less frequent in the chlorhexidine group than in the placebo group, particularly at the first assessment. Although skin flora on the breasts of the treated mothers was reduced, there was no difference in the frequency of mastitis between the treated and placebo groups. No obvious side effects occurred in the breastfed infants and there were no differences in the rates of oral thrush in infants between the treatments.[6] A systematic review concluded that this practice is not justified based on current evidence.[7]
Possible alternatives to Chlorhexidine
Benzalkonium Chloride.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Arena Ansotegui J, Emparanza Knorr JI, San Millan Vege MJ et al. [Iodine overload in newborn infants caused by the use of PVP-iodine for perineal preparation of the mother in vaginal delivery]. An Esp Pediatr. 1989;30:23-6. PMID: 2648916
2. Chanoine JP, Boulvain M, Bourdoux P et al. Increased recall rate at screening for congenital hypothyroidism in breast fed infants born to iodine overloaded mothers. Arch Dis Child. 1988;63:1207-10. PMID: 3196047
3. Chanoine JP, Pardou A, Bourdoux P, Delange F. Withdrawal of iodinated disinfectants at delivery decreases the recall rate at neonatal screening for congenital hypothyroidism. Arch Dis Child. 1988;63:1297-8. Letter. PMID: 3196066
4. Biggar RJ, Miotti PG, Taha TE et al. Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission. Lancet. 1996;347:1647-50. PMID: 8642957
5. Gaillard P, Mwanyumba F, Verhofstede C et al. Vaginal lavage with chlorhexidine during labour to reduce mother-to-child HIV transmission: clinical trial in Mombasa, Kenya. AIDS. 2001;15:389-96. PMID: 11273219
6. Herd B, Feeney JG. Two aerosol sprays in nipple trauma. Practitioner. 1986;230:31-8. PMID: 3513148
7. Vieira F, Bachion MM, Mota DD, Munari DB. A systematic review of the interventions for nipple trauma in breastfeeding mothers. J Nurs Scholarsh. 2013;45:116-25. PMID: 23452043
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
