Search Medications (Drugs):
Medications (Drugs) from A to Z:
Home > Medications (Drugs) > Clindamycin > More information about Clindamycin

More information about Clindamycin

Pronunciation

(klin da MYE sin)


U.S. Brand Names

Cleocin®; Cleocin HCl®; Cleocin Pediatric®; Cleocin Phosphate®; Cleocin T®; Clindagel®; ClindaMax™; Clindesse™; Clindets®; Evoclin™

Synonyms

Clindamycin Hydrochloride; Clindamycin Palmitate; Clindamycin Phosphate

Generic Available

Yes: Excludes foam, vaginal suppositories, vaginal cream

Canadian Brand Names

Alti-Clindamycin; Apo-Clindamycin®; Clindoxyl®; Dalacin® C; Dalacin® T; Dalacin® Vaginal; Novo-Clindamycin

Use

Treatment against aerobic and anaerobic streptococci (except enterococci), most staphylococci, Bacteroides sp and Actinomyces; bacterial vaginosis (vaginal cream, vaginal suppository); pelvic inflammatory disease (I.V.); topically in treatment of severe acne; vaginally for Gardnerella vaginalis

Use - Dental

Alternate antibiotic, when amoxicillin cannot be used, for the standard regimen for prevention of bacterial endocarditis in patients undergoing dental procedures; alternate antibiotic in the treatment of common orofacial infections caused by aerobic gram-positive cocci and susceptible anaerobes; alternate antibiotic for prophylaxis for dental patients with total joint replacement

Use - Unlabeled/Investigational

May be useful in PCP; alternate treatment for toxoplasmosis

Pregnancy Risk Factor

B

Lactation

Enters breast milk/compatible

Contraindications

Hypersensitivity to clindamycin or any component of the formulation; previous pseudomembranous colitis; regional enteritis, ulcerative colitis

Warnings/Precautions

Dosage adjustment may be necessary in patients with severe hepatic dysfunction; can cause severe and possibly fatal colitis; discontinue drug if significant diarrhea, abdominal cramps, or passage of blood and mucus occurs. Vaginal products may weaken latex or rubber condoms, or contraceptive diaphragms. Barrier contraceptives are not recommended concurrently or for 3-5 days (depending on the product) following treatment. Some dosage forms contain benzyl alcohol or tartrazine. Use caution in atopic patients.

Adverse Reactions

Systemic:  

>10%: Gastrointestinal: Diarrhea, abdominal pain

1% to 10%:

Cardiovascular: Hypotension

Dermatologic: Urticaria, rash, Stevens-Johnson syndrome

Gastrointestinal: Pseudomembranous colitis, nausea, vomiting

Local: Thrombophlebitis, sterile abscess at I.M. injection site

Miscellaneous: Fungal overgrowth, hypersensitivity

<1% (Limited to important or life-threatening): Renal dysfunction (rare), neutropenia, granulocytopenia, thrombocytopenia, polyarthritis

Topical:  

>10%: Dermatologic: Dryness, burning, itching, scaliness, erythema, or peeling of skin (lotion, solution); oiliness (gel, lotion)

1% to 10%: Central nervous system: Headache

<1% (Limited to important or life-threatening): Pseudomembranous colitis, nausea, vomiting, diarrhea (severe), abdominal pain, folliculitis, hypersensitivity reactions

Vaginal:  

>10%: Genitourinary: Fungal vaginosis, vaginitis or vulvovaginal pruritus (from Candida albicans)

1% to 10%:

Central nervous system: Back pain, headache

Gastrointestinal: Constipation, diarrhea

Genitourinary: Urinary tract infection

Respiratory: Nasopharyngitis

Miscellaneous: Fungal infection

<1% (Limited to important or life-threatening): Atrophic vaginitis, bladder infection, bladder spasm, cervical dysplasia, diarrhea, dizziness, epistaxis, erythema, fever, hypersensitivity, hyperthyroidism, local edema, menstrual disorder, nausea, pain, palpable lymph node, pruritus, pyelonephritis, pyrexia, rash, sciatica, stomach cramps, upper respiratory urticaria, uterine cervical disorder, uterine spasm, vaginal burning, vertigo, vomiting, vulvar erythema, vulvar laceration, wheezing

Overdosage/Toxicology

Symptoms of overdose include diarrhea, nausea, and vomiting. Treatment is supportive.

