Is Chlorhexidine compatible with breastfeeding? Do we have alternatives for Chlorhexidine?

Chlorhexidine

July 2, 2015 (Very Low Risk)

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.

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.

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.

Although use in the nipple may not cause troubles to the breastfed infant (except one reported case in 1989) it is not considered to be a justified practice for prevention of mastitis. Any way, it is preferred to avoid use on the nipple, at least on a long-term basis. If used, wash the nipple thoroughly before nursing.

List of Essential Medicines by WHO 2002: compatible with breastfeeding.

Alternatives

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

Very Low Risk

Compatible. Not risky for breastfeeding or infant.

Low Risk

Moderately safe. Mild risk possible. Follow up recommended. Read the Comment.

High Risk

Poorly safe. Evaluate carefully. Use a safer alternative. Read the Comment.

Very High Risk

Not recommended. Cessation of breastfeeding or alternative.

Writings

  • كلورهيكسيدين (Arabic)
  • Хлоргексидин (Cyrillic)
  • 氯己定 (Chinese)
  • クロルヘキシジン (Japanese)

References

  1. Vieira F, Bachion MM, Mota DD, Munari DB. A systematic review of the interventions for nipple trauma in breastfeeding mothers. J Nurs Scholarsh. 2013Abstract
  2. 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. 2011Abstract
  3. Hirata K, Kurokawa A. Chlorhexidine gluconate ingestion resulting in fatal respiratory distress syndrome. Vet Hum Toxicol. 2002Abstract
  4. 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)
  5. 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. 1989Abstract
  6. Quinn MW, Bini RM. Bradycardia associated with chlorhexidine spray. Arch Dis Child. 1989Abstract Full text (link to original source) Full text (in our servers)
  7. 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. 1989Abstract
  8. Mucklow ES. Accidental feeding of a dilute antiseptic solution (chlorhexidine 0.05% with cetrimide 1%) to five babies. Hum Toxicol. 1988Abstract
  9. Herd B, Feeney JG. Two aerosol sprays in nipple trauma. Practitioner. 1986Abstract