Chlorhexidine + Metronidazole Pharmacology

Chlorhexidine + Metronidazole

About Chlorhexidine + Metronidazole
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Mechanism of Action of Chlorhexidine + Metronidazole
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Pharmacokinets of Chlorhexidine + Metronidazole
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Onset of Action for Chlorhexidine + Metronidazole
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Duration of Action for Chlorhexidine + Metronidazole
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Half Life of Chlorhexidine + Metronidazole
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Side Effects of Chlorhexidine + Metronidazole
N/A
Contra-indications of Chlorhexidine + Metronidazole
N/A
Special Precautions while taking Chlorhexidine + Metronidazole
N/A
Pregnancy Related Information
Contraindicated; since Clorhexedine is contraindicated in pregnancy, the combination generic cannot be used in pregnancy.
Old Age Related Information
N/A
Breast Feeding Related Information
Contraindicated; since Clorhexedine is contraindicated in breast feeding, the combination generic cannot be used in breast feeding mother.
Children Related Information
N/A
Indications for Chlorhexidine + Metronidazole
It is a combination of antiptozoal and antibacterial Metronidazole antiseptic Chlorhexidine.
1.Gingivitis
2.Promote gum healing after surgery
3.Mouth ulcers
4.Sore mouth
5.Oral thrush
6.Prevent plaque build-up on the teeth
Interactions for Chlorhexidine + Metronidazole
N/A
Typical Dosage for Chlorhexidine + Metronidazole
Rinse the mouth.Then apply the medicament as thin film 3 - 4 times daily.
Schedule of Chlorhexidine + Metronidazole
N/A
Storage Requirements for Chlorhexidine + Metronidazole
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Effects of Missed Dosage of Chlorhexidine + Metronidazole
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Effects of Overdose of Chlorhexidine + Metronidazole
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Chlorhexidine

About Chlorhexidine
A bisbiguanide antimicrobial agent, Anti-infective, antiseptic.
Mechanism of Action of Chlorhexidine
This drug has positive charge so it attach to the negative charge cell wall. This destabilizes and destroys the integrity and penetrates bacterial cell membranes. It results precipitation of the cytoplasm and interferes with membrane function by inhibiting oxygen utilization leading to a decrease in cellular ATP levels and cell death. In gram-negative bacteria, chlorhexidine affects the outer membrane allowing the release of periplasmic enzymes. The inner membrane of these organisms is not ruptured but the uptake of small molecules is impaired. At low concentrations chlorhexidine exhibits a bacteriostatic effect while at high concentrations it is bactericidal.
Pharmacokinets of Chlorhexidine
Absorption- Poorly from the gastrointestinal tract.
Distribution- 87% bound to the plasma proteins.
Excretion- Excreted through feces.
Onset of Action for Chlorhexidine
N/A
Duration of Action for Chlorhexidine
N/A
Half Life of Chlorhexidine
N/A
Side Effects of Chlorhexidine
1. Bleeding
2. Tender
3. Enlarged gums
4. Cough
5. Congestion or tightness in chest
6. Wheezing
7. Staining of teeth
8. Calculus formation above the gum line
Contra-indications of Chlorhexidine
1. Hypersensitivity to the drug
Special Precautions while taking Chlorhexidine
1. Avoid eating or drinking for at least 1 hour after each dose
2. To minimize the staining apply drug with the hollow cup brush tip of the Rota-dent perio tool to only the gum tissue, especially focus on the areas with pockets depths over 4mm
3. You may also alternate drug with custom bleaching trays at home
Pregnancy Related Information
Contraindicated
Old Age Related Information
Use with caution
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution
Indications for Chlorhexidine
1. Gingivitis
2. Acute and chronic otitis externa (ear infection/inflammation)
3. Periodontal disease
4. Superficial skin infections
5. Irrigation (cleansing) of wounds and as a medicated shampoo for the treatment of certain skin conditions (hot spots or acute moist dermatitis
Interactions for Chlorhexidine
N/A
Typical Dosage for Chlorhexidine
Oral rinse solutions - 0.1 percent.
Otic (ear) solutions - 1 percent.
Chlorhexidine solutions - 2 percent.
Chlorhexidine shampoo and conditioner 1 and 2 percent.
As an ear-cleansing agent - flush the ear canal once a day in cases of diagnosed otitis externa.
For skin conditions - clean the area twice daily.
For gingivitis - Chlorhexidine oral solution is applied as directed once a day. In the morning brush and floss for 2 minutes and than rinse with Chlorhexidine for 30 seconds.
Use 1/2 fl. oz. of undiluted. Swish in mouth for 30 seconds. After rinsing for 30 seconds be sure to spit out all the rinse, do NOT swallow any of the rinse. To minimize medicinal taste, DO NOT rinse with water immediately after use. In the evening brush and floss and rinse again for 30 seconds.
Chlorhexidine shampoo and conditioner - once or twice a week.
Pellet (extended-release), Periochip (in a biodegradable matrix of hydrolyzed gelatin cross-linked with glutaraldehyde), Cream, Dressing, Gel, Lotion, Ointment, Sponge forms are also available.
Schedule of Chlorhexidine
N/A
Storage Requirements for Chlorhexidine
Store at room temperature below 77 degree F. Do not freeze.
Effects of Missed Dosage of Chlorhexidine
Take any missed dose as soon as possible but not if it is almost time for the next dose. If it is time for the next dose, skip the missed dose and resume your regular schedule. Do not "double-up" the dose.
Effects of Overdose of Chlorhexidine
Give symptomatic and supportive treatment.

