Usage
Benzydamine + Chlorhexidine Gluconate is prescribed for the symptomatic relief of painful inflammatory conditions of the mouth and throat, such as gingivitis, stomatitis, pharyngitis, tonsillitis, aphthous ulcers (mouth ulcers), and oral mucositis (especially after radiotherapy or chemotherapy). It also aids in mouth and throat antisepsis and can be used before and after dental procedures.
Pharmacological Classification:
- Benzydamine: Non-steroidal anti-inflammatory drug (NSAID), Analgesic, Local anesthetic
- Chlorhexidine Gluconate: Antiseptic, Disinfectant
Mechanism of Action:
Benzydamine acts as an NSAID by stabilizing cell membranes and inhibiting prostaglandin synthesis, thereby reducing inflammation and pain. It also provides local anesthetic action. Chlorhexidine gluconate exerts its antiseptic effect by disrupting bacterial cell membranes and inhibiting bacterial growth.
Alternate Names
There are no widely recognized alternate names for the combination product itself. However, the individual components have other names:
- Benzydamine Hydrochloride
- Chlorhexidine digluconate
Brand Names:
Several brand names exist for products containing this combination, including Difflam-C, Andolex-C, Orofit, Oryza-C, Bensodyl, and Kloroben.
How It Works
Pharmacodynamics:
Benzydamine’s anti-inflammatory and analgesic effects stem from its action on cell membranes and prostaglandin synthesis. Its local anesthetic effect provides further pain relief. Chlorhexidine gluconate’s antiseptic action comes from disrupting bacterial cell membranes, preventing their growth and spread.
Pharmacokinetics:
- Absorption: Benzydamine is well-absorbed from the oral mucosa. Chlorhexidine gluconate has limited systemic absorption.
- Metabolism: Benzydamine is primarily metabolized in the liver. Chlorhexidine is minimally metabolized.
- Elimination: Benzydamine and its metabolites are excreted mainly in the urine. Chlorhexidine is excreted primarily in feces with a small portion in urine.
Mode of Action:
Benzydamine interacts with cell membranes, reduces prostaglandin production, and provides local anesthetic action. Chlorhexidine gluconate binds to bacterial cell walls and disrupts their integrity.
Receptor binding, enzyme inhibition, or neurotransmitter modulation: Benzydamine stabilizes cell membranes and inhibits prostaglandin synthesis. Chlorhexidine directly affects bacterial membranes without involving specific receptors or enzymes.
Elimination pathways: Benzydamine undergoes hepatic metabolism and renal excretion. Chlorhexidine primarily undergoes fecal excretion.
Dosage
Standard Dosage
Adults:
15 ml of solution as a gargle or rinse every 1.5 to 3 hours. Alternatively, 4-8 sprays (0.15% solution) or 2-4 sprays (0.3% solution) every 1.5-3 hours, directed at the affected area.
Children:
Children over 12 years of age: Same as adult dose.
Children under 12 years: Not recommended due to limited clinical data.
Special Cases:
- Elderly Patients: No dose adjustment typically required.
- Patients with Renal Impairment: Caution advised; consider systemic effects due to potential accumulation of benzydamine and metabolites.
- Patients with Hepatic Dysfunction: Caution advised; consider systemic effects due to benzydamine’s hepatic metabolism.
- Patients with Comorbid Conditions: Assess individual cases, particularly in patients with hypersensitivity reactions, asthma, or fructose intolerance.
Clinical Use Cases Dosage for specific medical settings aligns with standard adult or pediatric recommendations, as there are no specific guidelines for intubation, surgical procedures, mechanical ventilation, or ICU use. In emergency situations, the drug’s use is not typically indicated.
Dosage Adjustments
Adjustments are necessary for patients with renal or hepatic impairment. Close monitoring is recommended. Consider other factors such as concurrent medications and individual patient response.
Side Effects
Common Side Effects
Oral numbness, altered taste perception, dry mouth, staining of teeth and tongue (mostly with chlorhexidine), burning or stinging sensation in the mouth.