Drug Interactions

Increased duration of neuromuscular blockade from tubocurarine, pancuronium

Ethanol/Nutrition/Herb Interactions

Food: Peak concentrations may be delayed with food.

Herb/Nutraceutical: St John's wort may decrease clindamycin levels.

Stability

Capsule: Store at room temperature of 20°C to 25°C (68°F to 77°F)

Cream: Store at room temperature

Foam: Store at room temperature of 20°C to 25°C (68°F to 77°F); avoid fire, flame, or smoking during or following application

Gel: Store at room temperature

Clindagel®: Do not store in direct sunlight

I.V.: Infusion solution in NS or D5W solution is stable for 16 days at room temperature

Lotion: Store at room temperature of 20°C to 25°C (68°F to 77°F)

Oral solution: Do not refrigerate reconstituted oral solution (it will thicken); following reconstitution, oral solution is stable for 2 weeks at room temperature of 20°C to 25°C (68°F to 77°F)

Ovule: Store at room temperature of 15°C to 30°C (68°F to 77°F)

Pledget: Store at room temperature

Topical solution: Store at room temperature of 20°C to 25°C (68°F to 77°F)

Compatibility

Stable in D5LR, D51/2NS, D5NS, D5W, D10W, LR, NS; variable stability (consult detailed reference) in peritoneal dialysis solutions

Y-site administration: Compatible:   Amifostine, amiodarone, amphotericin B cholesteryl sulfate complex, amsacrine, aztreonam, cefpirome sulfate, cisatracurium, cyclophosphamide, diltiazem, docetaxel, doxorubicin liposome, enalaprilat, esmolol, etoposide, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, heparin, hydromorphone, labetalol, levofloxacin, linezolid, magnesium sulfate, melphalan, meperidine, midazolam, morphine, multivitamins, ondansetron, perphenazine, piperacillin/tazobactam, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine, vitamin B complex with C, zidovudine. Incompatible:   Allopurinol, filgrastim, fluconazole, idarubicin

Compatibility in syringe: Compatible:   Amikacin, aztreonam, gentamicin, heparin. Incompatible:   Tobramycin

Compatibility when admixed: Compatible:   Amikacin, ampicillin, aztreonam, cefamandole, cefazolin, cefepime, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftizoxime, cefuroxime, cephalothin, cimetidine, fluconazole, gentamicin, heparin, hydrocortisone sodium succinate, kanamycin, methylprednisolone sodium succinate, metoclopramide, metronidazole, metronidazole with sodium bicarbonate, ofloxacin, penicillin G, piperacillin, potassium chloride, sodium bicarbonate, tobramycin, verapamil, vitamin B complex with C. Incompatible:   Aminophylline, barbiturates, calcium gluconate, ceftriaxone, ciprofloxacin, gentamicin with cefazolin, magnesium sulfate, phenytoin. Variable (consult detailed reference):   Ranitidine

Mechanism of Action

Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal depending on drug concentration, infection site, and organism

Pharmacodynamics/Kinetics

Absorption: Topical: ~10%; Oral: Rapid (90%)

Distribution: High concentrations in bone and urine; no significant levels in CSF, even with inflamed meninges; crosses placenta; enters breast milk

Metabolism: Hepatic

Bioavailability: Topical: <1%

Half-life elimination: Neonates: Premature: 8.7 hours; Full-term: 3.6 hours; Adults: 1.6-5.3 hours (average: 2-3 hours)

Time to peak, serum: Oral: Within 60 minutes; I.M.: 1-3 hours

Excretion: Urine (10%) and feces (~4%) as active drug and metabolites

Dosage

Infants and Children:

Oral: 8-20 mg/kg/day as hydrochloride; 8-25 mg/kg/day as palmitate in 3-4 divided doses; minimum dose of palmitate: 37.5 mg 3 times/day

I.M., I.V.:

