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Clindamycin

Classification: A

Drug products: Acnatac, Clindamycin Actavis, Clindamycin Alternova, Clindamycin EQL Pharma, Clindamycin Orifarm, Clindamycin ratiopharm, Clindamycin Stragen, Dalacin, Dalacin®, Dalacine, Duac®, Klindamycin Ebb

ATC code: D10AF01, D10AF51, J01FF01

Substances: clindamycin, clindamycin hydrochloride, clindamycin monohydrochloride monohydrate, clindamycin palmitate hydrochloride, clindamycin phosphate

Summary

When patients with moderate to severe acne were treated with clindamycin, women responded better to treatment than men.

Diarrhea as a side effect to systemic clindamycin has been more reported in women than men.
 
In our opinion, the described differences do not motivate differentiated dosing or treatment in men and women.

Additional information

Pharmacokinetics and dosing

A pharmacokinetic study in healthy patients (11 men, 13 women) receiving an oral 600 mg dose of clindamycin showed that women had higher plasma levels than men, but the difference disappeared when the dose was weight adjusted [1]. The serum half-life of clindamycin is slightly increased in pregnant women compared to the average half-life in adults (3.3 h vs. 2.4 h) [2]. The clinical relevance is unclear as there are large variations in half-life. No sex differentiation in dosing has been recommended [3].

Effects

The efficacy of treatment with topical clindamycin phosphate 1.2% and benzoyl peroxide 3.75% gel has been studied in patients with moderate to severe acne in a double-blind, vehicle-controlled trial (256 men, 242 women). The absolute mean reduction in inflammatory, non-inflammatory, and total lesion counts was greater in women than men. Treatment success, defined as >2 grade reduction in Evaluator’s Global Severity Score from baseline, was achieved in 42.5% of women and in 28.2% of men [4].

Improvement in patient satisfaction after using topical clindamycin/benzoyl peroxide gel has shown to be similar in men and women mild to moderate acne [5].

Adverse effects

Elderly and women may be more likely to experience severe diarrhea or pseudomembranous colitis from systemic clindamycin treatment [6]. A prospective study (453 men, 547 women) found a higher incidence of diarrhea among women than men receiving clindamycin, 74.2% of patients developing diarrhea were women [7].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Updated: 2019-02-26

Date of litterature search: 2016-01-07

References

  1. del Carmen Carrasco-Portugal M, Luján M, Flores-Murrieta FJ. Evaluation of gender in the oral pharmacokinetics of clindamycin in humans. Biopharm Drug Dispos. 2008;29:427-30. PubMed
  2. Dollery C Sir, editor. Therapeutic drugs. 2nd ed. Edinburgh: Churchill Livingstone; 1999
  3. DALACIN (clindamycin). Summary of Product Characteristics. Swedish Medical Products Agency (MPA); 2015.
  4. Harper JC. The efficacy and tolerability of a fixed combination clindamycin (12%) and benzoyl peroxide (375%) aqueous gel in patients with facial acne vulgaris: gender as a clinically relevant outcome variable. J Drugs Dermatol. 2015;14:381-4. PubMed
  5. Fernandez-Obregon A, Davis MW. The BEST study: evaluating efficacy by selected demographic subsets. Cutis. 2003;71:18-26. PubMed
  6. Martindale: The Complete Drug Reference. Pharmaceutical Press.
  7. Swartzberg JE, Maresca RM, Remington JS. Clinical study of gastrointestinal complications associated with clindamycin therapy. J Infect Dis. 1977;135 Suppl:S99-103. PubMed
  8. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-06-30.] Socialstyrelsens statistikdatabas

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson