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DENTI-CARE DENTI-RINSE CHLORHEXIDINE GLUCONATE ORAL RINSE
chlorhexidine gluconate liquid
----------Denti-Care Denti-Rinse 0.12 % Chlorhexidine Gluconate Oral Rinse Mint
0.12 % CHLORHEXIDINE GLUCONATE ORAL RINSE
Ingredients: 0.12 % chlorhexidine gluconate in a base containing water, 11.6 % alcohol, glycerin, PEG-40 sorbitan diisostearate, flavor, sodium saccharin and FD and C Blue No.1.
KEEP OUT OF REACH OF CHILDREN
1 Pint (473 ml)
DIRECTIONS FOR USE: Fill cap to the “fill line” (15 mL).
Swish in mouth undiluted for 30 seconds,
then spit out. Use after breakfast and before
bedtime. Or, use as prescribed. NOTE: To minimize medicinal taste, do
not rinse with water immediately after use.
To open: Squeeze smooth areas near bottom of cap and turn.
To close: Turn Cap until it locks.
WHAT TO EXPECT WHEN USING CHLORHEXIDINE GLUCONATE ORAL
RINSE Your dentist has prescribed chlorhexidine gluconate oral rinse to treat
your gingivitis, to help reduce the redness and swelling of your gums,
and also to help you control any gum bleeding. Use chlorhexidine
gluconate oral rinse regularly, as directed by your dentist, in addition to
daily brushing. Spit out after use; Chlorhexidine gluconate oral rinse
should not be swallowed. Chlorhexidine gluconate oral rinse may cause
some tooth discoloration, or increase in tartar (calculus) formation,
particularly in areas where stain and tartar usually form. It is important to
see your dentist for removal of any stain or tartar at least every six
months or more frequently if your dentist advises.
• Both stain and tartar can be removed by your dentist or hygienist.
Chlorhexidine gluconate oral rinse may cause permanent discoloration
of some front-tooth fillings.
• To minimize discoloration, you should brush and floss daily,
emphasizing areas which begin to discolor.
• Local hypersensitivity and sometimes generalized allergic reactions
have also been reported. Chlorhexidine gluconate oral rinse should not
be used by persons who have a sensitivity to it or its components.
• Chlorhexidine gluconate oral rinse may taste bitter to some patients and
can affect how foods and beverages taste. This will become less
noticeable in most cases with continued use of chlorhexidine gluconate
• To avoid taste interference, rinse with chlorhexidine gluconate oral rinse
after meals. Do not rinse with water or other mouthwashes immediately
after rinsing with chlorhexidine gluconate oral rinse.
If you have any questions or comments about chlorhexidine gluconate
oral rinse, contact your dentist or pharmacist.
Store at USP Controlled Room Temperature (20°C - 25°C (68°F - 77°F)).
Manufactured for and distributed by: A.R. Medicom Inc. Montreal, Canada H8T 3J8
DESCRIPTION: Chlorhexidine gluconate is an oral rinse containing 0.12% chlorhexidine gluconate (1,11-hexamethylene bis[5-(p-chlorophenyl) biguanide] di-D-gluconate) in a base containing water, 11.6% alcohol, glycerin, PEG-40 sorbitan diisostearate, flavor, sodium saccharin, and FD and C Blue No.1. Chlorhexidine gluconate is a salt of chlorhexidine and gluconic acid.
CLINICAL PHARMACOLOGY: Chlorhexidine gluconate oral rinse provides antimicrobial
activity during oral rinsing. The clinical significance of chlorhexidine gluconate oral rinse’s
antimicrobial activities is not clear. Microbiological sampling of plaque has shown a general
reduction of counts of certain assayed bacteria, both aerobic and anaerobic, ranging from
54-97% through six months use.
Use of chlorhexidine gluconate oral rinse in a six month clinical study did not result in any significant changes in bacterial resistance, overgrowth of potentially opportunistic organisms or other adverse changes in the oral microbial ecosystem. Three months after chlorhexidine gluconate oral rinse use was discontinued, the number of bacteria in plaque had returned to baseline levels and resistance of plaque bacteria to chlorhexidine gluconate was equal to that at baseline.
