ADVERSE REACTIONS
Clinical trials
Non-pregnant Women
In clinical trials involving non-pregnant women, 1.8% of 600 patients who received treatment with CLEOCIN Vaginal Cream 2% for 3 days and 2.7% of 1325 patients who received treatment for 7 days discontinued therapy due to drug-related adverse events. Medical events judged to be related, probably related, possibly related, or of unknown relationship to vaginally administered clindamycin phosphate vaginal cream 2%, were reported for 20.7% of the patients receiving treatment for 3 days and 21.3% of the patients receiving treatment for 7 days. Events occurring in ≥1% of patients receiving clindamycin phosphate vaginal cream 2% are shown in Table 1.
| Event | CLEOCIN Vaginal Cream | |
|---|---|---|
| 3 Day n=600 | 7 Day n=1325 | |
| Urogenital | ||
| Vaginal moniliasis | 7.7 | 10.4 |
| Vulvovaginitis | 6.0 | 4.4 |
| Vulvovaginal disorder | 3.2 | 5.3 |
| Trichomonal vaginitis | 0 | 1.3 |
| Body as a Whole | ||
| Moniliasis (body) | 1.3 | 0.2 |
Other events occurring in <1% of the clindamycin vaginal cream 2% groups include:
Urogenital system: vaginal discharge, metrorrhagia, urinary tract infection, endometriosis, menstrual disorder, vaginitis/vaginal infection, and vaginal pain.
Body as a whole: localized abdominal pain, generalized abdominal pain, abdominal cramps, halitosis, headache, bacterial infection, inflammatory swelling, allergic reaction, and fungal infection.
Digestive system: nausea, vomiting, constipation, dyspepsia, flatulence, diarrhea, and gastrointestinal disorder.
Endocrine system: hyperthyroidism.
Central nervous system: dizziness and vertigo.
Respiratory system: epistaxis.
Skin: pruritus (non-application site), moniliasis, rash, maculopapular rash, erythema, and urticaria.
Special senses: taste perversion.
Pregnant Women
In a clinical trial involving pregnant women during the second trimester, 1.7% of 180 patients who received treatment for 7 days discontinued therapy due to drug-related adverse events. Medical events judged to be related, probably related, possibly related, or of unknown relationship to vaginally administered clindamycin phosphate vaginal cream 2%, were reported for 22.8% of pregnant patients. Events occurring in ≥1% of patients receiving either clindamycin phosphate vaginal cream 2% or placebo are shown in Table 2.
| Event | CLEOCIN Vaginal Cream | Placebo |
|---|---|---|
| 7 DAY n=180 | 7 DAY n=184 | |
| Urogenital | ||
| Vaginal moniliasis | 13.3 | 7.1 |
| Vulvovaginal disorder | 6.7 | 7.1 |
| Abnormal labor | 1.1 | 0.5 |
| Body as a Whole | ||
| Fungal infection | 1.7 | 0 |
| Skin | ||
| Pruritus, non-application site | 1.1 | 0 |
Other events occurring in <1% of the clindamycin vaginal cream 2% group include:
Urogenital system: dysuria, metrorrhagia, vaginal pain, and trichomonal vaginitis.
Body as a whole: upper respiratory infection.
Skin: pruritus (topical application site) and erythema.
Post-marketing Experience
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
In the post-marketing period, there have been case reports of pseudomembranous colitis with the use of clindamycin phosphate vaginal cream.
Other clindamycin formulations
Clindamycin vaginal cream affords minimal peak serum levels and systemic exposure (AUCs) of clindamycin compared to 100 mg oral clindamycin dosing. Although these lower levels of exposure are less likely to produce the common reactions seen with oral clindamycin, the possibility of these and other reactions cannot be excluded presently. Data from well-controlled trials directly comparing clindamycin administered orally to clindamycin administered vaginally are not available.
The following adverse reactions and altered laboratory tests have been reported with the oral or parenteral use of clindamycin:
Infections and Infestations: Clostridioides difficile colitis
Gastrointestinal: Abdominal pain, esophagitis, nausea, vomiting, diarrhea, and pseudomembranous colitis. (See WARNINGS.)
Hematopoietic: Transient neutropenia (leukopenia), eosinophilia, agranulocytosis, and thrombocytopenia have been reported. No direct etiologic relationship to concurrent clindamycin therapy could be made in any of these reports.
Hypersensitivity Reactions: Maculopapular rash and urticaria have been observed during drug therapy. Generalized mild to moderate morbilliform-like skin rashes are the most frequently reported of all adverse reactions. Cases of Acute Generalized Exanthematous Pustulosis (AGEP), erythema multiforme, some resembling Stevens-Johnson syndrome, have been associated with clindamycin. A few cases of anaphylactoid reactions have been reported. If a hypersensitivity reaction occurs, the drug should be discontinued.
Liver: Jaundice and abnormalities in liver function tests have been observed during clindamycin therapy.
Musculoskeletal: Cases of polyarthritis have been reported.
Renal: Acute kidney injury
Immune System: Drug reaction with eosinophilia and systemic symptoms (DRESS) cases have been reported.