Clindamycin phosphate vaginal
- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Vaginal cream containing clindamycin (as clindamycin phosphate)
Vaginosis - bacterial
One applicator full (approximately 5 g) intravaginally at bedtime for 7 consecutive days.
In patients in whom a shorter treatment course is desirable, a 3 day regimen has been shown to be effective.
Children under 16 years
History of antibiotic associated colitis
Inflammatory bowel disease
Precautions and Warnings
Do not use concurrently with other local intravaginal therapy
Consider pseudomembranous colitis if patient presents with diarrhoea
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue therapy if marked diarrhoea occurs
Male & female: Damages latex condoms and diaphragms
Advise on measures to take if diarrhoea occurs
Pregnancy and Lactation
Use clindamycin with caution during pregnancy.
The manufacturer suggests clindamycin should be administered with caution during pregnancy with the potential benefit weighed against possible risks. Briggs (2011) suggests clindamycin is compatible with use during pregnancy.
In a clinical trial in pregnant women during the second trimester, clindamycin cream was effective in treating bacterial vaginosis, and no drug-related medical events were reported in the neonates. Animal studies have revealed no evidence of impaired fertility or foetal harm. Because animal reproduction studies are not always predictive of human response, this drug should be used during the first trimester of pregnancy only if clearly needed.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Use clindamycin with caution in breastfeeding.
The manufacturer suggests clindamycin should be administered with caution in breastfeeding with the potential benefit weighed against possible risks. The Drugs and Lactation Database (LactMed) suggests infant side effects are unlikely after vaginal application although about 30% of a 100 mg vaginal dose is absorbed.
It is not known if clindamycin is excreted into human milk following the use of vaginally administered clindamycin. Clindamycin is excreted into breast milk after oral and parenteral clindamycin use. It is unlikely that a nursing infant can absorb a significant amount of clindamycin from its gastro-intestinal tract.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Last Full Review Date: July 2013
British National Formulary, 65th Edition (March - September 2013) Pharmaceutical Press, London.
BNF for Children (2012-2013) Pharmaceutical Press, London.
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.
Summary of Product Characteristics: Dalacin Cream 2%. Pharmacia Ltd. Revised January 2012.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Clindamycin. Last revised: January 31, 2011
Last accessed: July 12, 2013
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