clindamycin (Rx)

Brand and Other Names:Cleocin, Cleocin Pediatric, more...Clindesse, ClindaMax Vaginal
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 75mg
  • 150mg
  • 300mg

injectable solution

  • 150mg/mL

oral solution

  • 75mg/5mL

intravenous ready-to-use solution

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

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 ready-to-use solution

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

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

and clindamycin

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (12)

              • atracurium

                clindamycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • BCG vaccine live

                clindamycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • cholera vaccine

                clindamycin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • cisatracurium

                clindamycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • onabotulinumtoxinA

                clindamycin increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • pancuronium

                clindamycin increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • rapacuronium

                clindamycin increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • rimabotulinumtoxinB

                clindamycin increases effects of rimabotulinumtoxinB by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • rocuronium

                clindamycin increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • succinylcholine

                clindamycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              • typhoid vaccine live

                clindamycin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • vecuronium

                clindamycin increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

              Monitor Closely (17)

              • bazedoxifene/conjugated estrogens

                clindamycin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • conjugated estrogens

                clindamycin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • dienogest/estradiol valerate

                clindamycin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • digoxin

                clindamycin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

              • estradiol

                clindamycin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estrogens conjugated synthetic

                clindamycin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estropipate

                clindamycin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • ethinylestradiol

                clindamycin will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • incobotulinumtoxinA

                clindamycin increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • letermovir

                letermovir increases levels of clindamycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                clindamycin will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

              • mestranol

                clindamycin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • mipomersen

                mipomersen, clindamycin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

              • nitazoxanide

                nitazoxanide, clindamycin. Either increases levels of the other by Mechanism: plasma protein binding competition. Use Caution/Monitor.

              • ospemifene

                clindamycin, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                clindamycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • warfarin

                clindamycin increases effects of warfarin by Other (see comment). Use Caution/Monitor. Comment: Decr vitamin K-producing intestinal flora may increase INR after a few days.

              Minor (11)

              • balsalazide

                clindamycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • biotin

                clindamycin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • erythromycin base

                clindamycin, erythromycin base. Either decreases effects of the other by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin ethylsuccinate

                clindamycin, erythromycin ethylsuccinate. Either decreases effects of the other by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin lactobionate

                clindamycin, erythromycin lactobionate. Either decreases effects of the other by pharmacodynamic antagonism. Minor/Significance Unknown.

              • erythromycin stearate

                clindamycin, erythromycin stearate. Either decreases effects of the other by pharmacodynamic antagonism. Minor/Significance Unknown.

              • food

                food decreases levels of clindamycin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pantothenic acid

                clindamycin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyridoxine

                clindamycin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyridoxine (Antidote)

                clindamycin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • thiamine

                clindamycin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

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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

              Clostridium difficile colitis

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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; 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

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              Pregnancy & Lactation

              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.

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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

              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
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Cleocin vaginal
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              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              clindamycin injection
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              150 mg/mL vial
              Clindagel topical
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              1 % gel
              Clindesse vaginal
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              2 % cream
              Evoclin topical
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              1 % foam
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              1 % solution
              Cleocin T topical
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              1 % swab
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              Cleocin T topical
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              1 % lotion
              Cleocin T topical
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              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

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              clindamycin vaginal

              CLINDAMYCIN PHOSPHATE SINGLE DOSE CREAM - VAGINAL

              (klin-da-MYE-sin)

              COMMON BRAND NAME(S): Clindesse

              USES: This medication is used to treat a certain type of vaginal infection (bacterial vaginosis) in women who are not pregnant. Clindamycin is an antibiotic that works by stopping the growth of bacteria.

              HOW TO USE: Read the Patient Information Leaflet that comes with this product for instructions on the proper use of this medication. Consult your doctor or pharmacist if you have any questions.This product is for vaginal use only. Wash your hands before and after use. Avoid contact of this cream with your eyes. If it gets into your eyes, wash them right away with plenty of water. Call your doctor if eye irritation persists.Insert the applicator filled with medication high into the vagina and press the plunger to release the medication. This product is given as a single dose. This product may be used at any time of the day because it is designed to leak very little medication out of the vagina.Tell your doctor if your condition does not improve after several days.

              SIDE EFFECTS: Although uncommon, mild stomach upset may occur. If this effect persists or worsens, tell your doctor or pharmacist promptly.Rarely, vaginal discomfort/burning/itching/discharge may occur or worsen. These symptoms may be due to a new vaginal infection (such as a yeast/fungal infection). Contact your doctor if you notice a change in vaginal discharge or other new vaginal symptoms.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very small amount of this medication may be absorbed into your blood and may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using clindamycin, tell your doctor or pharmacist if you are allergic to it; or to lincomycin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: intestinal disease (such as C. difficile-associated diarrhea, enteritis, ulcerative colitis).Before using this medication, tell your doctor or pharmacist your medical history.Do not have vaginal intercourse or use tampons or douches during treatment with this medication because these can cause the cream to not work as well.The mineral oil in this product can weaken rubber products such as latex condoms and diaphragms and lead to their failure. Do not use these products during treatment with this medication and for 5 days after treatment is over. Consult your doctor about other forms of barrier protection/birth control (e.g., polyurethane condoms) during this time.During pregnancy, this medication should be used only when clearly needed. Antibiotics taken by mouth have been used to treat vaginal infections during pregnancy, especially high-risk pregnancies (e.g., if there is a risk of early childbirth). Consult your doctor for more details and to discuss the risks and benefits.It is unknown if the medication in this product passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.

              MISSED DOSE: Not applicable.

              STORAGE: Store at room temperature away from heat and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              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.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.