Cleocin (clindamycin) dosing, indications, interactions, adverse effects, and more (original) (raw)

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

injectable solution

oral solution

intravenous ready-to-use solution

Infections

Aerobic gram-positive cocci and the more susceptible anaerobes (NOT generally including Bacteroides fragilis, Peptococcus species and Clostridium species other than Clostridium perfringens)

600–1200 mg/day IV/IM divided BID/QID

More severe infections, particularly those due to proven or suspected Bacteroides fragilis, Peptococcus species, or Clostridium species other than Clostridium perfringens: 1200–2700 mg/day IV/IM divided BID/QID

For more serious infections, these doses may have to be increased; in life-threatening situations due to either aerobes or anaerobes these doses may be increased; doses of as much as 4800 mg qDay given IV to adults

Single intramuscular injections of > 600 mg not recommended

Alternatively, drug may be administered in the form of a single rapid infusion of first dose followed by continuous IV infusion as follows

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

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

Administration

PO: May take with food

Dosage Forms & Strengths

capsule

injectable solution

oral solution

intravenous ready-to-use solution

Infections

<1 month

1 month – 16 years

Serious Infections Caused by Anaerobic Bacteria

<7 days

>7 days

<1 month

>1 month

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

Interactions

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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

Acute generalized exanthematous pustulosis (AGEP)

Erythema multiforme, some resembling Stevens-Johnson syndrome

Acute kidney injury

Drug reaction with eosinophilia and systemic symptoms (DRESS)

Esophagitis and esophageal ulcer, particularly when taken in lying position or with small amount of water

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

Clindamycin is potentially nephrotoxic; acute kidney injury including acute renal failure reported; consider monitoring of renal function of patients with pre-existing renal dysfunction or taking concomitant nephrotoxic drugs; monitoring of renal function should be performed if therapy is prolonged

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

Due to risk of esophagitis and esophageal ulcer, important to ensure adherence with administration guidance

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

When solution is administered to pediatric population (birth to 16 years) appropriate monitoring of organ system functions is desirable

Toxicity in neonates

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.

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

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

Continuous IV infusion

Images

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Copyright © 2010 First DataBank, Inc.

Patient Handout

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CLINDAMYCIN - TOPICAL

(klin-duh-MY sin)

COMMON BRAND NAME(S): Cleocin T, Clinda-Derm

USES: This medication is used to treat acne. It helps to decrease the number of acne lesions. Clindamycin is an antibiotic which works by stopping the growth of bacteria.

HOW TO USE: Use this medication only on the skin. Clean and dry the affected area first. Follow all directions on the product package, or use as directed by your doctor.If you are using the lotion, shake the bottle well before using. Apply a thin layer of medication to the affected area as directed by your doctor, usually twice a day.If you are using the medicated pad or swab, apply to the the affected area gently with it, then discard. Depending on the size of the area to be treated, more than one pad or swab may be necessary.If you are using the foam, apply it to the affected areas as directed by your doctor, usually once daily. Use enough to cover the entire affected area. Do not spray the foam directly onto your hands or face, because the foam will begin to melt on contact with warm skin. Instead spray the amount needed directly into the cap or onto a cool surface such as a counter top. If the can seems warm or the foam seems runny, run the can under cold water. Please read the patient information leaflet available from your pharmacist for specific instructions on how to use the foam, and ask about any information that is unclear.Wash your hands after use.Avoid contact with your eyes, nose, mouth or any areas of broken skin. If you accidentally get medication in these areas, rinse well with plenty of cool water.It may take between 2 to 6 weeks to notice an improvement in your condition, and up to 12 weeks to see the full benefit.Tell your doctor if your condition does not improve or worsens.

SIDE EFFECTS: Burning, itching, dryness, redness, oily skin or skin peeling may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.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.This medication may be absorbed into your bloodstream and very 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, get medical help right away 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.Before using this medication, tell your doctor or pharmacist your medical history, especially of: chronic asthma or hay fever (atopic conditions), intestinal diseases (such as ulcerative colitis, enteritis, C. difficile-associated diarrhea).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant before using this medication.It is unknown if the medication in this product passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breastfeeding.

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: 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 1-800-222-1222. Canada residents can call 1-844-764-7669. This medication may be harmful if swallowed.

NOTES: Do not share this medication with others.

MISSED DOSE: If you miss a dose, apply it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. 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 May 2024. Copyright(c) 2024 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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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.
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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.