Universal reference book for medicines
Name of the drug: DALACIN ® C PHOSPHATE (DALACIN ® C PHOSPHATE)

Active substance: clindamycin

Type: Lincosamides group antibiotic

Manufacturer: PFIZER MFG.
BELGIUM (Belgium)
Description of the active substance:
This information is a reference and it is not enough that the drug was prescribed by a doctor.
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PHARMACHOLOGIC EFFECT
Antibiotic group of lincosamides.
In therapeutic doses has a bacteriostatic effect, in high doses has a bactericidal effect on sensitive strains. It disrupts the intracellular synthesis of the protein in the early stages by binding to the 50S subunit of ribosome bacteria.
Clindamycin is active against most aerobic Gram-positive bacteria, including Staphylococcus spp.
(including strains producing penicillinase); Streptococcus spp., Bacillus anthracis, Corynebacterium diphtheriae.
Clindamycin is also active against anaerobic Gram-positive bacteria, including Eubacterium, Propionibacterium, Peptococcus, Peptostreptococcus spp., Many strains of Clostrtidium perfringens and Clostrtidium tetani.

Among gram-negative anaerobes, clindamycin is sensitive to Fusobacterium spp.
(excluding F.varium, which is usually stable), Veillonella, Bacteroides spp. (including B. fragilis).
With respect to Mycoplasma spp.
Clindamycin is usually less active than erythromycin.
Some strains of Actinomyces spp. Are sensitive to clindamycin.
and Nocardia asteroides.
Some antiprotozoal activity against Toxoplasma gondii and Plasmodium spp. Has been reported.

Clindamycin is resistant to Enterococcus spp., Methicillin-resistant strains of Staphylococcus aureus, most gram-negative aerobic bacteria (including Enterobacteriaceae spp.), Neisseria gonorrhoeae, Neisseria meningitidis and Haemophilus influenzae, as well as fungi (including yeast) and viruses.

PHARMACOKINETICS
After oral administration, about 90% of the dose of clindamycin is absorbed from the gastrointestinal tract.
After taking a dose of 150 mg after 1 hour, the concentration of clindamycin in the blood plasma is 2-3 μg / ml, after 6 hours - about 0.7 μg / ml. After taking a dose of 300 mg and 600 mg C max in plasma is 4 μg / ml and 8 μg / ml, respectively. With simultaneous intake of food, the rate of absorption decreases, while the degree of absorption varies insignificantly.
After the / m introduction, a dose of 300 mg C max in plasma averages 6 μg / ml and is achieved within 3 hours, with a dose of 600 μg - 9 μg / ml.

In children, Cmax in plasma is achieved within 1 h. When the same doses are injected into / in C max in plasma is 7-10 μg / ml and is reached at the end of the infusion.

In small amounts, clindamycin is absorbed from the surface of the skin.

With intravaginal administration, systemic absorption may be about 5%.

Clindamycin is widely distributed in tissues and body fluids, including bones, but does not reach significant concentrations in the central nervous system.
High concentrations of clindamycin are determined in bile. Clindamycin accumulates in leukocytes and macrophages.
About 90% of clindamycin binds to plasma proteins.

Clindamycin is metabolized, mainly in the liver, with the formation of N-demethylated and sulfoxide metabolites, as well as inactive metabolites.

T 1/2 is 2-3 hours, increases in patients with severe kidney disease and in premature newborns.

About 10% of the dose is excreted in the urine in the form of unchanged drugs and metabolites and about 4% with feces.
The remainder is excreted as inactive metabolites. Excretion is slow, within 7 days.
It is not removed from the blood by dialysis.

INDICATIONS
For systemic use: infectious and inflammatory diseases of severe course caused by microorganisms sensitive to clindamycin: pneumonia, lung abscess, pleural empyema, osteomyelitis, endometritis, adnexitis, purulent infections of the skin, soft tissues, wounds, peritonitis.
Prevention of peritonitis and intra-abdominal abscess after perforation or intestinal injury (in combination with aminoglycosides). As an antibiotic reserve for infections caused by strains of staphylococcus and other gram-positive microorganisms resistant to penicillin. As a means of prophylaxis in the extraction of teeth.
For external use: acne vulgaris.

