Last update July 24, 2022

Chlorhexidine

Very Low Risk

Safe. Compatible. Minimal risk for breastfeeding and infant.

Iodine-free disinfectant which is widely use for skin, mouth, and, obstetric disinfection. It is preferred over iodine-based disinfectants in order to avoid high iodine exposure to the child in the neonatal and breastfeeding period that would pose a higher risk for thyroid dysfunction.

Since the last update we have not found published data on its excretion in breastmilk.

Because of pharmacokinetic data (high molecular weight, high capacity for serum protein-binding and poor oral or gut absorption) significant excretion into breast milk is unlikely.

Vaginal absorption is minimal (Nilsson 1989). Used for obstetrical purposes (vaginal or C-section wounds) even during birth or in the puerperal period, has failed to cause harm neither to the newborn nor the breastfed child (Pereira 2011) and it is preferable to the application of an iodinated disinfectant that can alter the thyroid function of the infant. (Nili 2015)

The use of chlorhexidine to prevent infection of nipple lesions had no adverse effects in infants. (Herd 1986)

Although use in the nipple does not cause troubles to the breastfed infant (Herd 1986), except one reported case (Quinn 1989), it is not considered to be a justified practice for prevention of mastitis. (Vieira 2103)

Five newborns had oral burns after accidental ingestion of a solution of chlorhexidine and cetrimide. The damage was attributed to the caustic effect of cetrimide. (Mucklow 1988)

Several medical societies and expert authors consider the use of this medication to be safe during breastfeeding (Li 2019). List of Essential Medicines by WHO 2002: compatible with breastfeeding. (WHO 2002)

Alternatives

We do not have alternatives for Chlorhexidine since it is relatively safe.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Chlorhexidine in other languages or writings:

Tradenames

Main tradenames from several countries containing Chlorhexidine in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. < 5 %
Molecular weight 505 daltons
Protein Binding 87 %
Tmax 0.5 hours
4 hours

References

  1. Li JN, Nijhawan RI, Srivastava D. Cutaneous Surgery in Patients Who Are Pregnant or Breastfeeding. Dermatol Clin. 2019 Jul;37(3):307-317. Abstract
  2. AEMPS. Angileptol. Ficha técnica. 2019 Full text (in our servers)
  3. Nili F, Hantoushzadeh S, Alimohamadi A, Shariat M, Rezaeizadeh G. Iodine-containing disinfectants in preparation for caesarean section: impact on thyroid profile in cord blood. Postgrad Med J. 2015 Dec;91(1082):681-4. Abstract
  4. Vieira F, Bachion MM, Mota DD, Munari DB. A systematic review of the interventions for nipple trauma in breastfeeding mothers. J Nurs Scholarsh. 2013 Jun;45(2):116-25. Abstract
  5. Pereira L, Chipato T, Mashu A, Mushangwe V, Rusakaniko S, Bangdiwala SI, Chidede OS, Darmstadt GL, Gwanzura L, Kandawasvika G, Madzime S, Lumbiganon P, Tolosa JE. Randomized study of vaginal and neonatal cleansing with 1% chlorhexidine. Int J Gynaecol Obstet. 2011 Abstract
  6. WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Full text (link to original source) Full text (in our servers)
  7. Arena Ansotegui J, Emparanza Knörr JI, San Millán Vege MJ, Garrido Chércoles A, Eguileor Gurtubai I. [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 Abstract
  8. Nilsson G, Larsson L, Christensen KK, Christensen P, Dykes AK. Chlorhexidine for prevention of neonatal colonization with group B streptococci. V. Chlorhexidine concentrations in blood following vaginal washing during delivery. Eur J Obstet Gynecol Reprod Biol. 1989 Abstract
  9. Quinn MW, Bini RM. Bradycardia associated with chlorhexidine spray. Arch Dis Child. 1989 Abstract Full text (link to original source) Full text (in our servers)
  10. Mucklow ES. Accidental feeding of a dilute antiseptic solution (chlorhexidine 0.05% with cetrimide 1%) to five babies. Hum Toxicol. 1988 Abstract
  11. Herd B, Feeney JG. Two aerosol sprays in nipple trauma. Practitioner. 1986 Abstract

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