Metronidazole

About Metronidazole
A nitroimidazole antibiotic, Anti-infective, Antiprotozoal,amebicide.
Mechanism of Action of Metronidazole
Metronidazole is nitro imidazoles which have broad spectrum cidal activity against Protozoa and some anaerobic bacteria. Its selective toxicity to anaerobic microbes involves 1. Drug enters the cell by diffusion, 2. Nitro group of drug is reduced by redox proteins present only in anaerobic organisms to reactive nitro radical which exerts cytotoxic action by damaging DNA and other critical biomolecules. 3. DNA helix destabilization & strand breakage has been observed.
Pharmacokinets of Metronidazole
Absorption: Well absorbed orally, Distribution: Widely distributed,
Metabolism: Metabolized in liver by oxidation & glucuronide conjugation, Excretion: Excreted in urine.
Onset of Action for Metronidazole
1 to 2 days
Duration of Action for Metronidazole
8hours.
Half Life of Metronidazole
8 hours.
Side Effects of Metronidazole
1.Anorexia.
2.Metallic taste
3.Nausea
4.Vomiting
5.Diarrhoea
6.Headache
7.Looseness of stool.
8.Peripheral neuropathy &CNS effects.
9.Mutagenesis.
10.Radiosensitisation.
11.Transient leucopenia
12.Dry mouth
13.Abdominal distress
14.Dizziness
15.Vertigo
16.Thrombophlebitis at site of injection
17.Ototoxicity
Contra-indications of Metronidazole
1.Hypersensitivity to the drug
2.Blood dyscrasias
3.CNS disorders
Special Precautions while taking Metronidazole
1.Renal impairment
2.Hepatic impairment
3.Alcoholic cirrhosis
4.Use cautiously along with other hepatotoxic drugs & In visual field changes
Pregnancy Related Information
Use with caution
First trimester:contra indicated
Old Age Related Information
May be used.
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution
Neonates: Contraindicated
Indications for Metronidazole
1.Amoebiasis
2.Giardiasis
3.Trichomonas vaginitis
4.Pseudo membranous enterocolitis
5.Anaerobic bacterial infections after surgery, Brain abscess, & Endocarditis
6.Helicobacter pylori infections
7.Ulcerative gingivitis
Interactions for Metronidazole
Warfarin & other coumarin anticoagulants: Potentiates the anticoagulant effect resulting in increased prothrombin time.
Alcohol: A disulfiram-like reaction. Abdominal cramps, nausea, vomiting, headache & flushing.
Disulfiram: Acute psychotic reaction or confusional state.
Phenobarbital & Phenytoin: Increased metabolism of metronidazole resulting in decreased efficacy.
Lithium: Increased lithium levels and toxicity.
Flurouracil: Increased toxicity of flurouracil.
Lab tests: May interfere with chemical analysis for AST,SGOT, ALT, SGPT, LDH, triglycerides and hexokinase glucose. Zero values may occur.
Typical Dosage for Metronidazole
Adult
Amoebiasis:400 to 800 mg 8hourly for 5 to 10days depending up on the severity of infection
In severe infections and liver abscess: 1gm as slow I.V. infusion followed by 0.5 gm twice daily till oral therapy is started
Giardiasis:200mg 8hourly for 1week or 2gm/day for 3days or I.V.500mg thrice daily
Trichomonas vaginitis: 400mg 8 hourly for a week or 2gm once daily for a week.
Male partner should be concurrently treated with the drug
Pseudo membranous enterocolitis:800 mg 8hourly
Anaerobic bacterial infections after surgery, Brain abscess, & Endocarditis:400 to 800 mg 8hourly
In severe cases: 15mg/kg I.V. infusion for 1hour followed by 7.5mg/kg 4 times daily till oral therapy is substituted
Helicobacter pylori infections:400mg 8hourly along with amoxicillin/clarithromycin and a proton pump inhibitor
Ulcerative gingivitis:200 to 800mg 8hourly
Children
Amoebiasis: 30 to 50mg/kg/day for 5to10 days.
Giardiasis:10 to 15mg/kg/day thrice daily
Children (below 12years): 7.5mg/kg I.V.
Schedule of Metronidazole
H
Storage Requirements for Metronidazole
Store in a well closed container in a cool dark place. Keep out of the reach of children.
Effects of Missed Dosage of Metronidazole
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Metronidazole
Treatment is supportive & symptomatic. Drug is removed by induced emesis, gastric lavage, and administration of activated charcoal & use of cathartics. For controlling seizures diazepam & phenytoin may be used.

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