For topical use: vaginosis caused by sensitive microorganisms.

DOSING MODE
Inside adults - 150-450 mg every 6 hours. When extracting teeth for prevention, a single dose of 600 mg in 1-2 admission scheme.

Inside the children - 3-6 mg / kg every 6 hours.

With a / m or / in the introduction of adults - 0.6-2.7 g / day in divided doses.
With very severe infections, IV can be administered up to 4.8 g / day. Maximum doses:with a single injection, a single dose of 600 mg, with an intravenous infusion of 1 h - 1.2 g.
With / m or / in the introduction of children over the age of 1 month - 15-40 mg / kg / day in divided doses.
In severe infections, a total dose of at least 300 mg / day should be administered.
Outer - applied to the affected area 2-3 times / day.

Intravaginally - 100 mg at night for 3-7 days.

SIDE EFFECT
On the part of the digestive system: nausea, vomiting, abdominal pain, diarrhea, after intravenous administration in high doses - an unpleasant metallic taste;
after ingestion - the phenomenon of esophagitis; transient increase in the activity of hepatic transaminases and bilirubin in blood plasma; in isolated cases - jaundice and liver disease.
From the hemopoietic system: rarely - reversible leukopenia, neutropenia, thrombocytopenia, agranulocytosis.

Allergic reactions: urticaria;
rarely erythema multiforme; in some cases - angioedema, fever, anaphylactic shock.
From the side of the cardiovascular system: with rapid IV / injection - lowering blood pressure, dizziness, weakness.

Local reactions: with iv injection in high doses - phlebitis;
with / m introduction rarely - irritation at the injection site, the development of infiltration, abscess.
For external use: irritation in the application site, contact dermatitis.
Due to small systemic absorption, there is a possibility of systemic side effects.
With topical application: cervicitis, vaginitis or vulvovaginal irritation.

Effects caused by chemotherapeutic action: pseudomembranous colitis, candidiasis.

CONTRAINDICATIONS
Hypersensitivity to clindamycin or lincomycin.

For systemic use: severe impairment of liver or kidney function, myasthenia gravis, bronchial asthma, ulcerative colitis (in anamnesis), pregnancy, lactation, children under 1 month old.

PREGNANCY AND LACTATION
Clindamycin penetrates the placental barrier into the fetal circulatory system.
Excreted in breast milk.
Clindamycin for oral administration and parenterally contraindicated in pregnancy and lactation.

Intravaginal application of clindamycin in pregnancy is possible if the intended benefit to the mother exceeds the potential risk to the fetus;
during lactation - only on strict indications.
APPLICATION FOR FUNCTIONS OF THE LIVER
In severe violations of kidney function, systemic use is contraindicated.

APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
In severe violations of liver function, systemic use is contraindicated.

APPLICATION FOR CHILDREN
In childhood, up to 1 month, systemic use is contraindicated.

APPLICATION IN ELDERLY PATIENTS
In the elderly, systemic use is contraindicated.

SPECIAL INSTRUCTIONS
With caution apply in patients with gastrointestinal diseases in the anamnesis.

If there is diarrhea or symptoms of colitis, clindamycin should be discontinued.

Pseudomembranous colitis can appear both in the presence of clindamycin, and 2-3 weeks after discontinuation of treatment.
Do not use drugs that inhibit the intestinal peristalsis.
It is not recommended to use clindamycin concomitantly with drugs that slow down neuromuscular transmission.

Intravaginally not recommended at the same time as other intravaginal drugs.

DRUG INTERACTION
Clindamycin increases the effect of drugs that block neuromuscular transmission.

With simultaneous use with opioids, it is possible to intensify the inhibitory effect on respiration.
Clindamycin may exhibit antagonism against the activity of sympathomimetics.
Synergism has been noted with respect to antibacterial action on some anaerobes between clindamycin and ceftazidime, metronidazole, ciprofloxacin.

There is evidence that clindamycin inhibits the bacterial activity of aminoglycosides.
Due to the similarity of binding sites on the ribosomes, clindamycin can competitively inhibit the action of macrolides and chloramphenicol.
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