Paroex is an oral rinse containing 0.12% Chlorhexidine gluconate (1,1′-hexamethylene bis [5-(p-chlorophenyl) biguanide] di-D-gluconate) in a base containing deionized water, propylene glycol, glycerin, polyoxyl 40 hydrogenated castor oil, mint flavor, potassium acesulfame, FD&C Red #40 and D&C Red #33. Paroex ® is a near-neutral solution (pH range 5-7). Chlorhexidine gluconate is a salt of Chlorhexidine and gluconic acid.
Chlorhexidine – Clinical Pharmacology
Paroex provides antimicrobial activity during oral rinsing. The clinical significance of Chlorhexidine gluconate’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 bacteria resistance, overgrowth of potentially opportunistic organisms or other adverse changes in the oral microbial ecosystem. Three months after Chlorhexidine gluconate 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 studies with 0.12% Chlorhexidine gluconate oral rinse indicates approximately 30% of the active ingredient is retained in the oral cavity following rinsing. This retained drug is slowly released into 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 than 1% of the Chlorhexidine gluconate ingested by these subjects was excreted in the urine.
Indications and Usage for Chlorhexidine
Paroex (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) 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 gingival, including gingival bleeding upon probing. Paroex has not been tested among patients with acute necrotizing ulcerative gingivitis (ANUG.
Paroex should not be used by persons who are known to be hypersensitive to Chlorhexidine gluconate or other formula ingredients.
The effect of Paroex 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. Anaphylaxis, as well as serious allergic reactions, has been reported during post marketing use with dental products containing Chlorhexidine
- For patients having coexisting gingivitis and periodontitis, the presence or absence of gingival inflammation following treatment with Paroex should not be used as a major indicator of underlying periodontitis.
- Paroex 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 Paroex does not adversely affect health of the gingival 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 or margins. If natural stain cannot be removed from these surfaces by a dental prophylaxis, patients should be excluded from Paroex 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.
- Some patients may experience an alteration in taste perception while undergoing treatment with Paroex (Chlorhexidine Gluconate Oral Rinse USP, 0.12%). Rare instances of permanent taste alteration following Chlorhexidine gluconate oral rinse use have been reported via post-marketing product surveillance.
The most common side effects associated with Chlorhexidine gluconate oral rinse 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.
Oral irritation and local allergy-type symptoms have been spontaneously reported as side effects associated with use of Chlorhexidine gluconate rinse. The following oral mucosal side effects were reported during placebo-controlled adult clinical trials: aphthous ulcer, grossly obvious gingivitis, trauma, ulceration, erythema, desquamation, coated tongue, keratinization, geographic tongue, 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.
Ingestion of 1 or 2 ounces of Paroex (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) by a small child (~10 kg body weight) might result in gastric distress, including nausea. Medical attention should be sought if more than 4 ounces of Paroex is ingested by a small child.
Chlorhexidine Dosage and Administration
Paroex (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) therapy should be initiated directly following a dental prophylaxis. Patients using Paroex should be reevaluated and given a thorough prophylaxis at intervals no longer than six months. Recommended use is twice daily, oral rinsing for 30 seconds, morning and evening after tooth brushing. Usual dosage is 15 mL (½ FL OZ) of undiluted Paroex. Patients should be instructed not to rinse with water, or other mouthwashes, brush teeth, or eat immediately after using Paroex. Paroex is not intended for ingestion and should be expectorated after rinsing.