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clindamycin (Rx)Brand and Other Names:Cleocin, Cleocin Pediatric, more...Clindesse, ClindaMax Vaginal

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 75mg
  • 150mg
  • 300mg

injectable solution

  • 150mg/mL

oral solution

  • 75mg/5mL

intravenous solution

  • 300 mg/50mL (5% dextrose)
  • 600 mg/50mL (5% dextrose)
  • 900 mg/50mL (5% dextrose)
more...

Serious Infections Caused by Anaerobic Bacteria

150-450 mg PO q6-8hr; not to exceed 1.8 g/day, OR

1.2-2.7 g/day IV/IM divided q6-12hr; not to exceed 4.8 g/day

Amnionitis

450-900 mg IV q8hr

Inhalational & Gastrointestinal Anthrax (Off-label)

900 mg IV q8hr with ciprofloxacin 400 mg PO q12hr or doxycycline 150-300 mg PO q12hr

Bacterial Vaginosis

300 mg PO q12hr for 7 days

Surgical Prophylaxis

900 mg PO/IV 1 hr prior to procedure; may redose q6hr if necessary

Bite Wounds (Human or Animal)

300 mg PO q6hr

Gangrenous Pyomyositis

900 mg IV q8hr with penicillin G

Group B Streptococcus

Neonatal prophylaxis

900 mg IV q8hr until delivery

Orofacial/Parapharyngeal Space Infections

150-450 mg PO q6hr for at least 7 days; not to exceed 1.8 g/day, OR

600-900 mg IV q8hr

Pelvic Inflammatory Disease

900 mg IV q8hr with gentamicin 2 mg/kg; THEN 1.5 mg/kg q8hr; continue after discharge with doxycycline 100 mg PO q12hr to complete 14 days of therapy

Toxic Shock Syndrome

900 mg IV q8hr plus oxacillin or nafcillin (2 g IV q4hr) or vancomycin (30 mg/kg/day IV divided q12hr

Endocarditis Prophylaxis (Off-label)

600 mg PO/IV/IM 30-60 min before procedure

Avoid IM injections in patients receiving anticoagulant therapy; administer PO in these circumstances; in general, administer IV only if patient does not tolerate or is unable to absorp oral medications

Dosing considerations

  • Recent AHA guidelines recommend only for high-risk patients undergoing invasive procedures

CNS Toxoplasmosis, With Pyrimethamine or Leucovorin (Off-label)

600 mg IV or PO q6hr for at least 6 weeks

Gardnerella Vaginalis (Off-label)

PO: 300 mg PO q12hr for 7 days

Pneumocystis (Carinii) Jiroveci (Off-label)

30 mg/kg/day divided q6-8hr 

300-450 mg PO q6-8hr with primaquine for 21 days

600-900 mg IV q6-8hr with primaquine for 21 days

Sarcoidosis (Orphan)

Orphan indication sponsor

  • Autoimmunity Research Foundation; 3423 Hill Canyon Avenue; Thousand Oaks, CA 91360

Administration

PO: May take with food

Dosage Forms & Strengths

capsule

  • 75mg
  • 150mg
  • 300mg

injectable solution

  • 150mg/mL

oral solution

  • 75mg/5mL

intravenous solution

  • 300 mg/50mL (5% dextrose)
  • 600 mg/50mL (5% dextrose)
  • 900 mg/50mL (5% dextrose)
more...

Serious Infections Caused by Anaerobic Bacteria

<7 days

  • <2 kg (or >7 days, <1.2 kg): 10 mg/kg/day IV/IM divided q12hr  
  • >2 kg (or >7 days, 1.2-2 kg): 15 mg/kg/day IV/IM divided q8hr

>7 days

  • >2 kg: 20 mg/kg/day IV/IM divided q6hr

<1 month

  • 15-20 mg/kg/day divided q6-8hr

>1 month

  • Hydrochloride: 8-20 mg/kg/day PO
  • Palmitate: 8-25 mg/kg/day divided q6-8hr; 37.5 mg q8hr minimum palmitate dose

Anthrax

15-40 mg/kg/day IV divided q6-8hr 

8-25 mg/kg/day PO divided 6-8hr

Endocarditis

Prophylaxis

20 mg/kg PO 30-60 min before procedure, OR 

20 mg/kg IV/IM within 30-60 minutes before procedure

Streptococcal Pharyngitis

May consider use in patients allergic to penicillin (IDSA guidelines)

Chronic carrier treatment: 20-30 mg/kg/day PO divided q8hr; not to exceed 300 mg/dose

Acute treatment in penicillin-allergic patients: 7 mg/kg/dose TID for 10 days; not to exceed 300 mg/dose 

Orofacial Infections

10-20 mg/kg/day PO divided q6-8hr, OR 

15-25 mg/kg/day IV divided q6-8hr

May adjust dose as necessary not to exceed 40 mg/kg/day

Dosing Considerations

IM: No more than 600 mg per injection

Endocarditis: Recent AHA guidelines recommend only for invasive procedures in high-risk patients

Administration

May take with food

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Interactions

Interaction Checker

clindamycin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Abdominal pain

            Agranulocytosis

            Eosinophilia (transient)