<1 month: 15-20 mg/kg/day

>1 month: 20-40 mg/kg/day in 3-4 divided doses

Children: Prevention of bacterial endocarditis (unlabeled use): Oral: 20 mg/kg 1 hour before procedure with no follow-up dose needed; for patients allergic to penicillin and unable to take oral medications: 20 mg/kg I.V. within 30 minutes before procedure

Children

12 years and Adults: Topical:

Gel, pledget, lotion, solution: Apply a thin film twice daily

Foam (Evoclin™): Apply once daily

Adults:

Oral: 150-450 mg/dose every 6-8 hours; maximum dose: 1.8 g/day

Prevention of bacterial endocarditis in patients unable to take amoxicillin (unlabeled use): Oral: 600 mg 1 hour before procedure with no follow-up dose needed; for patients allergic to penicillin and unable to take oral medications: 600 mg I.V. within 30 minutes before procedure

I.M., I.V.: 1.2-1.8 g/day in 2-4 divided doses; maximum dose: 4.8 g/day

Pelvic inflammatory disease: I.V.: 900 mg every 8 hours with gentamicin 2 mg/kg, then 1.5 mg/kg every 8 hours; continue after discharge with doxycycline 100 mg twice daily to complete 14 days of total therapy

Pneumocystis carinii pneumonia (unlabeled use):

Oral: 300-450 mg 4 times/day with primaquine

I.M., I.V.: 1200-2400 mg/day with pyrimethamine

I.V.: 600 mg 4 times/day with primaquine

Bacterial vaginosis: Intravaginal:

Suppositories: Insert one ovule (100 mg clindamycin) daily into vagina at bedtime for 3 days

Cream:

Cleocin®: One full applicator inserted intravaginally once daily before bedtime for 3 or 7 consecutive days in nonpregnant patients or for 7 consecutive days in pregnant patients

Clindesse™: One full applicator inserted intravaginally as a single dose at anytime during the day in nonpregnant patients

Dosing adjustment in hepatic impairment:   Adjustment recommended in patients with severe hepatic disease

Administration

I.M.: Deep I.M. sites, rotate sites; do not exceed 600 mg in a single injection

Intravaginal:

Cream: Insertion should be as far as possible into the vagina without causing discomfort

Ovule: The foil should be removed; if the applicator is used for insertion, it should be washed for additional use

I.V.: Never administer as bolus; administer by I.V. intermittent infusion over at least 10-60 minutes, at a rate not to exceed 30 mg/minute (not exceed 1200 mg/hour); final concentration for administration should not exceed 18 mg/mL

Oral: Administer with a full glass of water to minimize esophageal ulceration; give around-the-clock to promote less variation in peak and trough serum levels

Topical foam: Dispense directly into cap or onto a cool surface; do not dispense directly into hands

Monitoring Parameters

Observe for changes in bowel frequency, monitor for colitis and resolution of symptoms; during prolonged therapy monitor CBC, liver and renal function tests periodically

Dietary Considerations

May be taken with food.

Patient Education

I.M., I.V.: Report any burning, pain, swelling, or redness at infusion or injection site.

Oral: Take as directed. Take each dose with a full glass of water. Complete full prescription, even if feeling better. If a dose is missed, take as soon as possible, but do not double doses. Report immediately any diarrhea, bloody stools, abdominal pain or cramping (do not use antidiarrheals without consulting prescriber). You may experience headache (consult prescriber for appropriate analgesic); nausea or vomiting (small, frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help). Report dizziness, skin redness or rash; fever, chills, unusual bruising, bleeding, or signs of infection (plaques on tongue, vaginal itching or discharge); other persistent adverse effects, or no improvement.

Topical, foam: Wash hands thoroughly or wear gloves. Do not dispense directly onto hands or face (foam will begin to melt on contact with warm skin). Dispense an amount the will cover the affected area directly into the cap or onto a cool surface. If can seems warm or foam seems runny, run can under cold water. Pick up small amounts of foam with fingertips and gently massage into affected areas until foam disappears. Wash hands thoroughly. Wait 30 minutes before shaving or applying make-up.

