Klindex Special Precautions

Serious Allergic Reactions/Severe Skin Reactions: Serious allergic reactions, including severe skin reactions such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) (some with fatal outcome) and acute generalized exanthematous pustulosis (AGEP) have been reported in patients receiving clindamycin therapy. If a hypersensitivity or severe skin reaction occurs, clindamycin should be discontinued and appropriate therapy should be initiated [see Adverse Reactions]. The usual agents (adrenaline, corticosteroids, antihistamines and colloid infusion) should be available for emergency treatment of serious reactions.
A thorough inquiry about the patient's history of hypersensitivity reactions should be made prior to initiating clindamycin therapy.
Use with caution in atopic individuals, as well as in patients with a history of gastrointestinal disease, particularly colitis.
Clindamycin has neuromuscular blocking properties which may enhance the effect of other neuromuscular blocking agents [see Interactions].
Clindamycin should not be used for the treatment of meningitis since it does not diffuse adequately into the CSF.
The combination of clindamycin with primaquine may cause hemolytic reactions in patients with G-6-PD deficiency; reference should also be made to the primaquine product monograph for other possible risk groups for other hematologic reactions. Blood examinations should be done routinely during clindamycin therapy with primaquine to monitor potential hematologic toxicities.
Use with caution in patients with severe renal and/or hepatic impairment accompanied by severe metabolic aberrations; serum clindamycin levels should be monitored during high-dose therapy in these patients.
Periodic liver and kidney function tests and blood counts should be performed during prolonged therapy.
Surgical drainage and removal of necrotic tissue should be performed in combination with antibiotic therapy, when indicated.
Prescribing clindamycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of antibiotic resistance.
As with other antibacterial drugs, long term or repeated use may result in overgrowth of non-susceptible organisms, including fungi.
Patients with Hepatic Impairment: Prolongation of the clindamycin t_1/2 has been observed in patients with moderate to severe liver disease. However, it is postulated from studies that when clindamycin is administered every eight hours, accumulation of the drug should rarely occur. Therefore, dosage reduction of clindamycin in patients with liver disease is not generally considered necessary. Liver enzyme levels should be determined periodically when treating patients with severe liver disease.
Patients with Renal Impairment: Dose modification of clindamycin may not be necessary in patients with renal disease. The serum t_1/2 of clindamycin is increased slightly in patients with markedly reduced renal function.
Use in Children: Administration of clindamycin in pediatric patients 16 years old and younger warrants organ system function monitoring.
Use in the Elderly: Pharmacokinetic studies have shown no clinically important differences between elderly and younger patients with normal hepatic function and normal (age-adjusted) renal function after oral or intravenous administration of clindamycin. Therefore, dosage modifications are not recommended in elderly patients with normal hepatic and normal (age-adjusted) renal function.
Clinical experience has demonstrated that antibiotic-associated diarrhea and colitis may occur more frequently and be more severe in geriatric patients (>60 years old). Therefore, geriatric patients receiving clindamycin should be carefully monitored for the development of diarrhea.