A-Z Drug Facts > Clindamycin

Clindamycin

Pronouncation: (KLIN-duh-MY-sin)
Class: Antibiotic, Anti-infective, Lincosamide Clindamycin Phosphate

Trade Names:
Cleocin
- Vaginal ovules 100 mg
- Vaginal cream 2%

Trade Names:
Cleocin Phosphate
- Injection 150 mg/mL

Trade Names:
Cleocin T
- Gel 1%
- Lotion 1%
- Solution, topical 1%

Trade Names:
Clindagel
- Gel 1%

Trade Names:
ClindaMax
- Gel 1%
- Lotion, topical 1%
- Vaginal cream 2%

Trade Names:
Clindesse
- Vaginal cream 2%

Trade Names:
Clindets
- Suspension, topical 1%

Trade Names:
Evoclin
- Foam 1%

Dalacin C Phosphate (Canada)
Dalacin T Topical (Canada)
Clindamycin Hydrochloride

Trade Names:
Cleocin
- Capsules 75 mg
- Capsules 150 mg
- Capsules 300 mg

Clindamycin Palmitate Hydrochloride

Trade Names:
Cleocin Pediatric
- Granules for oral solution 75 mg per 5 mL

Dalacin C (Canada)
ratio-Clindamycin (Canada)

Pharmacology

Suppresses bacterial protein synthesis.

Pharmacokinetics

Absorption

Oral

Rapidly absorbed. C _max is 2.5 mcg/mL. T _max is 45 min. Bioavailability is 90%.

IM

T _max is 3 h (adults) and 1 h (children).

IV

C _max is 7 to 14 mcg/mL.

Vaginal

About 5% is absorbed (cream); 30% (suppositories).

Distribution

Widely distributed (including bones); no significant levels attained in CSF. Excreted in breast milk.

Metabolism

Rapidly converted to active clindamycin.

Elimination

The t _½ is 2.4 to 3.2 h. About 10% of bioactivity is excreted in the urine and 3.6% in the feces; the remainder is excreted as inactive metabolites.

Special Populations

Renal Function Impairment

The t _½ is increased slightly. Dosage adjustment is not usually needed.

Hepatic Function Impairment

The t _½ is increased slightly. Dosage adjustment is not usually needed.

Elderly

The t _½ is increased slightly. Dosage adjustment is not usually needed.

Indications and Usage

Treatment of serious infections caused by susceptible strains of anaerobes, streptococci, staphylococci, and pneumococci; treatment of acne vulgaris (topical use); treatment of bacterial vaginosis (vaginal use) in nonpregnant women and second or third trimester pregnant women ( Cleocin and ClindaMax only).

Contraindications

Hypersensitivity to lincosamides or any product component; history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis.

Dosage and Administration

Adults

PO 150 to 450 mg every 6 h. IM/IV 0.6 to 2.7 g/day divided into 2 to 4 equal doses (up to 4.8 g/day have been used). Do not use more than 600 mg in single IM injection.

Children Clindamycin hydrochloride

PO 8 to 20 mg/kg/day divided into 3 to 4 doses.

Clindamycin palmitate hydrochloride

PO 8 to 25 mg/kg/day divided into 3 to 4 doses.

Children 1 mo of age and older

IM/IV 20 to 40 mg/kg/day divided into 3 to 4 equal doses.

Newborns 1 mo of age and younger

IM/IV 15 to 20 mg/kg/day divided into 3 to 4 equal doses.

Acne
Adults

Topical Apply thin film to affected area once daily ( Clindagel , Evoclin ) or twice daily.

Acute Pelvic Inflammatory Disease
Adults

IV 900 mg every 8 h with gentamicin loading dose 2 mg/kg IV or IM, followed by 1.5 mg/kg every 8 h. Parenteral therapy may be discontinued after 24 h. After discharge from hospital, continue with doxycycline 100 mg twice daily for 10 to 14 days or oral clindamycin 450 mg 4 times daily for 10 to 14 days.

Vaginosis
Adults

Intravaginal cream 1 applicatorful, preferably at bedtime, for 3 or 7 consecutive days in nonpregnant patients and 7 consecutive days in pregnant patients. Clindesse : 1 applicatorful any time of the day for 1 day. Intravaginal suppositories Insert 1 suppository/day, preferably at bedtime, for 3 consecutive days.

General Advice

• Capsules and oral solution
• Administer without regard to meals but administer with food if GI upset occurs.
• Administer capsules with a full glass of water to reduce esophageal irritation.
• Administer prescribed dose of oral solution using dosing spoon or dosing syringe.

