Latin name
Release form
Lozenges
1 tablet contains:
Active ingredients: chlorhexidine dihydrochloride - 5 mg, benzocaine - 1.5 mg.
Excipients: isomalt, peppermint oil, menthol, thymol, aspartame, purified water.
Packaging
pharmachologic effect
Hexoral is an antiseptic.
The antimicrobial effect of the drug Hexoral® is associated with the suppression of oxidative reactions of bacterial metabolism (thiamine antagonist). The drug has a wide spectrum of antibacterial and antifungal action, in particular against gram-positive bacteria and fungi of the genus Candida, however, Hexoral® can also have an effect in the treatment of infections caused, for example, by Pseudomonas aeruginosa or Proteus. At a concentration of 100 mg / ml, the drug inhibits most bacterial strains. Resilience development was not observed. Hexetidine has a weak anesthetic effect on the mucous membrane.
Indications
- Inflammatory and infectious diseases of the oral cavity and pharynx.
- In the complex treatment of severe febrile or purulent diseases of the oral cavity and pharynx, requiring the appointment of antibiotics and sulfonamides, tonsillitis.
- Sore throats (including sore throats with damage to the lateral ridges, Plaut-Vincent sore throats).
- Pharyngitis.
- Gingivitis and bleeding gums.
- Periodontopathy (periodontal diseases and their symptoms).
- Stomatitis (inflammation of the oral mucosa), glossitis (inflammation of the tongue), aphthous ulcers (painful inflammation with superficial tissue defects) in order to prevent superinfections.
- Infection of the alveoli (tooth sockets) after tooth extraction.
- Fungal infections of the oral cavity and pharynx, especially candidal stomatitis (thrush).
- Before and after operations in the oral cavity and pharynx.
- Additional oral hygiene for common diseases.
- Elimination of bad breath, especially in the case of decaying tumors of the oral cavity and pharynx.
- An adjuvant in the treatment of colds.
Contraindications
Children under 3 years old; hypersensitivity to drug components.
Application during pregnancy and lactation
Pregnant and lactating women should consult a doctor before using the drug.
Method of administration and dosage
Apply topically. The tablet should be slowly dissolved in the mouth until it is completely dissolved.
The drug should be started as soon as the first symptoms of the disease appear and continued for several days after the symptoms disappear.
Adults and children over 12 years old: as a rule, 1 tab is prescribed. every 1-2 hours as needed, but not more than 8 tablets / day.
Children aged 4-12 years: appoint up to 4 tablets / day.
Use in children is possible only as directed by a doctor.
Do not use the drug in children under 4 years of age.
Side effects
Local reactions: with prolonged use, a short-term violation of taste and numbness of the tongue is possible; reversible discoloration of teeth and tongue is also possible.
Allergic reactions: in the presence of hypersensitivity to benzocaine, in rare cases, the development of hypersensitivity reactions up to anaphylactic shock is possible.
Others: benzocaine can cause methemoglobinemia in children.
special instructions
Information for people with diabetes
If it is necessary to use the drug in patients with diabetes mellitus, it should be borne in mind that the carbohydrate content in 1 tablet corresponds to 0.1 XE.
Disposal rules of the drug
The patient should be informed that if the medicinal product has become unusable or the expiration date has expired, then it should not be thrown into the wastewater or outside. Place the medicine in a bag and put it in the trash can. These measures will help protect the environment.
Drug interactions
Benzocaine, due to the formation of a metabolite of 4-aminobenzoic acid, reduces the antibacterial activity of sulfonamides and aminosalicylates.
Sucrose, polysorbate 80, insoluble salts of magnesium, zinc and calcium reduce the effect of chlorhexidine.
Overdose
When used correctly, an overdose of the drug is impossible, because chlorhexidine is practically not absorbed into the bloodstream, and the amount of absorbed benzocaine is extremely small.
Chlorhexidine
Chlorhexidine hydrochloride is poorly soluble in water, all cases of overdose are described only when taking chlorhexidine gluconate, which is highly soluble in water.
Symptoms: damage to the mucous membrane during direct contact with chlorhexidine gluconate, as well as a systematic reversible increase in the concentration of hepatic enzyme.
Treatment: no specific treatment.
Benzocaine
Overdose is possible only if used incorrectly.
Symptoms: a toxic effect on the central nervous system is possible, manifested at first by tremors, vomiting, convulsions, and later - by depression of the central nervous system. Coma is possible due to respiratory depression. High toxic concentrations cause bradycardia, AV block and cardiac arrest. Benzocaine can cause methemoglobinemia (especially in children), accompanied by suffocation and cyanosis.
