Names and pronunciation
(klin-da-my′sin) Cleocin, Cleocin T, Clinda- Derm, Clindagel, Clindesse, Clindets, Dalacin T , Evolin, Dalacin C
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Individual generic drug information
Extracted information for clindamycin only.
(klin-da-my′sin) Cleocin, Cleocin T, Clinda- Derm, Clindagel, Clindesse, Clindets, Dalacin T , Evolin, Dalacin C
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Func. class.: Antiinfective— miscellaneous
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Chem. class.: Lincomycin derivative
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ACTION: Binds to 50S subunit of bac- terial ribosomes, suppresses protein synthesis
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USES: Skin, skin structure, respiratory tract infections; septicemia; intra-abdomi- nal infections; endocarditis prophylaxis; infections caused by staphylococci, strep- tococci, Rickettsia, Fusobacterium, Acti- nomyces, Peptococcus, Bacteroides, Pneumocystis jiroveci
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Extracted information for clindamycin only.
CONTRAINDICATIONS: Hyper- sensitivity to this product or lincomycin, tartrazine dye; ulcerative colitis/enteritis
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Black Box Warning: Pseudomembra- nous colitis Precautions: Pregnancy, breastfeeding, GI/hepatic disease, asthma, allergy, diarrhea Black Box Warning: CDAD: bowel pat- tern prior to, during treatment; if severe diarrhea occurs, product should be dis- continued; may occur several weeks after therapy is terminated; use this product in serious infections only • Monitor blood studies: CBC • Serious skin reactions: Stevens- Johnson syndrome, exfoliative dermatitis (monitor for rash); discontinue at first appearance of rash, may occur after con- clusion of therapy • Pregnancy/breastfeeding: no well- controlled studies; use in pregnancy only if benefits outweigh fetal risk; excreted in breast milk, not recommended if breast- feeding Black Box Warning: To notify nurse or prescriber of diarrhea with pus, mucus, rash TREATMENT OF HYPER SENSITIVITY: • Withdraw product; maintain airway; administer EPINEPHrine, O2, IV cortico- steroids
Source pages 296, 298
SIDE EFFECTS GI: Nausea, vomiting, abdominal pain, diarrhea, CDAD, anorexia CV: Dysrrthmias, hypotension INTEG: Rash, urticaria, pruritus, abscess at inj site SYST: Stevens-Johnson syndrome, exfo- liative dermatitis MISC: Candidiasis
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INTERACTIONS • May block clindamycin effect: erythro- mycin; avoid using together Increase: neuromuscular blockade— neuromuscular blockers Decrease: absorption—kaolin/pectin Drug/Lab Test Increase: alkaline phosphatase, bilirubin, CPK, AST, ALT
Source page 298
Extracted information for clindamycin only.
DOSAGE AND ROUTES Most infections • Adult: PO 150-450 mg q6hr, max 2700 mg/day; IM/IV 1.2-2.7 g/day in 2-4 divided doses, max 4800 mg/day severe infections • Child >1 mo: PO 8-25 mg/kg/day in divided doses q6-8hr; IM/IV 20-40 mg/ kg/day in 3-4 equal divided doses q6-8hr • Neonate: IM/IV 15-20 mg/kg/day divided doses q6-8hr PID • Adult: IV 900 mg q8hr plus gentamicin Bacterial endocarditis prophylaxis • Adult: PO/IV 600 mg 1 hr (PO), 30 min (IV) prior to procedure Bacterial vaginosis • Adult/adolescent: Vaginal: (Clin- damax) 1 applicator (5 g) at bedtime × 3-7 day; (Clindesse) 1 applicator (5 g) single dose or 1 suppository (100 mg) at bedtime × 3 nights
Source page 296
Available forms: Capsules 75, 150, 300 mg; granules for oral solution 75 mg/5 mL; injection infusion in D5W 300 mg, 600 mg, 900 mg/16 mL; injection 150 mg/mL, 300 mg/2 mL, 600 mg/4 mL, 900 mg/6 mL; topical: foam/gel, lotion, solution 1%, cream 2%; vaginal: cream 2%; vaginal suppositories 100 mg
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Administer: • In equal intervals around the clock to maintain blood levels • Obtain C&S prior to use, may start product before results are received PO route • Do not break, crush, chew capsules • Orally with at least 8 oz of water Oral solution • Do not refrigerate reconstituted prod- uct; store at room temperature ≤2 wk • Reconstitute granules with most of 75 mL of water, shake well, add remaining water, shake well (75 mg/5 mL) Vaginal route • Use applicator supplied • Partner is not treated Topical route • Do not get in eyes, mouth cuts IM route • IM deep injection; rotate sites; do not give >600 mg in single IM injection IV route • Visually inspect parenteral products for particulate matter and discoloration prior to use • Vials: dilute 300- and 600-mg doses with 50 mL of a compatible diluent; dilute 900-mg doses with 50-100 mL of a compatible diluent; dilute 1200-mg doses with 100 mL of a compatible diluent, fi- nal concentration max 18 mg/mL • ADD-vantage vials: dilute 600- and 900-mg ADD-vantage containers with 50 or 100 mL, respectively, of NS or D5W • Storage: when diluted in D5W, NS, or LR, solutions with concentrations of 6, 9, or 12 mg/mL are stable for 16 days at room temperature or 32 days under re- frigeration when stored in glass bottles or minibags; when diluted in D5W, solutions with a concentration of 18 mg/mL are stable for 16 days at room temperature Intermittent IV infusion route • Infuse over at least 