lincomycin (Rx)

Brand and Other Names:Lincocin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 300mg/mL

Susceptible Infections

IM: 600 mg q12-24hr

IV: 600-1000 mg q8-12hr; not to exceed 8 g/day

Renal Impairment, severe: 25-30% of usual dose

Other Indications & Uses

Streptococcus pneumoniae & other streptococci

Dosage Forms & Strengths

injectable solution

  • 300mg/mL

Susceptible Infections

<1 month old

  • Safety & efficacy not established

>1 month old

  • IV: 10-20 mg/kg/day divided q8-12hr  
  • IM: 10 mg/kg q12-24hr
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Interactions

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            Adverse Effects

            Frequency Not Defined

            Nausea

            Vomiting

            Diarrhea

            Abdominal pain

            Tenesmus

            Glossitis

            Stomatitis

            Pruritus

            Angioedema

            Serum sickness and anaphylactic or anaphylactoid reactions

            Rash

            Urticaria

            Vaginitis

            Exfoliative/vesiculobullous dermatitis

            Erythema multiforme

            Thrombophlebitis

            Erythema

            Pain

            Swelling

            Transient increases in serum bilirubin, alkaline phosphatase, & AST (SGOT) concentrations

            Jaundice

            Transient leukopenia, neutropenia, eosinophilia

            Thrombocytopenia

            Agranulocytosis

            Headache

            Myalgia

            Tinnitus

            Dizziness

            Vertigo

            Postmarketing Reports

            Anal pruritus, pseudomembranous colitis, Clostridium difficile colitis, pancytopenia, aplastic anemia, thrombocytopenic purpura, liver function test abnormal, transaminases increased, renal impairment, oliguria, proteinuria, azotemia, cardio-respiratory arrest

            Skin and subcutaneous tissue disorders: Toxic epidermal necrolysis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, dermatitis bullous, dermatitis exfoliative, erythema multiforme, rash, urticaria, pruritus may occur

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            Warnings

            Black Box Warnings

            Pseudomembranous colitis may range from severe to mild to life-threatening

            Reserve use for serious infections only

            Do not use this drug in patients with nonbacterial infections

            Clostridium difficile-associated diarrhea (CDAD) should be considered in patients who present with diarrhea following antibiotic use; C difficile produces toxins A and B, which contribute to the development of CDAD

            Hypertoxin-producing strains of C difficile caused increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy

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

            Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C difficile, and surgical evaluation should be instituted as clinically indicated

            Contraindications

            Hypersensitivity to lincomycin or clindamycin

            Cautions

            Not for gram-positive bacteria

            Discontinue if persistent diarrhea occurs

            History of GI disease (colitis), asthma or allergies

            Parenteral form contains benzyl alcohol; risk of benzyl alcohol toxicity depends on quantity administered and liver and kidneys’ capacity to detoxify the chemical; AAP states the small amounts doesn't proscribe it in neonates

            Severe hypersensitivity reactions, including anaphylactic reactions and severe cutaneous adverse reactions (SCAR) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and erythema multiforme (EM) reported; if anaphylactic reaction or severe skin reaction occurs, discontinue drug and initiate appropriate therapy

            Certain infections may require incision and drainage or other indicated surgical procedures in addition to antibacterial therapy

            Drug should not be injected intravenously undiluted as a bolus, but should be infused over at least 60 minutes as directed

            Prescribing drug in absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

            Therapy may result in overgrowth of nonsusceptible organisms—particularly yeasts; should superinfections occur, appropriate measures should be taken as indicated by clinical situation; when patients with pre-existing monilial infections require therapy with lincomycin, concomitant antimonilial treatment should be given

            Serum half-life of lincomycin may be prolonged in patients with severe impairment of renal function compared to patients with normal renal function; in patients with abnormal hepatic function, serum half-life may be twofold longer than in patients with normal hepatic function

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            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies in pregnant women; sterile Solution contains benzyl alcohol as a preservative; benzyl alcohol can cross placenta; should be used during pregnancy only if clearly needed; experience with obstetrical patients receiving drug revealed no ill effects related to pregnancy

            Animal data

            • No evidence of teratogenicity when drug administered in diet or via oral gavage to pregnant Sprague Dawley rats during period of major organogenesis at doses up to 5000 mg/kg and 100 mg/kg (approximately 6 times and 0.12 times the maximum recommended human dose [MRHD], respectively, based on body surface area comparison)
            • Reproduction studies performed in rats administered drug for 2 weeks prior to mating, throughout pregnancy and lactation, revealed no adverse effects on survival of offspring from birth to weaning at doses up to 1000 mg/kg (1.2 times the MRHD based on body surface area comparison) up to 2 generations

            Lactation

            Drug has been reported to appear in human milk in concentrations of 0.5 to 2.4 mcg/mL; because of potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing, or to discontinue drug, taking into account importance of drug to mother

            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 ribosome, which in turn affects the process of peptide initiation and causes bacterial cell death.

            Absorption

            Bioavailability: 20-30%

            Peak plasma time: 2-4 hr (PO); 30-60 min (IM)

            Peak plasma concentration: 1.8-5.3 mcg/mL (500 mg PO); 9.3-18.5 mcg/mL (600 mg IM)

            Distribution

            Distributed in many body tissues and fluids (including peritoneal fluid, pleural fluid, synovial fluid, bone, bile, aqueous humor eye), poorly in CSF (but in presence of inflamed meninges, low concentration diffuses), readily crosses the placenta, distributed in milk

            Protein Bound: 5 mcg/mL: 72%, 1 mcg/mL: 57%

            Metabolism

            Hepatic

            Elimination

            Half-life: 4-6.4 hr

            Excretion: 4-14% urine (IV/IM); 1.8-30.3% urine (IV/IM)

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            Administration

            IV Compatibilities

            Solution: D5W, D5 in NS, D10W, NS

            Additive: amikacin, cimetidine, cytarabine, heparin, ranitidine

            Syringe: doxapram, heparin, penicillin G

            IV Incompatibilities

            Additive: penicillin G(?), phenytoin

            Syringe: ampicillin

            IV Preparation

            1000 mg should be diluted in 100 mL or more of D5W, D5 in NS, D10W, or NS

            IV Administration

            Infusion over 1 hr

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            Formulary

            FormularyPatient Discounts

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

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