Version August 2022
Acne vulgaris: Note: Due to emerging resistance patterns, should not typically be used as monotherapy for the management of acne vulgaris (Eichenfield 2013; AAD [Zaenglein 2016])
Children ≥7 years and Adolescents: Limited data available in <12 years of age (Eichenfield 2013): Topical:
Gel (Clindagel), Foam (Evoclin): Apply to affected area once daily
Gel (Cleocin T), pledget, lotion, solution: Apply a thin film twice daily
Bacterial vaginosis: Limited data available: Adolescents: Intravaginal:
Cream 2%: Limited data available: One full applicator (5 g) inserted intravaginally at bedtime for 7 days (CDC [Workowski 2015]; Red Book [AAP 2015])
Suppository: Insert one ovule (100 mg clindamycin) intravaginally once daily at bedtime for 3 days
There are no dosage adjustments provided in the manufacturer's labeling; however, no dosage adjustments are required with systemic clindamycin use.
There are no dosage adjustments provided in the manufacturer's labeling; however, no dosage adjustments are required with systemic clindamycin use; use caution with severe hepatic impairment.
(For additional information see "Clindamycin (topical): Drug information")
Acne: Topical:
Gel (Cleocin T, ClindaMax), pledget, lotion, solution: Apply a thin film twice daily.
Gel (Clindagel), foam (Evoclin): Apply once daily.
Bacterial vaginosis:
Note: Treatment is generally not warranted for asymptomatic patients who are not pregnant. When treatment is given, the 7-day regimen is preferred (CDC [Workowski 2021]).
2% cream (Cleocin): Intravaginal: One applicatorful (5 g containing ~100 mg clindamycin) once daily at bedtime for 7 days (CDC [Workowski 2021]).
2% cream (Clindesse) (alternative agent): Intravaginal: One applicatorful (5 g containing ~100 mg clindamycin) once as a single dose (CDC [Workowski 2021]; Faro 2005).
100 mg suppository (alternative agent): Intravaginal: One suppository once daily at bedtime for 3 days (CDC [Workowski 2021]).
Hidradenitis suppurativa (off-label use): Solution: Topical: Apply to affected area twice daily (Jemec 2012).
Rosacea (off-label use): Lotion: Topical: Apply twice daily to the face (Wilkin 1993).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, Vaginal, as phosphate [strength expressed as base]:
Cleocin: 2% (40 g) [contains benzyl alcohol]
Clindesse: 2% (5 g) [contains disodium edta, methylparaben, propylparaben]
Generic: 2% (40 g)
Foam, External, as phosphate [strength expressed as base]:
Evoclin: 1% (50 g, 100 g) [contains alcohol, usp, cetyl alcohol, propylene glycol]
Evoclin: 1% (50 g [DSC], 100 g [DSC]) [contains cetyl alcohol, propylene glycol]
Generic: 1% (50 g, 100 g)
Gel, External, as phosphate [strength expressed as base]:
Cleocin-T: 1% (30 g, 60 g) [contains methylparaben, propylene glycol]
Clindagel: 1% (75 mL) [contains methylparaben, polyethylene glycol, propylene glycol]
Generic: 1% (30 g, 60 g, 75 mL)
Kit, External, as phosphate [strength expressed as base]:
Clindacin ETZ: 1% [contains cetyl alcohol, isopropyl alcohol, propylene glycol]
Clindacin Pac: 1% [contains cetyl alcohol, isopropyl alcohol, propylene glycol]
Lotion, External, as phosphate [strength expressed as base]:
Cleocin-T: 1% (60 mL) [contains cetostearyl alcohol, methylparaben]
Generic: 1% (60 mL)
Solution, External, as phosphate [strength expressed as base]:
Cleocin-T: 1% (60 mL [DSC]) [contains isopropyl alcohol, propylene glycol]
Generic: 1% (30 mL, 60 mL)
Suppository, Vaginal, as phosphate [strength expressed as base]:
Cleocin: 100 mg (3 ea)
Swab, External, as phosphate [strength expressed as base]:
Cleocin-T: 1% (60 ea) [contains isopropyl alcohol, propylene glycol]
Clindacin ETZ: 1% (60 ea) [contains isopropyl alcohol, propylene glycol]
Clindacin-P: 1% (69 ea) [contains isopropyl alcohol, propylene glycol]
Generic: 1% (60 ea)
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, Vaginal, as phosphate [strength expressed as base]:
Dalacin Vaginal: 2% (40 g) [contains benzyl alcohol, propylene glycol]
Solution, External, as phosphate [strength expressed as base]:
Clinda-T: 1% (30 mL, 60 mL) [contains isopropyl alcohol, propylene glycol]
Dalacin T: 1% ([DSC]) [contains alcohol, usp, propylene glycol]
Generic: 1% (30 mL, 60 mL)
Xaciato Vaginal Gel: FDA approved December 2021; anticipated availability currently unknown. Information pertaining to this product within the monograph is pending revision. Xaciato is indicated for the treatment of bacterial vaginosis in female patients 12 years of age and older. Consult the prescribing information for additional information.