Rare but Serious Side Effects
Allergic reactions (rash, itching, swelling), hypersensitivity (including anaphylactic shock), dizziness, headache.
Long-Term Effects
Chronic complications from prolonged use are rare, but may include increased calculus formation and persistent taste alteration with chlorhexidine.
Adverse Drug Reactions (ADR)
Severe allergic reactions, angioedema, hypotension, unconsciousness.
Contraindications
Hypersensitivity to benzydamine or chlorhexidine, pregnancy, breastfeeding. Use cautiously in patients with a history of asthma or allergies to NSAIDs.
Drug Interactions
Few drug interactions have been reported. Chlorhexidine is incompatible with anionic compounds like soap. It is compatible with cationic and non-ionic surfactants, but high concentrations of these can reduce chlorhexidine’s activity. The effect of anionic substances like sodium lauryl sulfate in toothpaste can interact with the cationic chlorhexidine, making brushing before use to reduce staining possibly counterproductive. Therefore, rinse thoroughly with water after toothbrushing prior to use.
Pregnancy and Breastfeeding
Contraindicated in pregnancy and breastfeeding due to potential fetal risks and lack of data on breast milk excretion.
Drug Profile Summary
- Mechanism of Action: Benzydamine: NSAID, analgesic, local anesthetic. Chlorhexidine: antiseptic.
- Side Effects: Oral numbness, taste alteration, staining, burning/stinging sensation. Rarely: allergic reactions.
- Contraindications: Hypersensitivity, pregnancy, breastfeeding.
- Drug Interactions: Limited. Incompatibility of Chlorhexidine with anionic substances.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults/Children >12 years: 15ml rinse/gargle every 1.5-3 hours, or 4-8 sprays (0.15%)/ 2-4 sprays (0.3%) every 1.5-3 hours.
- Monitoring Parameters: Observe for local side effects and allergic reactions.
Popular Combinations
This combination itself is commonly used. There are no other established popular drug combinations with this specific mix.
Precautions
- General Precautions: Screen for allergies. Use cautiously in patients with asthma or a history of allergic reactions to NSAIDs.
- Specific Populations: Avoid use during pregnancy and breastfeeding. Not recommended for children under 12.
- Lifestyle Considerations: Limit consumption of staining agents like tea, coffee, and red wine during treatment with chlorhexidine. Brush teeth before use. Driving or operating machinery is generally not affected.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Benzydamine + Chlorhexidine Gluconate?
A: Adults and children over 12 years: 15 ml gargle/rinse every 1.5-3 hours, or as a spray (dosage varies by concentration) every 1.5-3 hours, as directed. Not recommended for children under 12 years.
Q2: What are the primary uses of this medication?
A: It is primarily used to relieve pain and inflammation in the mouth and throat due to various conditions like sore throat, mouth ulcers, gingivitis, and oral mucositis. It also acts as an antiseptic.
Q3: What are the common side effects?
A: Common side effects include oral numbness, altered taste, dry mouth, tooth and tongue staining (mainly from chlorhexidine), and a burning or stinging sensation.
Q4: Can I use this medication if I’m pregnant or breastfeeding?
A: No, it’s contraindicated during pregnancy and breastfeeding.
Q5: Are there any drug interactions I should be aware of?
A: Limited drug interactions are known. Chlorhexidine can be incompatible with anionic substances like soap. Concurrent use with some other mouthwashes is not recommended. Brush teeth before use and avoid toothpaste with sodium lauryl sulfate.
Q6: How long can I use this medication continuously?
A: Generally, it should not be used continuously for more than 7 days unless advised by a physician.
Q7: What should I do if I experience any allergic reactions?
A: Discontinue use immediately and seek medical attention.
Q8: Can I swallow this medication?
A: No, it’s intended for gargling or rinsing and should be expectorated afterward. The spray should be applied locally and swallowed gently, as directed.
Q9: Can this medication be used in children?
A: It’s not recommended for children under 12 years of age due to insufficient clinical data.
Q10: Will it affect my ability to drive or operate machinery?
A: Generally, it does not affect the ability to drive or operate machinery. However, if dizziness or drowsiness occur, caution should be exercised.
