Dosing & Uses
Dosage Forms & Strengths
gel/lotion/solution/foam/swab
- 1%
vaginal suppository
- 100mg
vaginal cream
- 2%
Acne Vulgaris
Gel/lotion/solution (Cleocin, ClindaMax): Apply a thin film to affected area q12hr
Foam/gel (Evoclin, Clindagel): Apply a thin film to affected area qDay
Swab: Use a swab to apply a thin film of clindamycin to affected area q12hr; each swab should be used only once, and then discarded
Bacterial Vaginosis
Suppository: Insert 1 suppository into vagina qHS for 3 days
Vaginal cream: 1 full applicator inserted intravaginally qHS for 3 days in nonpregnant patients and for 7 days in pregnant patients
Gardnerella Vaginalis (Off-label)
Suppository: Insert 1 suppository into vagina qHS for 3 days
Vaginal cream: 1 full applicator inserted intravaginally qHS for 3 days in nonpregnant patients and for 7 days in pregnant patients
Dosage Forms & Strengths
gel/lotion/solution/foam/swab
- 1%
Acne Vulgaris
<12 years old
- Safety and efficacy not established
>12 years
- Gel/lotion/solution (Cleocin T, ClindaMax): Apply a thin film to affected area q12hr
- Foam/gel (Evoclin, Clindagel): Apply a thin film to affected area qDay
- Swab: Use a swab to apply a thin film of clindamycin to affected area q12hr; each swab should be used only once, and then discarded
Adverse Effects
>10%
Dryness (18-23%)
Oiliness (1-18%)
Erythema (7-16%)
Peeling (7-11%)
Burning/itching (6-11%)
1-10%
Headache (3%)
Postmarketing Reports
Local skin effects
- Application site pain/erythema/rash
- Gram-negative folliculitis
- Hypersensitivity
- Seborrhea
- Urticaria
Systemic effects
- Abdominal discomfort
- Abdominal pain
- Colitis (including pseudomembranous colitis)
- Diarrhea
- Dizziness
- Hemorrhagic diarrhea
- Hypersensitivity
- Nausea
Postmarketing Reports
Eye pain
Contact dermatitis
Warnings
Black Box Warnings
Pseudomembranous colitis reported with nearly all antibacterial agents, including clindamycin, and may range in severity from mild to life-threatening; orally and parenterally administered clindamycin associated with severe colitis which may end fatally; diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) reported with use of orally and parenterally administered clindamycin, as well as with topical (dermal and vaginal) formulations of clindamycin; important to consider this diagnosis in patients who present with diarrhea subsequent to administration of clindamycin, even when administered by vaginal route, because approximately 5% of clindamycin dose is systemically absorbed from vagina
Contraindications
Hypersensitivity to clindamycin or lincomycin or to any of its components
History of regional enteritis, ulcerative colitis, or antibiotic-associated colitis (including pseudomembranous colitis)
Not indicated for inflammatory acne
Cautions
Systemic absorption of clindamycin has been demonstrated following topical use; discontinue immediately if significant diarrhea occurs
May cause irritation, especially when used with concomitant topical acne therapy, including with peeling, desquamating, or abrasive agents
Should be used with caution in atopic individuals
For external use only; avoid contact with eyes and mucous membranes
If applied to chest by nursing mothers, care should be taken to avoid accidental ingestion by infant
Pregnancy & Lactation
Pregnancy
In clinical trials with pregnant women, systemic administration of clindamycin during second and third trimesters has not been associated with increased frequency of congenital abnormalities; there are no adequate studies in pregnant women during first trimester of pregnancy; clindamycin should be used during first trimester of pregnancy only if clearly needed
Lactation
Not known whether clindamycin is excreted in human milk following therapy; however, orally and parenterally administered clindamycin has been reported to appear in breast milk; clindamycin has potential to cause adverse effects on breastfed infant's gastrointestinal flora; if oral or intravenous clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding, but an 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 the stool indicating possible antibiotic-associated colitis
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.Pharmacology
Mechanism of Action
Clindamycin is an antibacterial agent that binds to the 50S ribosomal subunits of susceptible bacteria and prevents elongation of peptide chains by interfering with peptidyl transfer, thereby suppressing protein synthesis; reduces surface fatty acids on skin; exact mechanism of action in treating acne unknown, but clindamycin inhibits Propionibacterium acnes in vivo
Pharmacokinetics
Absorption: 5% (vaginal cream); 30% (vaginal suppository); minimal (topical solution of foam)
Half-life: 1.5-2.8 hr (following repeated dosing); 11 hr (vaginal suppository)
Peak serum time: 10-14 hr (vaginal cream); 5 hr (vaginal suppository)
Metabolism: Hepatic
Excretion: Urine (0.2% with topical foam and solution)
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Patient Handout
Formulary
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