Intravaginal: Do not use for topical therapy, instillation in the eye, or oral administration. Wash hands prior to use. Remove foil from suppository; place cream or suppository into applicator; insert applicator into vagina as far as possible without causing discomfort and expel suppository or cream. Remain lying down for 30 minutes following administration. Wash applicator with soap and water following suppository use; if administering the cream, use each disposable applicator only once.
Topical: For dermal topical use only. Do not use intravaginally, instill in the eye, or administer orally. Avoid contact with eyes, mouth, lips, mucous membranes, or broken skin.
Foam: Before applying foam, wash affected area with mild soap, then dry. Remove cap, hold can at an upright angle, and dispense foam directly into the cap or onto a cool surface; do not dispense foam directly onto hands or face (foam will melt on content with warm skin). If can is warm or foam is runny, run can under cold water. Use fingertips to pick up small amounts of foam and gently massage into affected area until foam disappears. Wash hands after applying. Avoid fire, flame, or smoking during or immediately following application.
Gel, pledget, solution: Solution/pledget contains an alcohol base and if inadvertent contact with mucous membranes occurs, rinse with liberal amounts of water. Remove pledget from foil immediately before use; discard after single use. May use more than one pledget for each application to cover area.
Lotion: Shake well immediately before use; apply topically.
Intravaginal:
Cream: Insertion with the applicator should be as far as possible into the vagina without causing discomfort.
Suppository: Remove from packaging prior to use. If applicator is used for administration, insertion should be as far as possible into the vagina without causing discomfort; wash applicator after each use. Patient should lie down after administration to minimize leakage.
Topical:
Foam: Dispense directly into cap or onto a cool surface; do not dispense directly into hands or face (foam will melt on contact with warm skin). Wash skin with mild soap and allow to fully dry. Apply in small amounts to face using fingertips and gently massage into affected areas until foam disappears. Avoid contact with eyes, mouth, lips, mucous membranes, or broken skin.
Gel: Avoid contact with eyes.
Lotion: Shake well immediately before using.
Solution or pledget: Avoid contact with eyes, mouth or other mucous membranes; solution/pledget contains an alcohol base and if inadvertent contact with mucous membranes occurs, rinse with liberal amounts of water. Remove pledget from foil immediately before use; discard after single use. May use more than one pledget for each application to cover area.
Cream: Store at 20°C to 25°C (68°F to 77°F). Protect from freezing.
Foam: Store at 20°C to 25°C (68°F to 77°F). Avoid fire, flame, or smoking during or immediately following application. Do not puncture or incinerate container. Do not expose to heat or store at temperatures >49°C (120°F).
Gel: Store at 20°C to 25°C (68°F to 77°F). Protect from freezing.
Clindagel: Do not store in direct sunlight.
Lotion: Store at 20°C to 25°C (68°F to 77°F). Protect from freezing.
Pledget: Store at 20°C to 25°C (68°F to 77°F). Protect from freezing.
Suppository: Store at 25°C (77°F); excursions are permitted to 15°C to 30°C (59°F to 86°F). Avoid heat >30°C (86°F) and high humidity.
Topical solution: Store at 20°C to 25°C (68°F to 77°F). Protect from freezing.
