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Chlorhexidine

AEMPS

Biguanide antiseptic for skin and mucous membranes

ATC code: D08AC02

Brand names: Hibiclens, Peridex, Betasept

Updated · Methodology

Indications

A

Antiseptic skin and mucosal decontamination

First line

First-line antiseptic for preoperative skin and hand decontamination. 2% chlorhexidine in 70% isopropanol reduces SSI risk after clean surgery vs povidone-iodine. AEMPS and SEIMC recommend it as standard for central venous catheter care.

Sources

  1. AEMPS: Ficha técnica de Clorhexidina (2023)
  2. N Engl J Med: Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. (2010)
  3. Cochrane Database Syst Rev: Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. (2015)
  4. Am J Infect Control: Guidelines for the prevention of intravascular catheter-related infections. (2011)
B

Wound healing support

First line

Antiseptic for acute and chronic wound care. Use 0.02–0.05% aqueous solutions; higher concentrations are cytotoxic and impair healing. SEMI recommends it for routine clean-contaminated wound care, not for deep wound cavities.

Sources

  1. AEMPS: Ficha técnica de Clorhexidina (2023)

ICD-10: T14.1 · ICD-11: ND56.1

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Cationic biguanide. Binds the negatively charged bacterial wall, disrupts membrane osmotic balance and causes cytoplasmic leakage. Bacteriostatic at low concentrations, bactericidal at high ones. Spectrum: gram-positive and gram-negative bacteria (except Pseudomonas, Proteus), Candida, enveloped viruses. Weak activity against mycobacteria and spores.

Safety

Contraindications

  • Hypersensitivity to chlorhexidine (severe anaphylactic reactions possible)
  • Use in middle or inner ear with tympanic membrane perforation
  • Contact with eyes or meninges

Serious adverse effects

  • Anaphylactic shock (especially with catheter applications and prolonged contact)
  • Chemical burns in newborn skin with high concentrations
  • Contact dermatitis with prolonged use

Common adverse effects

  • Itching and burning at the application site
  • Skin dryness and desquamation
  • Tooth and tongue discoloration with mouthwash use (reversible)
  • Taste alteration

Uncommon adverse effects

  • Anaphylactic shock (especially with catheter use and prolonged contact)
  • Chemical burns in newborn skin with high concentrations
  • Contact dermatitis with prolonged use
  • Severe local reactions if instilled into middle or inner ear with tympanic membrane perforation

Pregnancy: can you take Chlorhexidine?

AEMPS summary of product characteristics (section 4.6): there are no or limited data on the use of chlorhexidine in pregnant women. Animal studies do not suggest direct or indirect harmful effects with respect to reproductive toxicity.

Breastfeeding: can you take Chlorhexidine?

Compatible. Minimal systemic absorption. eLactancia rates the risk as very low for topical use. When applied to nipples before feeding, wipe residue with warm water before latching.

Calculate RIDFull profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

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Frequently asked

What is Chlorhexidine used for?

Chlorhexidine is evaluated for the following indications with varying evidence strength: Antiseptic skin and mucosal decontamination (evidence tier A), Wound healing support (evidence tier B). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Chlorhexidine?

Common side effects of Chlorhexidine (≥ 1 in 100): Itching and burning at the application site, Skin dryness and desquamation, Tooth and tongue discoloration with mouthwash use (reversible), Taste alteration. See the Safety section for uncommon and serious reactions.

Is Chlorhexidine safe during pregnancy?

AEMPS summary of product characteristics (section 4.6): there are no or limited data on the use of chlorhexidine in pregnant women. Animal studies do not suggest direct or indirect harmful effects with respect to reproductive toxicity.

Is Chlorhexidine compatible with breastfeeding?

Compatible. Minimal systemic absorption. eLactancia rates the risk as very low for topical use. When applied to nipples before feeding, wipe residue with warm water before latching.

Who should not take Chlorhexidine?

Chlorhexidine is contraindicated in: Hypersensitivity to chlorhexidine (severe anaphylactic reactions possible); Use in middle or inner ear with tympanic membrane perforation; Contact with eyes or meninges. Full list in the Safety section.

Official sources

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Other drugs in this group

Ethanol, Isopropanol, Povidone-iodine