Cleocin, Dalacin C
CLINDAMYCIN PALMITATE HYDROCHLORIDE
Cleocin Phosphate, Cleocin T, Dalacin C, Evoclin, Cleocin Vaginal Ovules or Cream
Classifications: lincosamide antibiotic; Therapeutic: antibiotic
Pregnancy Category: B
75 mg, 150 mg, 300 mg capsules; 75 mg/5 mL oral suspension; 150 mg/mL injection; 2% vaginal cream; 100 mg suppositories; 10 mg gel, lotion; 1% foam
Semisynthetic derivative of lincomycin with a greater degree of antibacterial activity in vitro, better absorption, and
lower incidence of GI adverse effects than lincomycin. Suppresses protein synthesis by binding to 50 S subunits of bacterial
ribosomes, and, therefore, inhibits other antibiotics (e.g., erythromycin) that act at this site.
Particularly effective against susceptible strains of anaerobic streptococci. Also effective against aerobic gram-positive
Serious infections when less toxic alternatives are inappropriate. Topical applications are used in treatment of acne vulgaris.
Vaginal applications are used in treatment of bacterial vaginosis in nonpregnant women.
In combination with pyrimethamine for toxoplasmosis in patients with AIDS.
History of hypersensitivity to clindamycin or lincomycin; history of regional enteritis, ulcerative colitis, or antibiotic-associated
colitis; viral infection.
History of GI disease, renal or hepatic disease; atopic individuals (history of eczema, asthma, hay fever); older patients
>60 y; pregnancy (category B).
Route & Dosage
|Moderate to Severe Infections
Adult: PO 150450 mg q6h IM/IV 6001200 mg/d in divided doses (max: 2700 mg/d)
Child: PO 1030 mg/kg/d q68h IM/IV 2040 mg/kg/d in divided doses
Neonate: IM/IV ≤7 d, ≤2000
g, 10mg/kg/d q12h ≤7 d, >2000 g, 15 mg/kg/d q8h >7 d, <1200 g, 10 mg/kg/d q12h >7 d, 1200 g2000 g, 15 mg/kg/d q8h >7 d, >2000 g, 20 mg/kg/d q68h
Adult: Topical Apply to affected areas b.i.d.; 1% foam qd application
Adult: Topical Insert 1 suppository intravaginally at bedtime times 3 d, or insert 1 applicator full of cream intravaginally at bedtime
times 7 d
- Determine history of any previous sensitivities to drugs or other allergens prior to administration.
- Administer clindamycin capsules with a full [240 mL (8 oz)] glass of water to prevent esophagitis.
- Note expiration date of oral solution; retains potency for 14 d at room temperature. Do not refrigerate, as chilling causes
thickening and thus makes pouring it difficult.
- Deep IM injection is recommended. Rotate injection sites and observe daily for evidence of inflammatory reaction. Single
IM doses should not exceed 600 mg.
- IV administration to neonates, infants, and children: Verify correct IV concentration and rate of infusion with physician.
PREPARE: Intermittent: Each 18 mg must be diluted with at least 1 mL of D5W, NS, D5/.45% NaCl, or other compatible solution. Final concentration
should never exceed 18 mg/mL.
ADMINISTER: Intermittent: Never give a bolus dose. Do not give >1200 mg in a single 1-h infusion. Infusion rate should not exceed 30 mg/min.
INCOMPATIBILITIES Solution/additive: Aminophylline, barbituates, calcium gluconate, magnesium sulfate, ceftriaxone, ciprofloxacin, gentamicin, ranitidine. Y-site: Allopurinol, azithromycin, doxapram, filgrastim, fluconazole, idarubicin, lansoprazole.
- Store in tight containers at 15°30° C (59°86° F) unless otherwise directed.
Adverse Effects (≥1%) Body as a Whole:
sickness, sensitization, swelling of face (following topical use), generalized myalgia, superinfections, proctitis
, pain, induration, sterile abscess (following IM injections); thrombophlebitis (IV
Hypotension (following IM), cardiac arrest
). GI: Diarrhea,
abdominal pain, flatulence, bloating, nausea, vomiting, pseudomembranous colitis
; esophageal irritation, loss of taste, medicinal taste (high IV
, abnormal liver function tests. Hematologic: Leukopenia
, eosinophilia, agranulocytosis, thrombocytopenia
. Skin: Skin rashes,
urticaria, pruritus, dryness, contact dermatitis, gram-negative folliculitis, irritation, oily skin.
Diagnostic Test Interference
Clindamycin may cause increases in serum alkaline phosphatase, bilirubin, creatine phosphokinase (CPK) from muscle irritation following IM injection; AST, ALT.
Interactions Drug: Chloramphenicol, erythromycin
possibly are mutually antagonistic to clindamycin; neuromuscular blocking action enhanced by neuromuscular blocking agents (atracurium, tubocurarine, pancuronium).
Approximately 90% absorbed from GI tract; 10% of topical application is absorbed through skin. Peak:
4560 min PO; 3 h IM. Duration:
6 h PO; 812 h IM. Distribution:
Widely distributed except for CNS
; crosses placenta; distributed into breast milk. Metabolism:
In liver. Elimination:
In urine and feces. Half-Life:
Assessment & Drug Effects
- Lab tests: Culture and susceptibility testing should be performed initially and periodically during therapy. Periodic CBC
with differential and platelet count.
- Monitor BP and pulse in patients receiving drug parenterally. Hypotension has occurred following IM injection. Advise patient
to remain recumbent following drug administration until BP has stabilized.
- Severe diarrhea and colitis, including pseudomembranous colitis, have been associated with oral (highest incidence), parenteral,
and topical clindamycin. Report immediately the onset of watery diarrhea, with or without fever; passage of tarry or bloody
stools, pus, intestinal tissue, or mucus; abdominal cramps, or ileus. Symptoms may appear within a few days to 2 wk after
therapy is begun or up to several weeks following cessation of therapy.
- Closely observe older adult and bedridden patients, as they are at a higher risk of developing severe colitis.
- Be alert to signs of superinfection (see Appendix F).
- Be alert for signs of anaphylactoid reactions (see Appendix F), that require immediate attention.
Patient & Family Education
- Take drug for the full course of therapy as prescribed.
- Report loose stools or diarrhea promptly.
- Stop drug therapy if significant diarrhea develops (more than 5 loose stools daily) and notify physician.
- Do not self-medicate with antidiarrheal preparations. Antiperistaltic agents may prolong and worsen diarrhea by delaying
removal of toxins from colon.
- If using topical preparation for acne, discontinue other acne preparations unless otherwise directed by physician. Keep medication
away from eyes.
- Since 10% absorption of topical medication is possible, report the onset of systemic reactions to physician.