Treatment: induce vomiting and flush the stomach. Perhaps the appointment of activated carbon. In case of hypoxia and anoxia, artificial respiration with oxygen support is recommended, in case of cardiac arrest - cardiac massage. For seizures, diazepam or fast-acting barbiturates are prescribed (contraindicated in anoxic seizures); in especially severe cases, after intubation and artificial respiration, suxamethonium chloride is used. Blood circulation is supported by the introduction of blood plasma or electrolyte solutions. With methemoglobinemia, up to 50 ml of a 1% solution of methylene blue IV can be used.
Storage conditions
Keep out of the reach of children at a temperature not exceeding 25 ° C.
Result: positive feedback
Great for sore throat
Advantages: efficiency, good taste, low price
Disadvantages: did not notice
My throat often fails me, it becomes inflamed even from a slight breeze. In summer, in windy weather, you have to wear a thin scarf. And about ice cream and cold water, I already forgot to think. I tried many remedies for treatment and opted for Hexoral. It quickly relieves pain and inflammation in the throat, has a pleasant taste and does not burn the tongue when absorbed. Convenient packaging, four tablets each, fits in my purse, which allows you to keep it with you at all times. Up to 8 tablets can be consumed per day.
Result: positive feedback
hexoral tabs
Benefits: Inexpensive drug, rapid relief of sore throat
Disadvantages: high consumption of the number of tablets
Recently I had a sore throat, I turned to a therapist, she prescribed Hexoral Tabs for me. As it turned out, these are tablets for resorption, in a package there are 2 blisters of 10 tablets. I took them for the first time, before that I used Hexoral spray, it was fine with me. The sore throat subsided by the evening: I took it according to the instructions every 2 hours, in the end I got 8 tablets a day. As a result, the sore throat disappeared in three days, for prevention I drank another 2 days. It has its own advantages: it is an inexpensive (140 rubles) and effective drug. Unlike other drugs, it relieves the throat very quickly, it turned out to be non-allergic for me. I didn’t like too frequent (every 2 hours) consumption, we must constantly keep it under control, do not forget. In general, I rate Geksoral tabs positively. I recommend.
Result: positive feedback
Throat ambulance
Advantages: Affordable price, efficiency, good taste
Disadvantages: Not suitable for small children
These lozenges have a double effect: they are both antimicrobial and pain relieving. That is, for various inflammatory diseases of the pharynx, this is exactly what you need. And in dentistry, Hexoral tabs is used. There are several types of these pills, I usually buy the ones with peppermint oil. It tastes very good. The tablets are large, but dissolve rather quickly. After the first one, relief is felt. I often have sore throats, so Geksoral tabs is always in the first-aid kit. You dissolve the pill, and it immediately becomes easier to swallow, and the throat hardly hurts. And I gave these pills to my six-year-old son for stomatitis. The first time my caprice liked the medicine.
Result: neutral feedback
For a sore throat, pills are not so good what an assistant
Benefits: Taste
Disadvantages: weak effect, must be taken in combination for effect
In general, I don't really trust pills in the form of suckers. So, pampering is everything. My throat is a weak point of the body: as soon as I catch a cold, it starts to tickle and hurt. Even after the slightest draft, it turns red, in general, the infection makes itself felt. I am too lazy to get to the doctor and I have no time, and I go with a red, sore throat. When this state bothers me, I buy some suckers and sprinklers at the pharmacy. Usually I take vigorous throat sprays, this time I bought hexoral spray on the recommendation of the pharmacist, the effect was arranged - relief came, so I took the hexoral tablets to work. However, the effect of the tablets is exactly 20-30 minutes, so I combine them with a spray to have a positive result. In general, of course, you need to get to the doctor.
Result: positive feedback
Help if you start taking it on time
Benefits: inexpensive, good taste
Disadvantages: weak
Usually, at the first sign of a sore throat, I used Hexoral in the form of a spray or solution. But the last time, in order to save money, I decided to try lollipops. The annotation to the preparation indicates that there is no sugar in the composition. I took 5 tablets a day. Naturally, one package of the drug was not enough for me for the course, and therefore there was no saving. I bought lollipops with currant flavor, and they also come in orange, honey-lemon and lemon. But the effect of the drug is weak, it helps to numb the throat, but quite a bit. For five days with Geksoral Tabs, the pain in the throat did not go away, but only slightly weakened.
Hexoral Tabs tablets - a well-proven medicine for the throat, and according to Hexoral Tabs instructions for use, the drug is recommended for the treatment of tonsillitis, pharyngitis and other diseases of the upper respiratory tract.
Composition and types of tablets
Hexoral Tabs
The activity of this drug is determined by:
- Timol;
- Chlorhexidine;
- Benzocaine.