Topical: Foam, gel, lotion, pledget, solution: Treatment of acne vulgaris (FDA approved in ages ≥12 years and adults)
Vaginal:
Cleocin Vaginal Cream: Treatment of bacterial vaginosis (FDA approved in adults)
Cleocin Ovules, Clindesse cream: Treatment of bacterial vaginosis (FDA approved in post-menarche, nonpregnant adolescents and adults)
Cleocin may be confused with bleomycin, Clinoril, Cubicin, Lincocin
Clindamycin may be confused with clarithromycin, Claritin, vancomycin
Clindesse may be confused with Clindets [Canada]
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions report in adolescents and adults.
Topical:
>10%: Dermatologic: Burning sensation of skin (10% to 11%), erythema of skin (7% to 16%), exfoliation of skin (7% to 11%), local dryness of skin (1% to 23%), oily skin (1% to 18%), pruritus (7% to 11%)
1% to 10%:
Local: Application site burning (6%), application site pruritus (1%)
Nervous system: Headache (3%)
Intravaginal:
>10%: Genitourinary: Vaginitis (4% to 11%; including vaginal discharge, vaginal infection), vulvovaginal candidiasis (2% to 14%)
1% to 10%:
Gastrointestinal: Constipation (2%)
Genitourinary: Trichomonal vaginitis (1%), urinary tract infection (2%), vaginal pain (2%), vulvovaginal disease (3% to 5%; including localized erythema, localized swelling, vaginal discomfort, vaginal dryness, vaginal irritation, vulvitis, vulvovaginal bleeding, vulvovaginal burning, vulvovaginal pruritus), vulvovaginitis (4% to 6%)
Infection: Candidiasis (≤3%), fungal infection (1%)
Nervous system: Headache (7%)
Neuromuscular & skeletal: Back pain (5%)
<1%:
Dermatologic: Erythema of skin, maculopapular rash, pruritic rash, pruritus, skin rash, urticaria
Endocrine & metabolic: Hyperthyroidism, intermenstrual bleeding, menstrual disease
Gastrointestinal: Abdominal cramps, abdominal pain, diarrhea, dysgeusia, dyspepsia, flatulence, halitosis, nausea, vomiting
Genitourinary: Dysmenorrhea, dysuria, endometriosis, pelvic pain, uterine hemorrhage
Hypersensitivity: Hypersensitivity reaction
Infection: Bacterial infection
Local: Application site pain, application-site pruritus, localized edema
Nervous system: Dizziness, fatigue, flank pain, pain, vertigo
Renal: Pyelonephritis
Respiratory: Epistaxis
Miscellaneous: Fever, swelling (with inflammation)
Postmarking (all products):
Dermatologic: Contact dermatitis, folliculitis (gram-negative infection), seborrhea, skin irritation, skin pain
Gastrointestinal: Bloody diarrhea, Clostridioides difficile colitis, colitis, hematochezia
Local: Application site erythema, application site rash, local swelling
Ophthalmic: Eye pain
Hypersensitivity to clindamycin, lincomycin, or any component of the formulation; history of antibiotic-associated colitis, regional enteritis, ulcerative colitis.
Concerns related to adverse effects:
• Colitis: Use may result in fungal or bacterial superinfection, including Clostridioides difficile-associated diarrhea (CDAD); CDAD has been observed >2 months postantibiotic treatment. Discontinue drug if significant diarrhea, abdominal cramps, or passage of blood and mucus occurs.
• Superinfection: The use of clindamycin may result in the overgrowth of nonsusceptible organisms, particularly yeasts, in the vagina. Treatment-related moniliasis and vaginitis have been reported.
Special populations:
• Atopic patients: Use with caution in atopic patients.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling.
• Topical foam: Topical foam may cause irritation especially when used with abrasive, desquamating or peeling agents; avoid contact with eyes, mouth, lips, mucous membranes, or broken skin.
• Topical pledget or solution: Topical pledget and topical solution contain an alcohol base and may cause eye irritation or burning. Rinse with cool tap water if product comes in contact with mucous membranes, abraded skin, or eyes. Use caution when applying near mouth (unpleasant taste).
• Vaginal products: May weaken condoms, or contraceptive diaphragms; barrier contraceptives are not recommended concurrently or for 3 to 5 days (depending on the product) following treatment. Avoid vaginal intercourse or use of other vaginal products (eg, douches, tampons) during therapy. Vaginal cream contains ingredients that may cause eye burning and irritation; rinse with cool tap water if product comes in contact with the eyes.