Topical, gel, lotion, or solution: Wash hands thoroughly before applying or wear gloves. Apply thin film of gel, lotion, or solution to affected area. May apply porous dressing. Wash hands thoroughly. Wait 30 minutes before shaving or applying make-up. Report persistent burning, swelling, itching, excessive dryness, or worsening of condition.

Vaginal: Wash hands before using. At bedtime, gently insert full applicator into vagina and expel cream. Wash applicator with soap and water following use. Remain lying down for 30 minutes following administration. Avoid intercourse during therapy. Report adverse reactions (dizziness, nausea, vomiting, stomach cramps, or headache) or lack of improvement or worsening of condition.

Anesthesia and Critical Care Concerns/Other Considerations

Clindamycin may increase the duration of neuromuscular blockade after anesthesia. In adults, clindamycin injection can usually be dosed effectively on an every-8-hour basis.

Cardiovascular Considerations

Clindamycin may increase the duration of neuromuscular blockade after anesthesia. Clindamycin may also be considered in the prevention of bacterial endocarditis.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

None reported

Mental Health: Effects on Psychiatric Treatment

May cause neutropenia; use caution with clozapine and carbamazepine

Dosage Forms

Note:   Strength is expressed as base

Capsule, as hydrochloride: 150 mg, 300 mg

Cleocin HCl®: 75 mg [contains tartrazine], 150 mg [contains tartrazine], 300 mg

Cream, vaginal, as phosphate:

Cleocin®: 2% (40 g) [contains benzyl alcohol and mineral oil; packaged with 7 disposable applicators]

Clindesse™: 2% (5 g) [contains mineral oil; prefilled single disposable applicator]

Foam, topical, as phosphate (Evoclin™): 1% (50 g, 100 g) [contains ethanol 58%]

Gel, topical, as phosphate: 1% [10 mg/g] (30 g, 60 g)

Cleocin T®: 1% [10 mg/g] (30 g, 60 g)

Clindagel®: 1% [10 mg/g] (40 mL, 75 mL)

ClindaMax™: 1% (30 g, 60 g)

Granules for oral solution, as palmitate (Cleocin Pediatric®): 75 mg/5 mL (100 mL) [cherry flavor]

Infusion, as phosphate [premixed in D5W] (Cleocin Phosphate®): 300 mg (50 mL); 600 mg (50 mL); 900 mg (50 mL)

Injection, solution, as phosphate (Cleocin Phosphate®): 150 mg/mL (2 mL, 4 mL, 6 mL, 60 mL) [contains benzyl alcohol and disodium edetate 0.5 mg]

Lotion, as phosphate (Cleocin T®, ClindaMax™): 1% [10 mg/mL] (60 mL)

Pledgets, topical: 1% (60s) [contains alcohol]

Clindets®: 1% (69s) [contains isopropyl alcohol 52%]

Cleocin T®: 1% (60s) [contains isopropyl alcohol 50%]

Solution, topical, as phosphate (Cleocin T®): 1% [10 mg/mL] (30 mL, 60 mL) [contains isopropyl alcohol 50%]

Suppository (ovule), vaginal, as phosphate (Cleocin®): 100 mg (3s) [contains oleaginous base; single reusable applicator]

References

Abramowicz M, "Antimicrobial Prophylaxis in Surgery,"Medical Letter on Drugs and Therapeutics, Handbook of Antimicrobial Therapy, 16th ed, New York, NY: Medical Letter, 2002.

"Advisory Statement. Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements. American Dental Association; American Academy of Orthopedic Surgeons,"J Am Dent Assoc, 1997, 128(7):1004-8.

Dajani AS, Taubert KA, Wilson W, et al, "Prevention of Bacterial Endocarditis. Recommendations by the American Heart Association,"JAMA, 1997, 277(22):1794-801.

Falagas ME and Gorbach SL, "Clindamycin and Metronidazole,"Med Clin North Am, 1995, 79(4):845-67.

Hall G, Nord CE, and Heimdahl A, "Elimination of Bacteraemia After Dental Extraction: Comparison of Erythromycin and Clindamycin for Prophylaxis of Infective Endocarditis,"J Antimicrob Chemother, 1996, 37(4):783-95.