Substances thymol and chlorhexidine have an antiseptic effect. Benzocaine anesthetizes the mucous membrane, relieves sore throat.
The tablets additionally include:
- Flavoring additive;
- Menthol;
- Peppermint oil;
- Sweetener;
- Water.
The drug has a menthol-mint flavor.
Hexoral Tabs Classic
According to the instructions for the Classic, the activity of the drug is determined by:
- Dichlorobenzyl alcohol;
- Amylmetacresol.
The following substances have a complex effect:
- Anti-inflammatory (moderate);
- Antiseptic (expressed);
- Anesthetic (mild).
The Classic tablets additionally include:
- Peppermint oil;
- Sweeteners,
- Food colorings;
- Lemon acid.
The classic is presented in four flavors created by flavors and oils:
- Lemon flavor (anise oil, lemon oil concentrate);
- Orange flavor (anise and orange oils);
- Blackcurrant flavor (achieved with blackcurrant flavor);
- Honey-lemon flavor (honey flavor, lemon oil).
Hexoral Tabs Extra
Has a composition similar to the Classic version.
In addition to the antiseptic effect, Extra tablets have a pronounced anesthetic effect due to the lidocaine contained in the composition.
For Extra, flavors similar to Classic are available.
Indications for the use of tablets
Sore throat
Lozenges are indicated for pain that accompany infectious sore throats (laryngitis, tonsillitis, pharyngitis).
Lidocaine (Tabs Extra) and Benzocaine (Tabs) work almost instantly. A tangible anesthetic effect lasts for 5-10 minutes. It gradually decreases and disappears after 15-20 minutes.
Peppermint oil and menthol included in the preparation have a prolonged, but lighter analgesic effect.
The systematic use significantly reduces pain throughout the day.
Angina
Pills Hexoral - an effective adjuvant in the treatment of angina.
Amylmetacresol, dichlorobenzyl alcohol and chlorhexidine are highly active against the bacteria that cause tonsillitis. Resistance of bacteria to the drug is practically not formed.
Pharyngitis
Hexoral Tabs eliminates throat irritation - the most common symptom in strep throat. Chlorhexidine throat tablets are effective for bacterial sore throats.
It should be remembered that acute pharyngitis is often of a viral nature, with activity against certain types of viruses (coronavirus, influenza, respiratory syncytial) characterized by a complex of dichlorobenzyl alcohol + amylmetacresol.
The substances included in it destroy viruses without interfering with their reproduction, therefore it is necessary to start taking the drug at the first appearance of a sore throat.
Dental diseases
Hexoral Tabs helps with inflammation of the gums and oral mucosa (gingivitis, stomatitis, periodontal disease) of a bacterial nature. The instructions for the use of tablets for resorption contain instructions that in the presence of ulcers or wounds in the mouth, it is contraindicated to use the drug.
Contraindications of the drug
All Hexoral Tabs lozenges have the following contraindications:
- The patient's age is up to 4, 6 or 12 years (respectively Tabs, Classic or Extra);
- Sensitivity to the components of the drug (including fructose intolerance).
Additional contraindications:
- Sores or sores in the throat or mouth;
- Cholinesterase enzyme deficiency;
- Phenylketonuria.
Side effects from pills
For all Hexoral lozenges:
- Temporary discoloration of teeth and oral mucosa;
- Allergic reactions in the form of edema, mucosal irritation, anaphylactic reactions.
For tablets that contain an anesthetic component (Extra, Tabs):
- Decreased sensitivity of the oral mucosa;
- Numbness of the tongue;
- Change in taste.
The instructions for use contain instructions that an additional side effect is due to exposure to benzocaine, which can sometimes reduce the blood's ability to carry oxygen. This is due to an increase in the content of methemoglobin in the blood.
Interaction with other drugs
Hexoral Tabs may reduce the antibacterial activity of sulfonamides and aminosalicylates. This is due to the synthesis of the aminobenzoic acid metabolite.
The effect of chlorhexidine is markedly reduced with the simultaneous use of polysorbate 80, sucrose, insoluble salts of zinc, calcium and magnesium.
Instructions for using the drug
For adults
The instruction offers identical instructions for the use of the drug for all patients over 12 years old:
- It is recommended to switch to taking the tablets immediately after the appearance of perspiration.
- The time interval between doses should be two hours.
- The maximum allowed to take no more than 8 lozenges per day.
- It must be taken by slow absorption.
- It is recommended not to consume food and drinks for an hour after ingestion.