10-60 min, infu- sion rates max 30 mg/min and ≤1.2 g should be infused in a 1-hr period • Infuse 300-mg doses over 10 min; 600-mg doses over 20 min, 900-mg doses over 30 min, and 1200-mg doses over 40 min Continuous IV infusion route • Give first dose rapidly, then follow with continuous infusion • Rate is based on desired serum clindamycin levels • To maintain serum concentrations above 4 mcg/mL, use a rapid infusion rate of 10 mg/min for 30 min and a main- tenance rate of 0.75 mg/min; to maintain serum concentrations above 5 mcg/mL, use a rapid infusion rate of 15 mg/min for 30 min and a maintenance rate of 1 mg/ min; to maintain serum concentrations above 5 mcg/mL, use a rapid infusion rate of 20 mg/min for 30 min and a main- tenance rate of 1.25 mg/min Y-site compatibilities: Acyclovir, alfentanil, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, amphotericin B cholesteryl, amphotericin B lipid com- plex, amsacrine, anakinra, anidulafungin, ascorbic acid injection, atenolol, atracu- rium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, bu- prenorphine, butorphanol, calcium chlo- ride/gluconate, CARBOplatin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefoper- azone, cefotaxime, cefoTEtan, cefOXitin, cefpirome, cefTAZidime, ceftizoxime, ceftobiprole, cefuroxime, cephalothin, cephapirin, chloramphenicol, cimetidine, cisatracurium, CISplatin, codeine, cyanoco- C balamin, cyclophosphamide, cycloSPO- RINE, cytarabine, DACTINomycin, DAPTO- mycin, dexamethasone, dexmedetomidine, digoxin, diltiaZEM, diphenhydrAMINE, DOCEtaxel, DOPamine, doxacurium, DOXORUBicin, DOXOrubicin liposomal, doxycycline, enalaprilat, ePHEDrine, EPI- NEPHrine, epirubicin, epoetin alfa, eptifiba- tide, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fludarabine, fluoro- uracil, folic acid, foscarnet, furosemide, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, ifosfamide, imipenem-cilastatin, indometh- acin, insulin (regular), irinotecan, isopro- terenol, ketorolac, levoFLOXacin, lidocaine, linezolid, LORazepam, LR, magnesium sul- fate, mannitol, mechlorethamine, melpha- lan, meperidine, metaraminol, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNIDAZOLE, mezlocillin, miconazole, milrinone, morphine, moxa- lactam, multiple vitamins injection, nafcil- lin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, ni- troprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxyto- cin, PACLitaxel, palonosetron, pamidro- nate, pancuronium, pantoprazole, PEME- trexed, penicillin G potassium/sodium, pentazocine, perphenazine, PHENobarbital, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, potassium chlo- ride, procainamide, propofol, propranolol, protamine, pyridoxine, raNITIdine, remi- fentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sargramostim, sodium ace- tate/bicarbonate, succinylcholine, SUFent- anil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin- clavulanate, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trimetaphan, urokinase, vancomycin, vasopressin, ve- curonium, verapamil, vinCRIStine, vinorel- bine, vitamin B complex/C, voriconazole, zidovudine, zoledronic acid
Source pages 296, 297, 298
Extracted information for clindamycin only.
Assess: • Infection: C&S prior to product ther- apy; product may be given as soon as culture is taken; monitor appearances of wounds, sputum, stools, urine base- line and periodically
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Evaluate: • Therapeutic response: negative C&S
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take oral product with full glass of water; that antiperistaltic products may worsen diarrhea • About all aspects of product therapy; to complete entire course of medication to ensure organism death (10-14 days); culture may be taken after medication course completed • To report sore throat, fever, fatigue; may indicate superinfection • To take with food to reduce GI symptoms
Source page 298
Extracted information for clindamycin only.
PHARMACOKINETICS PO: Peak 45 min, duration 6-8 hr IM: Peak 3 hr (adult), 1 hr (child); duration 8-12 hr; half-life 2½ hr; metab- olized in liver by CYP3A4; excreted in urine, bile, feces as inactive metabolites; crosses placenta; excreted in breast milk, protein binding 94%
Source page 298
Filter the extracted dose blocks for this individual drug.
Most infections
• Adult: PO 150-450 mg q6hr, max 2700 mg/day; IM/IV 1.2-2.7 g/day in 2-4 divided doses, max 4800 mg/day severe infections
Candidate age grouping · source page 296
Most infections
• Child >1 mo: PO 8-25 mg/kg/day in divided doses q6-8hr; IM/IV 20-40 mg/ kg/day in 3-4 equal divided doses q6-8hr
Candidate age grouping · source page 296
Most infections
• Neonate: IM/IV 15-20 mg/kg/day divided doses q6-8hr PID
Candidate age grouping · source page 296
Most infections
• Adult: IV 900 mg q8hr plus gentamicin Bacterial endocarditis prophylaxis
Candidate age grouping · source page 296
Most infections
• Adult: PO/IV 600 mg 1 hr (PO), 30 min (IV) prior to procedure Bacterial vaginosis
Candidate age grouping · source page 296
Most infections
• Adult/adolescent: Vaginal: (Clin- damax) 1 applicator (5 g) at bedtime × 3-7 day; (Clindesse) 1 applicator (5 g) single dose or 1 suppository (100 mg) at bedtime × 3 nights
Candidate age grouping · source page 296