Chlorhexidine

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.

Since the last update we have not found published data on its excretion in breastmilk.

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.

Vaginal absorption is minimal ^{(Nilsson 1989)}. 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 ^{(Pereira 2011)} and it is preferable to the application of an iodinated disinfectant that can alter the thyroid function of the infant. ^{(Nili 2015)}

The use of chlorhexidine to prevent infection of nipple lesions had no adverse effects in infants. (Herd 1986)

Although use in the nipple does not cause troubles to the breastfed infant ^{(Herd 1986)}, except one reported case ^{(Quinn 1989)}, it is not considered to be a justified practice for prevention of mastitis. ^{(Vieira 2103)}

Five newborns had oral burns after accidental ingestion of a solution of chlorhexidine and cetrimide. The damage was attributed to the caustic effect of cetrimide. ^{(Mucklow 1988)}

Several medical societies and expert authors consider the use of this medication to be safe during breastfeeding ^{(Li 2019)}. List of Essential Medicines by WHO 2002: compatible with breastfeeding. ^{(WHO 2002)}