As in the case of other drugs, it is recommended to follow the instructions exactly: for example, it is forbidden to exceed the given daily dosage, and it is also recommended to take the tablets at least 2 hours later (compliance with this regimen increases the efficiency of eliminating microbes). In the absence of the possibility of timely administration of Hexoral Tabs, it is allowed to take the pill in advance.
Important! If the patient missed the appointment, then the next time he will still need to take 1 pill, it is forbidden to increase the dosage.
According to the instructions for use, the drug should be taken for another two days after the symptom elimination effect is achieved.
Hexoral Tabs for children
Nominally, the manufacturer offers the following age restrictions:
- Hexoral Tubs - 4 years;
- Classic - 6 years old;
- Extra - 12 years old.
The maximum dosage of Tabs for children aged 4 to 12 years is usually 4 tablets per day. Alternatively, you can divide the tablet into two and give one half every 2 hours.
According to the instructions for the options Classic and Extra, the dosage for children is identical to the rules for adults.
As for adults, children are also prohibited from drinking, eating and drinking for at least one hour after the tablet has been absorbed.
The instructions for the drug contain information about the possible appearance of a side effect in the form of a deterioration in the oxygen transport function, so the drug should be taken exclusively under the supervision of adults.
Pregnancy and breastfeeding
For obvious reasons, studies on humans have not been carried out, however, as a result of tests carried out on animals, no negative effects of the components of Hexoral Tabs on fetal development were noted.
It is generally known that pain relievers such as lidocaine and benzocaine are quickly absorbed by the mucous membrane and are found in the blood and liver. Directly these substances and decay products are able to pass through the placenta to the fetus, and they also penetrate into milk during lactation.
According to the instructions for Hexoral Tabs, the manufacturer allows limited use of the drug for expectant mothers and women during lactation, however, due to the presence of substitutes that do not contain anesthetic components, the use of Hexoral Tabs is inappropriate.
Video
Hexoral in other forms of release
In addition to Hexoral Tabs, the manufacturer also offers the drug in the form of a solution and aerosol:
- Spray Hexoral... According to the instructions for use, the use of an aerosol has indications that are identical to tablets. Method of application - spraying spray for two seconds on the affected areas. Usually, the aerosol is taken twice a day (morning and evening after meals). In the case of more severe pathologies, more frequent use of the spray is recommended.
- 0.1% solution Hexoral... The composition of Hexoral in this form of release includes hexetidine as the main component, as well as clove oil, ethanol, oils (eucalyptus and anise), methyl salicylate, citric acid monohydrate, levomenthol, polysorbate 60, azorubin, peppermint oil, sodium saccharin and purified water in as auxiliary elements. The method of using the drug in this form is to rinse the mouth and throat.
Analogs of tablets
There are no direct analogues of the drug, however, there are drugs that partially replace Hexoral Tabs. So, for example, there is a drug Stopangin 2A, where the substance tyrothricin is used as an antiseptic.
The classic, on the other hand, is distinguished by a large number of substitutes, such as: Suprima Lor, Astrasept, Ajisept, Rinza Lorsept, Gorpils, Terasil .
By analogy with Hexoral Tabs Classic, these drugs include a complex of amylmetacresol and dichlorobenzyl alcohol. The form of release is tablets and lozenges.
The Extra option has an analogue - Rinza Lorsept Anesthetics. The composition of both drugs contains a common complex: lidocaine + dichlorobenzyl alcohol + amylmetacresol.
Also, Hexoral Extra can be partially replaced by the German drug Neo-Angin. These tablets differ from Extra by the use of levomenthol instead of the stronger lidocaine. Neo-Angina has 30% less cost than the Extra option.
Active ingredients
Benzocaine
- chlorhexidine dihydrochloride (chlorhexidine)
Release form, composition and packaging
◊ Lozenges round, biconvex, opaque, with a rough surface from white or yellowish white to light gray or yellowish gray; uneven coloring, the presence of air bubbles and slight unevenness of the edges are allowed; the appearance of a white bloom (dusting) is possible.
Excipients: isomalt, peppermint oil, menthol, thymol, aspartame, purified water.
10 pieces. - blisters (2) - cardboard packs.
pharmachologic effect
Combined preparation for topical use. The double effect of the drug is due to the presence of 2 active ingredients. The antibacterial activity of the drug is due to the presence of chlorhexidine. The local anesthetic benzocaine works to reduce pain symptoms.
Chlorhexidinehas a wide spectrum of antibacterial action against gram-positive and gram-negative bacteria; acts by destroying the cytoplasmic membrane of a bacterial cell. Ineffective against yeast fungi, dermatophytes, mycobacteria, some species of Pseudomonas and Proteus.
Chlorhexidine is most effective in a neutral or slightly alkaline environment. In an acidic environment, its activity decreases. Efficacy is reduced in the presence of soaps, blood and purulent discharge.