• Injection
• For IV infusion or IM administration only. Not for intradermal, subcutaneous, or intra-arterial administration.
• To minimize injection-site reactions, administer by deep IM injection and avoid prolonged use of indwelling IV catheters.
• Do not administer undiluted solution by IV bolus. Infuse over at least 10 to 60 min. Follow manufacturer's guidelines for recommended dilutions and infusion rates.
• Follow manufacturer's recommendations for reconstituting clindamycin when using the ADD-Vantage system.
• Do not administer if particulate matter, cloudiness, or discoloration noted. Gently squeeze premixed IV solution bag before administration. Discard if leaks are detected.
• Do not add other drugs to the clindamycin infusion bag.
• Do not use plastic IV containers in series connections because of risk of air embolism.

• Topical gel, solution, and lotion
• For topical use only. Not for ophthalmic, vaginal, or oral administration.
• Cleanse areas to be treated before applying medication.
• Shake lotion well just before use.
• If using topical solution pledget, remove pledget from foil just before use. Do not use if seal is broken. Discard pledget after single use.
• Topical solution contains an alcohol base and will cause burning and irritation if applied to sensitive surfaces. Avoid contact with the eyes, mucous membranes, and abraded skin. If accidental contact occurs, rinse with large amounts of cool tap water.
• Do not use any other topical acne medication unless ordered by health care provider.
• Do not dispense foam directly onto hands or face; foam will melt on contact with warm skin. Dispense amount directly onto cap or on a cool surface. If the can seems warm or the foam seems runny, run the can under cold water.

• Vaginal cream and ovules
• For intravaginal use only. Not for ophthalmic, dermal, or oral administration.
• Administer Cleocin vaginal cream and ClindaMax vaginal cream using disposable applicator provided with medication.
• Administer Clindesse vaginal cream using the prefilled disposable applicator.
• Administer suppository using reusable applicator.
• If accidental contact of vaginal cream with the eye(s) occurs, rinse the eye(s) with large amounts of cool tap water.

Storage/Stability

Store capsules, oral solution, and injection at controlled room temperature (68° to 77°F). Do not refrigerate oral solution (causes thickening), and discard any unused oral solution after 14 days. Store topical gel, lotion, foam, and solution at controlled room temperature (68° to 77°F). Store Clindagel gel, Clindets , and ClindaMax gel and lotion between 59° and 86°F. Protect from freezing. Store vaginal cream at controlled room temperature (68° to 77°F). Store Clindesse vaginal cream between 59° and 86°F. Protect from freezing. Store vaginal suppositories at controlled room temperature (59° to 86°F). Avoid high humidity and temperature greater than 86°F.

Drug Interactions

Erythromycin

May cause antagonism.

Kaolin-pectin antidiarrheals

May delay absorption of clindamycin.

Nondepolarizing neuromuscular blockers

May enhance actions of neuromuscular blocking agents.

Incompatibility

Aminophylline, ampicillin, barbiturates, calcium gluconate, magnesium sulfate, phenytoin sodium.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Hypotension; cardiopulmonary arrest after too-rapid IV use (rare).

CNS

Headache (vaginal use).

Dermatologic

Burning, dryness, erythema (topical), hypersensitivity (eg, skin rash, urticaria, vesiculobullous rash, maculopapular rash, erythema multiforme, some cases resembling Stevens-Johnson syndrome [rare]), itching, oiliness/oily skin, peeling, pruritus (topical).

EENT

Nasopharyngitis (vaginal use).

GI

Abdominal pain; colitis, including pseudomembranous colitis (0.01% to 10%, more frequent with oral administration); constipation; diarrhea; esophagitis; nausea; unpleasant or metallic taste (following higher doses of IV infusion); vomiting.

Genitourinary

UTI; vaginitis; vulvovaginal disorder; vaginal pain; vaginal moniliasis; vaginal discharge.

Hematologic

Agranulocytosis; eosinophilia; leukopenia; neutropenia; thrombocytopenia.

Hepatic

Jaundice; LFT abnormalities.

Miscellaneous

Abnormal labor (vaginal); anaphylaxis; back pain (vaginal use); fungal infection; induration and sterile abscess after IM injection; pain after injection; thrombophlebitis after IV infusion; oliguria, polyarthritis, proteinuria, renal azotemia (rare). Topical or vaginal use may theoretically produce adverse effects seen with systemic use as a result of absorption.

Precautions

Warnings These agents can cause severe and possibly fatal colitis, characterized by severe persistent diarrhea, severe abdominal cramps, and possibly the passage of blood and mucus. When significant diarrhea occurs, discontinue the drug or, if necessary, continue only with close observation of the patient. Large bowel endoscopy is recommended. Promptly manage moderate to severe cases with fluid, electrolyte, and protein supplements as indicated, and treatment with an antibacterial agent clinically effective against Clostridium difficile colitis. Reserve for serious infections in which less toxic antimicrobial agents are inappropriate. Do not use in patients with nonbacterial infections (most upper respiratory tract infections).

Monitor Blood count/Renal function/Liver enzymes Ensure that blood counts, liver enzymes, and renal function are determined periodically during prolonged therapy. Response to therapy Monitor patient's response to therapy. Notify health care provider if infection does not appear to improve or worsens. Side effects Monitor patient for GI, DERM, general body side effects, and signs of superinfection. Report to health care provider if noted and significant. Immediately report severe diarrhea, diarrhea containing blood or pus, or severe abdominal cramping.

