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Pharmacology: Benzydamine is an anti-inflammatory and analgesic agent structurally unrelated to the steroid group. Benzydamine differs chemically from other non-steroidal anti-inflammatory agents in that it is a base rather than an acid.
Animal models show that when administered systemically, benzydamine is effective against pain and oedema due to inflammatory conditions. It also inhibits granuloma formation. At concentrations used for topical treatment, benzydamine possesses local anaesthetic action. Benzydamine does not cause erosion of the gastric mucosa when given orally to rats at doses of up to 100 mg/kg.
The analgesic activity of benzydamine was more pronounced in models involving an experimental inflammation rather than in non-inflammatory pain. In common with the aspirin-like drugs, benzydamine possesses an antipyretic activity. Peripheral reflexes were transiently inhibited after intravenous administration to cats.
Isomalt is a sugar-substitute. It is a disaccharide alcohol and is an approximately equimolar mixture of glucose-mannitol and glucose-sorbitol. Isomalt produces no measurable changes in blood glucose levels.
Chlorhexidine is a bisbiguanide antiseptic that helps to reduce the development of plaque and gingivitis when usual oral hygiene measures are interrupted. It is a strong base with affinity for oral structures including hydroxyapatite of tooth enamel, pellicle of tooth surface, bacteria and salivary proteins. Chlorhexidine reduces dental plaque deposition and associated gingivitis as characterized by redness, swelling or bleeding of the gingiva. It also increases the number of days between aphthous ulcers and increases the rate of healing following periodontal surgery.
Pharmacodynamics: The mechanism of anti-inflammatory action is not related to stimulation of the pituitary-adrenal axis. Like other non-steroidal anti-inflammatory agents, benzydamine inhibits the biosynthesis of prostaglandins under certain conditions, but its properties in this respect have not been fully elucidated. The stabilising effect on cellular membranes may also be involved in the mechanism of action.
Following normal topical application of Difflam-C, chlorhexidine produces an immediate bactericidal effect, followed by a prolonged bacteriostatic action. Chlorhexidine is active against a wide range of microorganisms including gram-positive and gram-negative bacteria, yeast, some fungi and viruses. Chlorhexidine appears to delay bacterial growth by a delayed surface action. It is attracted to and absorbed onto microbial cell walls and causes membrane leakage.
Pharmacokinetics: Absorption: Benzydamine is well absorbed following oral administration. Following topical administration of benzydamine hydrochloride in solution form and spray, benzydamine is well absorbed into the inflamed oral mucosa where it exerts anti-inflammatory and local anaesthetic actions. Plasma benzydamine levels following use of benzydamine orally are low and parallel to the amount actually ingested.
Chlorhexidine gluconate is poorly absorbed from the gastrointestinal tract (GIT). No detectable blood levels have been found in humans following oral use and percutaneous absorption, if it occurs at all, is insignificant.
Excretion: Benzydamine and its metabolites are excreted largely in the urine. Metabolism is largely by oxidative pathways, although dealkylation can be shown.
Benzydamine has been detected in blood and urine following gargling with benzydamine hydrochloride (Difflam) solutions. Most of the absorbed dose was eliminated in the first 24 hours. Repeated administration for 7 days did not result in accumulation of benzydamine in plasma.
Approximately 30% of the applied chlorhexidine gluconate is retained in the oral cavity and it is slowly released into the oral fluids for up to 24 hrs. Chlorhexidine is poorly absorbed from the GIT and is primarily excreted in the feces.