The use of lozenges leads to a significant reduction in the bacterial content of saliva. The use of chlorhexidine for several months is accompanied by a decrease in its effectiveness by reducing the sensitivity of bacteria.
Benzocaine- a local anesthetic that quickly and permanently relieves pain in the mouth and throat. Benzocaine penetrates the lipophilic areas of the cell membrane and acts on the peripheral pain receptors of the mucous membrane and skin. The anesthetic effect of benzocaine occurs in 15-30 seconds; as the substance is diluted with saliva, the anesthetic effect gradually decreases (within 5-10 minutes).
Pharmacokinetics
Chlorhexidine
There is no clinical data on the absorption of chlorhexidine through the oral mucosa of humans. Chlorhexidine can persist in saliva for up to 8 hours.
Benzocaine
Benzocaine is slightly soluble in water, which leads to its slow absorption. Like all ether derivatives of PABA, it is cleaved by esterase in the blood and liver. As a result, PABA and ethanol are formed, which is metabolized to acetyl coenzyme A. PABA is conjugated with glycine or excreted unchanged by the kidneys.
Indications
Infectious and inflammatory diseases of the pharynx or oral cavity:
- pharyngitis, tonsillitis and other inflammatory diseases of the pharynx;
- stomatitis;
- gingivitis.
Contraindications
- wound and ulcerative lesions of the oral cavity or pharynx;
- low concentration of cholinesterase in blood plasma;
- phenylketonuria;
- children under 4 years old;
- hypersensitivity to drug components.
Carefully and only under the supervision of a physician should the drug be used for erosive, desquamative changes in the oral mucosa.
Dosage
Apply topically. The tablet should be slowly dissolved in the mouth until it is completely dissolved.
The drug should be started as soon as the first symptoms of the disease appear and continued for several days after the symptoms disappear.
Adults and children over 12 years old appoint 1 tab. every 1-2 hours as needed, but not more than 8 tablets / day.
Children aged 4-12 appoint up to 4 tablets / day.
Use in children is possible only as directed by a doctor.
Do not use the drug in children under 4 years old.
Side effects
Adverse reactions identified with post-marketing use of the drug were classified as follows: very often (≥10%), often (≥1%, but<10%), нечасто (≥0.1%, но <1%), редко (≥0.01%, но <0.1%), очень редко (<0.01%), частота неизвестна (частота возникновения не может быть оценена на основании имеющихся данных).
The following adverse reactions were classified according to clinical or epidemiological studies, or when the number of cases is unknown or information about an adverse reaction was identified in the analysis of literature data, the frequency is not known.
Based on spontaneous reports of adverse reactions *
From the digestive tract:frequency unknown - decreased sensitivity of the oral mucosa, temporary numbness of the tongue, impaired taste (dysgeusia), discoloration of teeth, discoloration of the tongue (reversible), discoloration of silicate and composite materials of tooth restoration, plaque formation (), stomatitis, mucosal exfoliation oral cavity membranes, glossodynia, enlargement of the parotid salivary glands.
Allergic reactions: the frequency is unknown - hypersensitivity reactions (including urticaria, angioedema, anaphylactic reactions, anaphylactic shock).
On the part of the blood and lymphatic system: frequency unknown - methemoglobinemia.
* According to literature data.
If any of the side effects indicated in the instructions are aggravated or any other side effects not indicated in the instructions are noted, the patient should inform the doctor about it.
Overdose
When used correctly, an overdose of the drug is impossible, because chlorhexidine is practically not absorbed into the bloodstream, and the amount of absorbed benzocaine is extremely small.
Chlorhexidine
Chlorhexidine hydrochloride is poorly soluble in water, all cases of overdose are described only when taking chlorhexidine gluconate, which is highly soluble in water.
Symptoms: damage to the mucous membrane during direct contact with chlorhexidine gluconate, as well as a systematic reversible increase in the concentration of hepatic enzyme.
Treatment:there is no specific treatment.
Benzocaine
Overdose is possible only if used incorrectly.
Symptoms:a toxic effect on the central nervous system is possible, manifested at first by tremors, vomiting, convulsions, and later - by depression of the central nervous system. Coma is possible due to respiratory depression. High toxic concentrations cause bradycardia, AV block and cardiac arrest. Benzocaine can cause methemoglobinemia (especially in children), accompanied by suffocation and cyanosis.