Other warnings/precautions:
• Appropriate use: Acne: American Academy of Dermatology (AAD) acne guidelines recommend clindamycin (topical) be used in conjunction with other therapies (not as monotherapy) due to the risk of bacterial resistance. If given for mild acne, clindamycin (topical) should be used in combination with benzoyl peroxide. If given for moderate to severe acne, it should be used in combination with a topical retinoid or systemic antibiotic agent (AAD [Zaenglein 2016]).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).
None known.
Erythromycin (Systemic): May diminish the therapeutic effect of Clindamycin (Topical). Management: Consider avoiding the concomitant use of systemic erythromycin and topical clindamycin when treating acne vulgaris. This recommendation does not appear to apply to intravaginal use of clindamycin for the treatment of bacterial vaginosis. Risk D: Consider therapy modification
Erythromycin (Topical): May diminish the therapeutic effect of Clindamycin (Topical). Management: Consider avoiding use of topical erythromycin and topical clindamycin at the same application site when treating acne vulgaris. This recommendation does not appear to apply to intravaginal use of clindamycin for the treatment of bacterial vaginosis. Risk D: Consider therapy modification
Neuromuscular-Blocking Agents: Clindamycin (Topical) may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
Some vaginal products contain mineral oil which may weaken condoms or contraceptive diaphragms. Therefore, use of these products are not recommended for birth control during therapy or for 3 to 5 days (depending on the product) following treatment.
Clindamycin crosses the placenta following oral and parenteral dosing (Philipson 1973; Weinstein 1976). The amount of clindamycin available systemically is less following topical and vaginal application than with IV or oral administration.
Various clindamycin vaginal products are available for the treatment of bacterial vaginosis. Recommendations for use in pregnant woman vary by product labeling. Current guidelines note that the same oral or vaginal regimens used in nonpregnant patients may be used during pregnancy, including oral or vaginal clindamycin (CDC [Workowski 2021]).
If treatment for acne is needed during pregnancy, topical clindamycin may be considered if an antibiotic is needed. To decrease systemic exposure, pregnant women should avoid application to inflamed skin for long periods of time, or to large body surface areas (Kong 2013).
Observe for changes in bowel frequency.
Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal depending on drug concentration, infection site, and organism
Absorption: Topical solution or foam, phosphate: Minimal; Vaginal cream, phosphate: ~5%; Vaginal suppository, phosphate: ~30%
Metabolism: Hepatic; forms metabolites (variable activity); Clindamycin phosphate is converted to clindamycin HCl (active)
Half-life elimination: Vaginal cream: 1.5 to 2.6 hours following repeated dosing; Vaginal suppository: 11 hours (range: 4 to 35 hours, limited by absorption rate)
Time to peak, serum: Vaginal cream: ~10 to 14 hours (range: 4 to 24 hours); Vaginal suppository: ~5 hours (range: 1 to 10 hours)
Excretion: Urine (<0.2% with topical foam and solution)
Cream (Cleocin Vaginal)
2% (per gram): $6.03
Cream (Clindamycin Phosphate Vaginal)
2% (per gram): $2.72 - $3.26
Cream (Clindesse Vaginal)
2% (per gram): $30.40
Foam (Clindamycin Phosphate External)
1% (per gram): $6.93
Foam (Evoclin External)
1% (per gram): $11.44
Gel (Clindagel External)
1% (per mL): $28.44
Gel (Clindamycin Phosphate External)
1% (per gram): $1.80 - $3.46
Kit (Clindacin ETZ External)
1% (per each): $774.68
Kit (Clindacin Pac External)
1% (per each): $774.70
Lotion (Cleocin-T External)
1% (per mL): $2.34
Lotion (Clindamycin Phosphate External)
1% (per mL): $1.92 - $2.40
Solution (Clindamycin Phosphate External)
1% (per mL): $0.33 - $1.36
Suppository (Cleocin Vaginal)
100 mg (per each): $73.50
Swab (Clindacin ETZ External)
1% (per each): $12.91
Swab (Clindacin-P External)
1% (per each): $11.23
Swab (Clindamycin Phosphate External)
1% (per each): $0.84
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