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Chlorhexidine

Also indexed as: Peridex®, Periochip®, Periogard Oral Rinse®

Combination drug: Nystaform-HC®

Chlorhexidine is used to prevent and treat the redness, swelling, and bleeding gums associated with gingivitis. It is classified as an antimicrobial drug.

Safetychecker Summary for Chlorhexidine
(for details about the summarized interactions, read the full article)

Beneficial May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Vitamin K*
Beneficial May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Bifidobacterium longum*

Lactobacillus acidophilus*

Lactobacillus casei*

Saccharomyces boulardii*

Saccharomyces cerevisiae*

Vitamin K*
Beneficial May be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.

Saccharomyces boulardii*
Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Iron
Check Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.

Zinc
Reduced drug absorption/bioavailability

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Iron
Tooth staining is a common side effect of using chlorhexidine. One controlled study showed that people who took iron immediately after using chlorhexidine developed severe staining within two weeks.1 Therefore, individuals using chlorhexidine might prevent this side effect by taking iron supplements an hour before or two hours after using the drug.

Probiotics
A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.2

The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii3 or Saccharomyces cerevisiae (baker’s or brewer’s yeast)4 —helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.5 Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.6

Vitamin K
Several cases of excessive bleeding have been reported in people who take antibiotics.7 8 9 10 This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.11 Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

Zinc
Using a zinc solution at the same time as chlorhexidine may increase the anti-plaque activity of the drug12 and may reduce the possibility of staining.13 Whether taking a zinc supplement at the same time as chlorhexidine produces the same beneficial effects is unknown.

Interaction with Foods and Other Compounds

Coffee and Tea
Controlled studies show that drinking coffee and tea enhances the tooth-staining effect of chlorhexidine.14 People using chlorhexidine may prevent tooth staining if they consume coffee and tea an hour before or after using the drug, or if they avoid these beverages altogether.

References:

1. Warner RR, Myers MC, Burns J, Mitra S. Analytical electron microscopy of chlorhexidine-induced tooth stain in humans: direct evidence for metal-induced stain. J Periodontal Res 1993;28:255–65.

2. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

3. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

4. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer’s yeast. Lancet 1994;343:171–2.

5. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981–8.

6. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

7. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292–4.

8. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706–7.

9. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610–2.

10. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524–5.

11. Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531–9.

12. Waler SM, Rolla G. Plaque inhibiting effect of combinations of chlorhexidine and the metal ions zinc and tin. A preliminary report. Acta Odontol Scand 1980;38:213–7.

13. Sanz M, Vallcorba N, Fabregues S, et al. The effect of a dentifrice containing chlorhexidine and zinc on plaque, gingivitis, calculus and tooth staining. J Clin Peridontol 1994;21:431–7.

14. Leard A, Addy M. The propensity of different brands of tea and coffee to cause staining associated with chlorhexidine. J Clin Periodontol 1997;24:115–8.