Treatment:induce vomiting and flush the stomach. Perhaps the appointment of activated carbon. In case of hypoxia and anoxia, artificial respiration with oxygen support is recommended, in case of cardiac arrest - cardiac massage. For seizures, either fast-acting barbiturates are prescribed (contraindicated for anoxic seizures); in especially severe cases, after intubation and artificial respiration, suxamethonium chloride is used. Blood circulation is supported by the introduction of blood plasma or electrolyte solutions. With methemoglobinemia, up to 50 ml of a 1% solution of methylene blue IV can be used.
Drug interactions
Benzocaine, due to the formation of a metabolite of 4-aminobenzoic acid, reduces the antibacterial activity of sulfonamides and aminosalicylates.
Sucrose, polysorbate 80, insoluble salts of magnesium, zinc and calcium reduce the effect of chlorhexidine.
special instructions
Benzocaine can cause methemoglobinemia. This condition is manifested by symptoms such as discoloration of the skin, lips and nail beds to gray or blue or paleness, headache, light-headedness, shortness of breath, fatigue and tachycardia. The appearance of the listed symptoms indicates the presence of moderate to high methemoglobin and a significant decrease in the oxygen transport function of the blood. Children and elderly patients may be at higher risk of developing methemoglobinemia.
In children, the drug should be used under adult supervision.
The drug contains aspartame, which is a phenylalanine derivative, which is dangerous for patients with phenylketonuria.
Information for patients with diabetes mellitus: the carbohydrate content in 1 tablet corresponds to 0.1 XE.
The use of the drug is contraindicated in the presence of wound and ulcerative lesions of the mouth and throat.
Caution should be exercised when using the drug in young children and in persons with aspiration or swallowing disorders due to the risk of suffocation.
If a medicinal product has become unusable or has expired, it should not be thrown into wastewater or outside. It is necessary to put the drug in a bag and put it in the trash can. These measures will help protect the environment.
Influence on the ability to drive vehicles and use mechanisms
Gekoral tabs does not affect the ability to drive vehicles and engage in other potentially hazardous activities.
Pregnancy and lactation
There is a lack of experience with the use of the drug Tabs in pregnant and lactating women.
The use of the drug Hexoral Tabs during pregnancy and lactation is possible only in cases where the expected benefit of therapy for the mother outweighs the potential risk to the fetus and child.
Pediatric use
Use in children under 4 years of age is contraindicated.
Use in children over 4 years old is possible only as directed by a doctor.
Use in the elderly
Elderly patients may be at a higher risk of developing methemoglobinemia with the use of the drug.
Terms of dispensing from pharmacies
The drug is dispensed without a prescription.
Storage conditions and periods
The drug should be stored out of the reach of children at a temperature not exceeding 25 ° C. The shelf life is 3 years. Do not use after the expiration date printed on the package.
Hexoral Tabs (chlorhexidine + benzocaine) is a combined antiseptic with antibacterial and local analgesic effects and is used in otolaryngological and dental practice for the treatment of infectious and inflammatory diseases of the oropharynx. The double therapeutic effect of the drug is associated with the presence of two pharmacologically active substances in its composition: the antimicrobial activity is due to the presence of chlorhexidine in the combination, and the analgesic effect is provided by the anesthetic benzocaine. The spectrum of antibacterial action of chlorhexidine is impressive in its breadth and covers both gram-positive and gram-negative representatives of pathogenic microflora. This substance literally tears apart the cytoplasmic membrane of the bacterial cell, leaving no chance for salvation. True, this does not apply to individual species of Pseudomonas and Proteus, as well as dermatophytes (Epidermophyton spp., Trichophyton spp., Microsporum spp.), Yeast fungi and mycobacteria, for which chlorhexidine is practically useless. This antiseptic feels best in a slightly alkaline or neutral environment, but with a shift in pH to the acidic side, its activity significantly decreases. The effectiveness of chlorhexidine leaves much to be desired also in the presence of blood, pus and in a soapy environment. The use of chlorhexidine in the form of tablets for resorption leads to almost complete "anesthesia" of saliva. This means of local disinfection has its drawbacks (however, inherent in almost all antiseptics): with prolonged use, pathogenic microorganisms develop resistance to chlorhexidine, which causes a decrease in its effectiveness. The second component of Hexoral Tabs, benzocaine, is a local anesthetic agent capable of providing fast and persistent relief of pain in the mouth and throat. Benzocaine "squeezes" into cells through lipophilic membrane areas and "turns off" nociceptive receptors of the skin and mucous membranes. The anesthetic effect of benzocaine begins to manifest itself after 15-30 seconds, gradually decreasing over 5-10 minutes as it is diluted with saliva.
