Cleocin (Clindamycin) Interactions
- Benzoyl Peroxide
- Chloramphenicol
- Cyclosporine
- Erythromycin
- Kaolin; Pectin
Neuromuscular blockers
Opiate agonists
Oral contraceptives
- Salicylic Acid
- Soy Isoflavones
Cleocin (Clindamycin) Interactions
Clindamycin can potentiate the action of neuromuscular blockers, leading to skeletal muscle weakness and respiratory depression or paralysis. Concurrent use during surgery or postoperative use of clindamycin should be monitored carefully.
Kaolin; pectin products can reduce the rate of oral absorption of clindamycin if administered together thereby reducing maximum serum concentrations. Any absorbent antidiarrheal product should be taken 2 hours before or 3-4 hours after oral doses of clindamycin.
Clindamycin, which has been shown to exhibit neuromuscular blocking action, can enhance the effects of opiate agonists if used concomitantly, enhancing respiratory depressant effects. They should be used together with caution and the patient carefully monitored.
Clindamycin competes with erythromycin or chloramphenicol for binding with the 50 S ribosomal subunits and can antagonize the effects of either of these drugs. Concomitant use of clindamycin with either erythromycin or chloramphenicol is not recommended.
It was previously thought that antibiotics may decrease the effectiveness of oral contraceptives containing estrogens due to stimulation of estrogen metabolism or a reduction in estrogen enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with oral contraceptives (OCs) and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma levels of oral contraceptives. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review of the subject concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Benzoyl peroxide will, over time, oxidize and degrade topical formulations of antibiotics such as clindamycin; however, benzoyl peroxide is found in combination with clindamycin in some topical acne formulations. Physical incompatibilities or changes in pH may increase the risk of skin irritation when using formulations not intended for simultaneous use. When concomitantly prescribed for acne therapy, these separate medication formulations should be used separately at different times of the day to minimize skin irritation, unless directed otherwise by the prescriber. If skin irritation occurs, a decrease in dose or frequency of one or both agents may be necessary.
When concomitantly prescribed for acne therapy, apply salicylic acid and clindamycin topical solutions separately at different times of the day to minimize skin irritation, unless directed otherwise by the prescriber. If skin irritation occurs, a decrease in dose or frequency of one or both agents may be necessary.
Cyclosporine dosage adjustments may be required in patients receiving concurrent clindamycin. Two lung transplant patients receiving clindamycin for Staphylococcus aureus infections required increasing doses of cyclosporine to maintain target cyclosporine serum concentrations. When clindamycin treatment was stopped, the dose of cyclosporine was reduced to the regimen used prior to clindamycin therapy. The mechanism of the interaction is unknown. Close monitoring of cyclosporine serum concentrations is warranted before, during, and after concurrent clindamycin usage.
Bacteria in the intestine produce enzymes which hydrolyze the soy isoflavones to the active isoflavonoids genistein and daidzein; alterations in gut microflora have been correlated with effects on soy isoflavone bioavailability. Selected antibiotics (e.g., clindamycin, lincomycin, macrolides, neomycin, tetracyclines) significantly reduce the GI microflora and could theoretically prevent the formation of the active components of the soy isoflavones.
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