            Diarrhea

            Fungal overgrowth

            Pseudomembranous colitis

            Hypersensitivity

            Stevens-Johnson syndrome

            Rashes

            Urticaria

            Hypotension

            Nausea

            Vomiting

            Sterile abscess at IM site

            Thrombophlebitis

            Granulocytopenia

            Neutropenia

            Thrombocytopenia

            Polyarthritis

            Renal dysfunction

            Postmarketing reports

            Metallic taste

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            Warnings

            Black Box Warnings

            Clostridium difficile-associated diarrhea (CDAD) has been reported and may range in severity from mild diarrhea to fatal colitis

            C difficile produces toxins A and B, which contribute to CDAD; hypertoxin-producing C difficile strains increase morbidity and mortality (more likely to be refractory to antimicrobial therapy and may require colectomy)

            If CDAD suspected or confirmed, ongoing antibiotic use not directed against C difficile may need to be discontinued

            Contraindications

            Hypersensitivity to clindamycin, lincomycin, or formulation components

            Cautions

            Endocarditis prophylaxis: Use only for high-risk patients, per recent AHA guidelines

            Risk of potentially fatal pseudomembranous colitis, fungal or bacterial superinfection on prolonged use; discontinue therapy if significant abdominal cramps, diarrhea, or passage of blood and mucus occurs

            May increase risk of drug-resistant bacteria if prescribed in the absence of proven or strongly suspected bacterial infection

            Use caution in hepatic impairment, monitor for hepatic abnormalities

            Not for use in meningitis due to inadequate penetration into CSF

            Severe skin reactions (eg, toxic epidermal necrolysis), some with fatal outcome, have been reported; permanently discontinue

            Parenteral product contains benzyl alcohol, which has been associated with gasping syndrome and death in newborns

            Use with caution in patients with history of gastrointestinal disease, especially colitis

            Not for administration as a bolus; infuse over 10-60 min

            Consider possibility of clostridium difficile in all patients who present with diarrhea following antibiotic use

            Serious anaphylactic reactions require immediate emergency treatment with epinephrine; oxygen and intravenous corticosteroids should also be administered as indicated

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            Pregnancy & Lactation

            Pregnancy category: B

            In clinical trials with pregnant women, the systemic administration of clindamycin during the second and third trimesters, has not been associated with an increased frequency of congenital abnormalities

            Lactation: Excreted in breast milk; manufacturer suggests discontinue drug or do not nurse (AAP Committee states compatible with nursing)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Suppresses protein synthesis by binding to 50S ribosomal subunits; bacteriostatic or bactericidal depending on drug concentration, organism and infection site

            Absorption

            Bioavailability: Oral (rapid; 90%)

            Peak serum time: Within 60 min (PO); 1-3 hr (IM)

            Distribution

            High concentrations in bone and urine

            No significant levels in CSF, even with inflamed meninges

            Crosses placenta; enters breast milk

            Vd: ~2 L/kg

            Metabolism

            Hepatic

            Elimination

            Half-life: 2-3 hr (adults); 8.7 hr (premature neonates); 3.6 hr (full-term neonates); 2 hr (children); 4 hr (elderly)

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

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            Administration

            IV Incompatibilities

            Additive: Aminophylline, ceftriaxone, ciprofloxacin, gentamicin/cefazolin, ranitidine(?)

            Syringe: Tobramycin

            Y-site: Allopurinol, azithromycin, doxapram, filgrastim, fluconazole, idarubicin

            Reported to be physically incompatible with aminophylline, ampicillin, barbiturates, Ca-gluconate, magnesium sulfate, and phenytoin; other reports say ampicillin is additive compatible and magnesium sulfate is Y-site compatible

            IV Compatibilities

            Solution: Compatible with most common diluents

            Additive: Amikacin, aztreonam, cefazolin, cefepime, cefoperazone, cefotaxime, cefoxitin, ceftazidime, cefuroxime, cimetidine, fluconazole, gentamicin, heparin, hydrocortisone, kanamycin, methylprednisolone, metoclopramide, metronidazole, netilmicin, ofloxacin, KCl, penicillin G, piperacillin, Na-bicarbonate, tobramycin, verapamil, vitamin B/C

            Syringe: Amikacin, aztreonam, caffeine, gentamicin, heparin

            Y-site: Amifostine, amiodarone, amphotericin B CholSO4, amsacrine, aztreonam, bivalirudin, cefpirome, cisatracurium, cyclophosphamide, dexmedetomidine, diltiazem, docetaxel, doxorubicin liposomal, enalaprilat, esmolol, etoposide PO4, fenoldopam, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, hetastarch, hydromorphone, heparin, labetalol, levofloxacin, linezolid, meperidine, morphine, midazolam, milrinone, nicardipine, ondansetron, perphenazine, piperacillin/tazobactam, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine, vitamin B/C, zidovudine

            IV Preparation

            Dilute 300 and 600 mg in 50 mL of D5W

            Dilute 900 mg in 50-100 mL of D5W

            Dilute 1200 mg in 100 mL of D5W

            IV Administration

            Intermittent IV infusion

            • Infuse over 10-60 min at a rate not exceeding 30 mg/min
            • See manufacturer's PI for rapid and maintenance rates for specific desired serum levels
            • 300 mg doses infuse over 10 min
            • 600 mg doses infuse over 20 min
            • 900 mg doses infuse over 30 min
            • 1200 mg doses infuse over 60 min; no more than 1200 mg of drug should be given by IV infusion in 1 hr

            Continuous IV infusion

            • May give continuous IV infusion instead of intermittent after first dose has been given by rapid IV infusion
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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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