Local antiseptics are available in a wide variety of dosage forms: solutions for topical application and rinsing, aerosols, and lozenges. It should be noted that Hexoral Tabs in lozenges will have some advantage over solutions and sprays. So, when using the latter, a significant part of the drug is swallowed (in other words, it is wasted), and that part of the substance that has got to its intended purpose is quickly washed out without having time to come into contact with the mucous membrane of the oropharynx. The rinsing solutions have the shortest duration of action among all known dosage forms. If we talk about tablets for resorption, then they begin to act immediately after use. Unlike other dosage forms, there are no hard-to-reach places on the pharyngeal mucosa for tablets. This dosage form is also characterized by the longest duration of action. It is recommended to dissolve Geksoral Tabs tablets slowly, patiently waiting for them to completely dissolve (and never swallowing!). The condition for achieving optimal results is the timely initiation of pharmacotherapy, which should be understood as the moment when the first signs of the disease appear. Reception of Hexoral Tabs should be continued for another 2-3 days after the inflammatory symptoms subside. Adults and children over the age of 12 are advised to take 1 tablet every 1-2 hours as they feel. The maximum daily dose is 8 tablets. For children from 4 to 12 years old, Hexoral Tabs is prescribed up to 4 tablets per day.
One tablet of Hexoral tabs contains 0.1 XE of carbohydrates, which must be taken into account when prescribing the drug to persons suffering from diabetes. With the correct use of the drug in strict accordance with the instructions, an overdose is practically excluded, because chlorhexidine is not absorbed into the systemic circulation, and the amount of absorbed benzocaine is negligible.
Pharmacology
Combined preparation for topical use. The double action of the drug is due to the presence of 2 active substances. The antibacterial activity of the drug is due to the presence of chlorhexidine. The local anesthetic benzocaine works to reduce pain symptoms.
Chlorhexidine has a broad spectrum of antibacterial action against gram-positive and gram-negative bacteria; acts by destroying the cytoplasmic membrane of a bacterial cell. Ineffective against yeast fungi, dermatophytes, mycobacteria, some species of Pseudomonas and Proteus.
Chlorhexidine is most effective in a neutral or slightly alkaline environment. In an acidic environment, its activity decreases. Efficacy is reduced in the presence of soaps, blood and purulent discharge.
The use of chlorhexidine lozenges leads to a significant decrease in the bacterial content of saliva. The use of chlorhexidine for several months is accompanied by a decrease in its effectiveness by reducing the sensitivity of bacteria.
Benzocaine is a local anesthetic that relieves pain in the mouth and throat quickly and lastingly. Benzocaine penetrates the lipophilic areas of the cell membrane and acts on the peripheral pain receptors of the mucous membrane and skin. The anesthetic effect of benzocaine occurs in 15-30 seconds; as the substance is diluted with saliva, the anesthetic effect gradually decreases (within 5-10 minutes).
Pharmacokinetics
Chlorhexidine
There is no clinical data on the absorption of chlorhexidine through the oral mucosa of humans. Chlorhexidine can persist in saliva for up to 8 hours.
Benzocaine
Benzocaine is slightly soluble in water, which causes its slow absorption. Like all ether derivatives of PABA, it is cleaved by esterase in blood plasma and liver. As a result, PABA and ethanol are formed, which is metabolized to acetyl coenzyme A. PABA is conjugated with glycine or excreted unchanged by the kidneys.
Release form
Lozenges are round, biconvex, opaque, with a rough surface from yellow-white to yellow-gray; uneven coloring, the presence of air bubbles and slight unevenness of the edges are allowed; the appearance of a white coating (dusting) is possible.
Excipients: isomalt - 2243.681 mg, peppermint oil - 0.9 mg, menthol - 0.645 mg, thymol - 0.045 mg, aspartame - 2.29 mg, purified water - 45.789 mg.
10 pieces. - blisters (2) - cardboard packs.
Dosage
Apply topically. The tablet should be slowly dissolved in the mouth until it is completely dissolved.
The drug should be started as soon as the first symptoms of the disease appear and continued for several days after the symptoms disappear.
Adults and children over 12 years old: as a rule, 1 tab is prescribed. every 1-2 hours as needed, but not more than 8 tablets / day.
Children aged 4-12 years: appoint up to 4 tablets / day.
Use in children is possible only as directed by a doctor.
Do not use the drug in children under 4 years of age.
Overdose
When used correctly, an overdose of the drug is impossible, because chlorhexidine is practically not absorbed into the bloodstream, and the amount of absorbed benzocaine is extremely small.
Chlorhexidine
Chlorhexidine hydrochloride is poorly soluble in water, all cases of overdose are described only when taking chlorhexidine gluconate, which is highly soluble in water.
Symptoms: damage to the mucous membrane during direct contact with chlorhexidine gluconate, as well as a systematic reversible increase in the concentration of hepatic enzyme.