Katlama C, De Wit S, O'Doherty E, et al, "Pyrimethamine-Clindamycin vs Pyrimethamine-Sulfadiazine as Acute and Long-Term Therapy for Toxoplasmic Encephalitis in Patients With AIDS,"Clin Infect Dis, 1996, 22(2):268-75.

Luft BJ, Hafner R, Korzun AH, et al, "Toxoplasmic Encephalitis in Patients With the Acquired Immunodeficiency Syndrome. Members of the ACTG 077p/ANRS 009 Study Team,"N Engl J Med, 1993, 329(14):995-1000.

Safrin S, Finkelstein DM, Feinberg J, et al, "Comparison of Three Regimens for Treatment of Mild to Moderate Pneumocystis carinii Pneumonia in Patients With AIDS. A Double-Blind, Randomized, Trial of Oral Trimethoprim-Sulfamethoxazole, Dapsone-Trimethoprim, and Clindamycin-Primaquine. ACTG 108 Study Group,"Ann Intern Med, 1996, 124(9):792-802.

Smilack JD, Wilson WR, and Cockerill FR 3d, "Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole,"Mayo Clin Proc, 1991, 66(12):1270-80.

Toma E, Thorne A, Singer J, et al, "Clindamycin With Primaquine vs Trimethoprim-Sulfamethoxazole Therapy for Mild and Moderately Severe Pneumocystis carinii Pneumonia in Patients With AIDS: A Multicenter, Double-Blind, Randomized Trial (CTN 004). CTN-PCP Study Group,"Clin Infect Dis, 1998, 27(3):524-30.

Wynn RL and Bergman SA, "Antibiotics and Their Use in the Treatment of Orofacial Infections, Part I and Part II,"Gen Dent, 1994, 42(5):398-402, 498-502.

Wynn RL, "Clindamycin: An Often Forgotten but Important Antibiotic,"AGD Impact, 1994, 22:10.

Yoshikawa TT, "Antimicrobial Therapy for the Elderly Patient,"J Am Geriatr Soc, 1990, 38(12):1353-72.

