clindamycin (Rx)

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

Clostridium difficile colitis

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; periodic liver enzyme determinations should be made when treating patients with severe liver disease

Not for use in meningitis due to inadequate penetration into CSF

Severe skin reactions including toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS), some with fatal outcome, reported; permanently discontinue if reactions occur

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

Prescribe with caution in atopic individuals

Indicated surgical procedures should be performed in conjunction with antibiotic therapy

Clindamycin dosage modification may not be necessary in patients with renal disease

Discontinue therapy permanently and institute appropriate therapy if anaphylactic or severe hypersensitivity reaction occurs

Pregnancy

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

Clindamycin should be used during first trimester of pregnancy only if clearly needed; there are no adequate and well-controlled studies in pregnant women during first trimester of pregnancy. Because animal reproduction studies are not always predictive of the human response, this drug should be used during pregnancy only if clearly needed

Lactation

Clindamycin has been reported to appear in breast milk in range of 0.5 to 3.8 mcg/mL; clindamycin has potential to cause adverse effects on breastfed infant's gastrointestinal flora; if oral or intravenous clindamycin is required by nursing mother, it is not a reason to discontinue breastfeeding, but alternate drug may be preferred; monitor infant for possible adverse effects on gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash) or rarely, blood in stool indicating possible antibiotic-associated colitis

The developmental and health benefits of breastfeeding should be considered along with mother's clinical need for clindamycin and any potential adverse effects on breastfed child from clindamycin or from underlying maternal condition

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.

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

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

150 mg/mL solution for injection must be diluted before infused IV

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