Treatment: no specific treatment.
Benzocaine
Overdose is possible only if used incorrectly.
Symptoms: a toxic effect on the central nervous system is possible, manifested at first by tremors, vomiting, convulsions, and later - by depression of the central nervous system. Coma is possible due to respiratory depression. High toxic concentrations cause bradycardia, AV block and cardiac arrest. Benzocaine can cause methemoglobinemia (especially in children), accompanied by suffocation and cyanosis.
Treatment: induce vomiting and flush the stomach. Perhaps the appointment of activated carbon. In case of hypoxia and anoxia, artificial respiration with oxygen support is recommended, in case of cardiac arrest - cardiac massage. For seizures, diazepam or fast-acting barbiturates are prescribed (contraindicated in anoxic seizures); in especially severe cases, after intubation and artificial respiration, suxamethonium chloride is used. Blood circulation is supported by the introduction of blood plasma or electrolyte solutions. With methemoglobinemia, up to 50 ml of a 1% solution of methylene blue IV can be used.
Interaction
Benzocaine, due to the formation of a metabolite of 4-aminobenzoic acid, reduces the antibacterial activity of sulfonamides and aminosalicylates.
Sucrose, polysorbate 80, insoluble salts of magnesium, zinc and calcium reduce the effect of chlorhexidine.
Side effects
Adverse reactions identified during post-marketing use of the drug were classified as follows: very frequent (≥10%), frequent (≥1%, but<10%), нечастые (≥0.1%, но <1%), редкие (≥0.01%, но <0.1%), очень редкие (<0.01%), частота неизвестна (частота возникновения не может быть оценена на основании имеющихся данных).
The following adverse reactions were classified according to clinical or epidemiological studies, or when the number of cases is unknown or information about an adverse reaction was identified in the analysis of literature data, the frequency is not known.
Spontaneous Adverse Reaction Reporting *
From the gastrointestinal tract: the frequency is unknown - decreased sensitivity of the oral mucosa, temporary numbness of the tongue, taste disturbance (dysgeusia), discoloration of the teeth, discoloration of the tongue (reversible), discoloration of silicate and composite materials of tooth restoration, the formation of plaque (tartar) ), stomatitis, detachment of the oral mucosa, glossodynia, enlargement of the parotid salivary glands.
From the immune system: the frequency is unknown - hypersensitivity reactions (including urticaria, angioedema, anaphylactic reactions, anaphylactic shock).
On the part of the blood and lymphatic system: the frequency is unknown - methemoglobinemia.
* According to literature data.
If any of the side effects indicated in the instructions are aggravated or any other side effects not indicated in the instructions are noted, the patient should inform the doctor about it.
Indications
Infectious and inflammatory diseases of the pharynx or oral cavity:
- pharyngitis, tonsillitis and other inflammatory diseases of the pharynx;
- stomatitis;
- gingivitis.
Contraindications
- wound and ulcerative lesions of the mouth or pharynx;
- low concentration of cholinesterase in blood plasma;
- phenylketonuria;
- children under 4 years of age;
- hypersensitivity to drug components.
Application features
Application during pregnancy and lactation
There is no sufficient experience with the use of Hexoral Tabs in pregnant and lactating women.
The use of the drug Hexoral Tabs during pregnancy and lactation is possible only in cases where the expected benefit of therapy for the mother outweighs the potential risk of harmful effects to the fetus and child.
Application in children
Use in children under 4 years of age is contraindicated.
Use in children over 4 years old is possible only as directed by a doctor.
special instructions
Benzocaine can cause methemoglobinemia. This condition is manifested by symptoms such as discoloration of the skin, lips and nail beds to gray or blue or paleness, headache, light-headedness, shortness of breath, fatigue and tachycardia. The appearance of the listed symptoms indicates the presence of moderate to high methemoglobin and a significant decrease in the oxygen transport function of the blood. Children and elderly patients may be at higher risk of developing methemoglobinemia.
In children, the drug should be used under adult supervision.
The drug contains aspartame, which is a phenylalanine derivative, which is dangerous for patients with phenylketonuria.
The use of the drug is contraindicated in the presence of wound and ulcerative lesions of the mouth and throat.
Caution should be exercised when using the drug in young children and in persons with aspiration or swallowing disorders due to the risk of suffocation.
If a medicinal product has become unusable or has expired, it should not be thrown into wastewater or outside. It is necessary to put the drug in a bag and put it in the trash can. These measures will help protect the environment.
Influence on the ability to drive vehicles and use mechanisms
Gekoral Tabs does not affect the ability to drive vehicles and engage in other potentially hazardous activities.