Pharmacokinetics: Pharmacokinetic studies with chlorhexidine gluconate oral rinse indicate approximately 30% of the active ingredient, chlorhexidine gluconate, is retained in the oral cavity following rinsing. This retained drug is slowly released in the oral fluids. Studies conducted on human subjects and animals demonstrate chlorhexidine gluconate is poorly absorbed from the gastrointestinal tract. The mean plasma level of chlorhexidine gluconate reached a peak of 0.206 μg/g in humans 30 minutes after they ingested a 300 mg dose of the drug. Detectable levels of chlorhexidine gluconate were not present in the plasma of these subjects 12 hours after the compound was administered. Excretion of chlorhexidine gluconate occurred primarily through the feces (~90%). Less that 1% of the chlorhexidine gluconate ingested by these subjects was excreted in the urine.
INDICATION: Chlorhexidine gluconate oral rinse is indicated for use between dental visits as part of a professional program for the treatment of gingivitis as characterized by redness and swelling of the gingivae, including gingival bleeding upon probing. Chlorhexidine gluconate oral rinse has not been tested among patients with acute necrotizing ulcerative gingivitis (ANUG). For patients having coexisting gingivitis and periodontitis; see PRECAUTIONS.
CONTRAINDICATIONS: Chlorhexidine gluconate oral rinse should not be used by persons who are known to be hypersensitive to chlorhexidine gluconate or other formula ingredients.
WARNINGS: The effect of chlorhexidine gluconate oral rinse on periodontitis has not been determined. An increase in supragingival calculus was noted in clinical testing in chlorhexidine gluconate oral rinse users compared with control users. It is not known if chlorhexidine gluconate oral rinse use results in an increase in subgingival calculus. Calculus deposits should be removed by a dental prophylaxis at intervals not greater than six months. Hypersensitivity and generalized allergic reactions have occurred; SEE CONTRAINDICATIONS.
1. For patients having coexisting gingivitis and periodontitis, the presence of absence of
gingival inflammation following treatment with chlorhexidine gluconate oral rinse
should not be used as a major indicator of underlying periodontitis.
2. Chlorhexidine gluconate oral rinse can cause staining of oral surfaces, such as tooth
surfaces, restorations, and the dorsum of the tongue. Not all patients will experience a
visually significant increase in tooth staining. In clinical testing, 56% of chlorhexidine
gluconate oral rinse users exhibited a measurable increase in facial anterior stain,
compared to 35% of control users after six months; 15% of chlorhexidine gluconate
oral rinse users developed what was judged to be heavy stain, compared to 1% of
control users after six months. Stain will be more pronounced in patients who have
heavier accumulations of unremoved plaque. Stain resulting from use of chlorhexidine
gluconate oral rinse does not adversely affect health of the gingivae or other oral
tissues. Stain can be removed from most tooth surfaces by conventional professional
prophylactic techniques. Additional time may be required to complete the prophylaxis.
Discretion should be used when prescribing to patients with anterior facial
restorations with rough surfaces of margins. If natural stain cannot be removed from
these surfaces by a dental prophylaxis, patients should be excluded from
chlorhexidine gluconate oral rinse treatment if permanent discoloration is
unacceptable. Stain in these areas may be difficult to remove by dental prophylaxis
and on rare occasions may necessitate replacement of these restorations.
3. Some patients may experience an alteration in taste perception while undergoing
treatment with chlorhexidine gluconate oral rinse. Rare instances of permanent taste
alteration following chlorhexidine gluconate oral rinse use have been reported via
post-marketing product surveillance.
Pregnancy: Teratogenic EffectsPregnancy Category B. Reproduction studies have been
performed in rats and rabbits at chlorhexidine gluconate doses up to 300 mg/kg/day and
40 mg/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.