International Brand Names

Aclinda® (DE); Acnestop® (AR); Albiotin® (ID); Alti-Clindamycin (CA); Anerocid® (ID); Apo-Clindamycin® (CA); Basocin® (DE); Bexon® (CO); Chinacin-T® (TH); Cindala® (ID); Clamine-T® (TR); Cleocin® (AT, AU, TR); Cleocin® [extern./inj.] (AT, IT, TR); Cleocin T® (TR); Clidacin-T® (JO, RO); Clidam® (AT); Clidets® (CO); Climadan® (ID, SG); Clinac® (NZ); Clinbercin® (ID); Clinda 1A Pharma® (DE); Clindabeta® (DE); Clindac® (AT, ZA); Clindacin® (AR, JO, PL, RO); Clindacne® (PL); Clinda-hameln® (DE); Clindahexal® (DE, ZA); Clindahexal injekt® (DE); Clinda Lich® (DE); Clindamicina Biocrom® (AR); Clindamicina Biol® (AR); Clindamicina Combino Pharm® (ES); Clindamicina Fabra® (AR); Clindamicina Fosfato IBP® (IT); Clindamicina IBI® (IT); Clindamicina Klonal® (AR); Clindamicina Larjan® (AR); Clindamicina Normon® (ES); Clindamicina Northia® (AR); Clindamicina Richet® (AR); Clindamicina Rovi® (ES); Clindamicina Same® (IT); Clindamicin® (RU); Clindamycin 1A Pharma® (AT); Clindamycin Abbott® (TH); Clindamycin AbZ® (DE); Clindamycin AL® (DE); Clindamycin Azupharma® (DE); Clindamycin® (BG, ID, IL, NO, RU); Clindamycin curasan® (DE); Clindamycin dura® (DE); Clindamycine FNA® (NL); Clindamycin findusFit® (DE); Clindamycin-Fresenius® (ZA); Clindamycin Heumann® (DE); Clindamycin Klast® (DE); Clindamycin Lindo® (DE); Clindamycin-MIP (PL); Clindamycin ratiopharm® (AT); Clindamycin-ratiopharm® (DE); Clindamycin ratiopharm® (SE); Clindamycin Sandoz® (DE); clindamycin von ct® (DE); Clindamyl® (BG, JO, KW, LB, MA, MY, SY); Clinda-saar® (DE); Clinda-saar® [inj.] (DE); Clindastad® (DE); Clindatop® (DE); Clinda-Wolff® (DE); Clindazyn® [inj.] (MX); Clindexcin® (ID); Clindopax® (AR); Clindo® (PL); Clindoxyl® (CA); Clin® [inj.] (TR); Clinium® (ID); Clinjos® (ID); Clinmas® (ID); Clin-Sanorania® (DE); Clintopic® (AR); Clin® [caps] (TR); Clinwas® (ES); Cloridrato de Clindamicina® (BR); C-Mycin® (SG); Cutaclin® [gel] (MX); Dacin-F® (TH); Dalacin® (AR, AT, BE, CZ, DK, ES, FI, GB, HR, HU, IE, IN, LU, NO, PL, RU, SE, ZA); Dalacin C® (AR, AT, AU, BE, BG, BR); Dalacin® C (CA); Dalacin C® (CH, CL, CO, CR, CZ, GB, GT, HK, HN, HR, HU, ID, IE, IL, IT, LU, MX, NL, NZ, PA, PL, PT, RO, RU, SG, SI, SV, ZA); Dalacin C Fosfato® [inj.] (CL, IT, PT); Dalacin C® [inj.] (BE, BG, BR, CH, CO, CR, CZ, GB, GT, HN, IL, LU, MX, NL, PA, SV, TH); Dalacin C Paranova® (DK); Dalacin C Phosphate® (AU, GB, NZ, RU, SG); Dalacin C Phosphat® [inj.] (AT, HK); Dalacine® (FR); Dalacin S T® (AR); Dalacin T® (AU, BE, BG, BR); Dalacin® T (CA); Dalacin T® (CH, CL, CO, GB, HK, HR, HU, ID, IE, IT, MX, NL, NZ, PT, RU, SG, SI, TH, ZA); Dalacin® Vaginal (CA); Dalacin Vaginal Cream® (CZ, ES, IL); Dalacin Vaginal® (ES); Dalacin Vaginal Ovule® (IL); Dalacin V® (BG, BR, CH, CL, CO, CR, GT, HN, MX, PA, PT, RO, SV); Dalacin V Cream 2%® (AU, NZ); Dalacin V Ovulos® (CO); Dalagis T® (IL); Dalcap® (IN); Damicine® (CO); Damiclin® (CO); Damiclin V® (CO); Dentomycin® (DE); Ethidan® (ID); Euroclin® (DO, EC, GT, HN, PA, SV); Fosfato de Clindamicina® (BR); Galecin® [inj.] (MX); Indanox® (ID); Infex® (CO); Jutaclin® (DE); Klimicin® (CZ, HR, HU, PL, RO, RU, SI, TH); Klindamicin® (YU); Klindan® [inj.] (RO, TR); Klindan® (TR); Klindaver® (TR); Klinna® (TH); Klinoksin® [inj.] (TR); Klinoksin® (TR); Klitopsin® [inj.] (TR); Klitopsin® (TR); Klyndaken® (MX); Lacin® (TH); Lanacine® (AT, RO); Lanacine® [inj.] (AT); Lando® (ID); Librodan® (ID); Lindacyn® (ID); Lindan® (ID); Lindhaver® (TR); Mediklin® (ID); Microxin® (DO); Microxin-T® (DO); Microxin-V® (DO); Niladacin® (ID); Novo-Clindamycin (CA); Nufaclind® (ID); Probiotin® (ID); Prolic® (ID); Queritan® (AR); Sobelin® [caps.] (DE); Sobelin Granulat® (DE); Sobelin Solubile® [inj.] (DE); Sobelin Vaginalcreme® (DE); Teclind® (BR); Tidact YSP® (SG); Topicil® (SG); Torgyn® (AR); Turimycin® (DE); Turimycin® [inj.] (DE); Xeldac® (ID); Zindaclin® (BE, DE, GB, IE); Zindacline® (FR); Zumatic® (ID)

Advertisement
Header