Pregnancy

Category B . Clindamycin does cross the placenta.

Lactation

Excreted in breast milk.

Children

Monitor organ system functions in newborns and children (16 yr of age and younger); parenteral form may contain benzyl alcohol, which can cause gasping syndrome in premature infants.

Intravaginal

Safety and efficacy not established.

Topical

Safety and efficacy not established in children younger than 12 yr of age.

Elderly

May not tolerate diarrhea well (dehydration).

Hypersensitivity

Use drug with caution in patients with asthma or significant allergies or who are atopic.

Renal Function

Use drug with caution in patients with severe renal disease with severe metabolic aberrations.

Hepatic Function

Use drug with caution in patients with severe hepatic disease with severe metabolic aberrations.

Special Risk Patients

Use with caution in patients with a history of GI disease or atopic patients.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible organisms.

Tartrazine Sensitivity

Some products contain tartrazine, which may cause allergic-type reactions in susceptible individuals.

Debilitated patients

May not tolerate diarrhea well (dehydration).

Meningitis

Drug does not diffuse into CSF. Do not use to treat meningitis.

Mineral oil

Vaginal cream contains mineral oil, which may weaken latex rubber condoms or diaphragms.

Patient Information

• Instruct patient to take exactly as prescribed and not to change the dose or discontinue therapy unless advised by health care provider.
• Reinforce to patient or caregiver the need to take exactly as prescribed and complete the entire course of therapy, even if symptoms of infection have disappeared. Caution patient or caregiver that skipping doses or not completing the full course of therapy may allow the infection to worsen and increase the possibility that the bacteria will become resistant to the antibiotic, which may cause infections that will not be treatable in the future.
• Instruct patient to notify health care provider if infection does not appear to be improving or appears to be getting worse.
• Advise patient to report the following signs of superinfection to health care provider: black furry tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
• Warn patient that diarrhea containing blood or pus may be a sign of a serious disorder and to seek medical care if noted and not treat at home. Caution patient that this may occur even weeks after completing therapy.
• Advise patient to report any other bothersome side effect to health care provider.

• Capsules and oral solution
• Advise patient or caregiver that capsules and oral solution can be taken without regard to meals but to take with food if stomach upset occurs.
• Advise patient to take capsules with a full glass of water.
• Advise patient or caregiver that oral solution should be administered using a dosing spoon or syringe.

• Vaginal cream and suppositories
• Remind patient using suppositories that they are for intravaginal use only and not to take by mouth.
• For patient using Cleocin or ClindaMax vaginal cream, review instructions for filling applicator and administering medication. Advise patient that applicator is disposable and not to reuse.
• For patient using Clindesse vaginal cream, review instructions for preparing the prefilled applicator and administering medication. Advise patient that applicator is disposable and not to reuse.
• For patient using vaginal suppositories, review instructions for loading and administering applicator and cleaning applicator for reuse. Advise patient that suppository can also be inserted directly using fingers.
• Advise patient using vaginal cream that if accidental contact with the eye(s) occurs, to rinse with large amounts of cool tap water. Advise patient to notify health care provider if eye irritation persists after rinsing.
• Advise patient to avoid vaginal intercourse or use other vaginal products (eg, tampons, douches) during treatment with either product.
• Caution patient that vaginal cream contains mineral oil and vaginal suppository contains an oil-type base that can weaken latex or rubber products such as condoms and vaginal contraceptive diaphragms. Caution patient not to use such products within 72 h following treatment with Cleocin or ClindaMax vaginal cream or vaginal suppositories, or within 5 days of treatment with Clindesse vaginal cream.
• Advise patient to discontinue use and notify health care provider if vaginal irritation develops while using the medication.

• Topical gel, solution, and lotion
• Advise patient to cleanse areas to be treated before applying medication, then apply a thin film of medication once daily ( Clindagel or Evoclin ) or twice daily to entire affected areas.
• Advise patient using lotion to shake well just before use.
• Advise patient using topical solution pledget to remove pledget from foil just before use and then discard pledget after using. Caution patient not to use pledget if seal is broken.
• Advise patient using topical solution that it contains an alcohol base and will cause burning and irritation if applied to sensitive surfaces. Caution patient to avoid contact with the eyes, mucous membranes, and abraded skin. Advise patient that if accidental contact occurs, to rinse with large amounts of cool tap water.
• Advise patient that if local irritation occurs, to apply the medication less frequently. If irritation persists, advise patient to discontinue use and notify health care provider.
• Caution patient not to use any other topical acne medication unless ordered by health care provider.
• Advise patient to notify health care provider if acne does not improve or worsens.

• Injection
• Advise patient, family, or caregiver that medication will be prepared and administered by a health care provider in a health care setting.
• Advise patient to report injection-site pain or redness.

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