Nursing Mothers: It is not known whether this drug is excreted in human milk. Because
many drugs are excreted in human milk, caution should be exercised when chlorhexidine
gluconate oral rinse is administered to nursing women.
In parturition and lactation studies with rats, no evidence of impaired parturition or of
toxic effects to suckling pups was observed when chlorhexidine gluconate was
administered to dams at doses that were over 100 times greater than that which would
result from a person’s ingesting 30 mL (2 capfuls) of chlorhexidine gluconate oral rinse
Pediatric Use: Clinical effectiveness and safety of chlorhexidine gluconate oral rinse have not been established in children under age of 18.
Carcinogenesis, Mutagenesis, and Impairment of Fertility: In a drinking water study in rats, carcinogenic effects were not observed at doses up to 38 mg/kg/day. Mutagenic effects were not observed in two mammalian in vivo mutagenesis studies with chlorhexidine gluconate. The highest doses of chlorhexidine used in a mouse dominant-lethal assay and a hamster cytogenetics test were 1000 mg/kg/day and 250 mg/kg/day, respectively. No evidence of impaired fertility was observed in rats at doses up to 100 mg/kg/day.
ADVERSE REACTIONS: The most common side effects associated with
chlorhexidine gluconate oral rinses are: 1) an increase in staining of teeth and other oral
surfaces; 2) an increase in calculus formation; and 3) an alteration in taste perception; see WARNINGS and PRECAUTIONS. Oral irritation and local allergy-type symptomshave been spontaneously reported as side effects associated with use of chlorhexidinegluconate rinse. The following oral mucosal side effects were reported duringplacebo-controlled adult clinical trials: aphthous ulcer, grossly obvious gingivitis,trauma, ulceration, erythema, desquamation, coated tongue, keratinization, geographictongue, mucocele, and short frenum. Each occurred at a frequency of less than 1.0%.
Among post marketing reports, the most frequently reported oral mucosal symptoms
associated with chlorhexidine gluconate oral rinse are stomatitis, gingivitis, glossitis,
ulcer, dry mouth, hypesthesia, glossal edema, and paresthesia.
Minor irritation and superficial desquamation of the oral mucosa have been noted in
patients using chlorhexidine gluconate oral rinse.
There have been cases of parotid gland swelling and inflammation of the salivary glands (sialadenitis) reported in patients using chlorhexidine gluconate oral rinse.
OVERDOSAGE: Ingestion of 1 or 2 ounces of chlorhexidine gluconate oral rinse by a small child (~10 kg body weight) might result in gastric distress, including nausea, or signs of alcohol intoxication. Medical attention should be sought if more than 4 ounces of chlorhexidine gluconate oral rinse is ingested by a small child or if signs of alcohol intoxication develop.
DOSAGE AND ADMINISTRATION: Chlorhexidine gluconate oral rinse therapy should be initiated directly following a dental prophylaxis. Patients using chlorhexidine gluconate oral rinse should be reevaluated and given a thorough prophylaxis at intervals of no longer than six months. Recommended use is twice daily rinsing for 30 seconds, morning and evening after tooth brushing. Usual dosage is 15 mL (marked in cap) of undiluted chlorhexidine gluconate oral rinse. Patients should be instructed to not rinse with water, or other mouthwashes, brush teeth, or eat immediately after using chlorhexidine gluconate oral rinse. Chlorhexidine gluconate oral rinse is not intended for ingestion and should be expectorated after rinsing.
HOW SUPPLIED: Chlorhexidine gluconate oral rinse is supplied as a blue liquid in
1-pint (473 mL) amber plastic bottles with child-resistant dispensing closures,
Store at USP Controlled Room Temperature (20°C - 25°C (68°F - 77°F)).
Rx Only. Keep out of reach of children. Revised: December 2009 Manufactured for and distributed by: A.R. Medicom Inc. Montreal, Canada H8T 3J8
Revised: 04/2010 AR Medicom Inc.
Reproduced with permission of U.S. National Library of Medicine
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