• Clinex indications
• Uses of Clinex in details
• Clinex description
• Clinex dosage
• Clinex interactions
• Clinex side effects
• Clinex contraindications

What is Clinex?

Clinex belongs to the family of medicines called antibiotics.

Topical Clinex is used to help control acne. It may be used alone or with one or more other medicines that are used on the skin or taken by mouth for acne.

Topical Clinex may also be used for other problems as determined by your doctor.

Clinex is available only with your doctor's prescription.

Clinex indications

Clinex (Clinex palmitate HCl) is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria.

Clinex is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci and staphylococci. Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Because of the risk of colitis, as described in the WARNING box, before selecting Clinex the physician should consider the nature of the infection and the suitability of less toxic alternatives (e.g., erythromycin).

Anaerobes: Serious respiratory tract infections such as empyema, anaerobic pneumonitis and lung abscess; serious skin and soft tissue infections; septicemia; intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal gastrointestinal tract); infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis and postsurgical vaginal cuff infection.

Streptococci: Serious respiratory tract infections; serious skin and soft tissue infections.

Staphylococci: Serious respiratory tract infections; serious skin and soft tissue infections.

Pneumococci: Serious respiratory tract infections.

Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to Clinex.

In Vitro Susceptibility Testing

A standardized disk testing procedure2 is recommended for determining susceptibility of aerobic bacteria to Clinex. A description is contained in the Clinex® Susceptibility Disk (Clinex) insert. Using this method, the laboratory can designate isolates as resistant, intermediate, or susceptible. Tube or agar dilution methods may be used for both anaerobic and aerobic bacteria. When the directions in the Clinex® Susceptibility Powder insert are followed, an MIC (minimal inhibitory concentration) of 1.6 mcg/mL may be considered susceptible; MICs of 1.6 to 4.8 mcg/mL may be considered intermediate and MICs greater than 4.8 mcg/mL may be considered resistant.

Clinex Susceptibility Disks 2 mcg. See package insert for use.

Clinex Susceptibility Powder 20 mg. See package insert for use.

For anaerobic bacteria the minimal inhibitory concentration (MIC) of Clinex can be determined by agar dilution and broth dilution (including microdilution) techniques. If MICs are not determined routinely, the disk broth method is recommended for routine use. THE KIRBY-BAUER DISK DIFFUSION METHOD AND ITS INTERPRETIVE STANDARDS ARE NOT RECOMMENDED FOR ANAEROBES.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Clinex and other antibacterial drugs, Clinex should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

How should I use Clinex?

Use Clinex suppositories as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Clinex suppositories comes with an extra patient information sheet called a Medication Guide. Read it carefully. Read it again each time you get Clinex suppositories refilled.
• Do not use this product if the foil pouch that contains Clindamycin suppositories is torn, open, or not sealed all the way.
• Insert into vagina at bedtime for 3 consecutive days.
• Once inside the vagina, Clinex suppositories melts. Lie down as soon as possible to minimize leakage.
• Clinex suppositories works best if it is used at the same time each day.
• To clear up your infection completely, use Clinex suppositories for the full course of treatment. Keep using it even if you feel better in a few days.
• If you miss a dose of Clinex suppositories and you are using it regularly, use it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not use 2 doses at once. If more than one dose is missed, contact your doctor or pharmacist.

Ask your health care provider any questions you may have about how to use Clinex suppositories.

Uses of Clinex in details

Use: Labeled Indications

Bone and joint infections: Treatment of bone and joint infections, including acute hematogenous osteomyelitis caused by Staphylococcus aureus and as adjunctive therapy in the surgical treatment of chronic bone and joint infections caused by susceptible organisms.

Gynecological infections: Treatment of gynecologic infections, including endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection caused by susceptible anaerobes.

Intraabdominal infections: Treatment of intraabdominal infections, including peritonitis and intraabdominal abscess caused by susceptible anaerobic organisms.

Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, empyema, and lung abscess caused by susceptible anaerobes, Streptococcus pneumoniae, other streptococci (except Enterococcus faecalis), and S. aureus.

Septicemia: Treatment of septicemia caused by S. aureus, streptococci (except E. faecalis), and susceptible anaerobes.

Skin and soft tissue infection: Treatment of skin and soft tissue infection caused by Streptococcus pyogenes, S. aureus, and susceptible anaerobes.

Off Label Uses

Anthrax

Based on the Centers for Disease Control and Prevention (CDC) expert panel meetings on prevention and treatment of anthrax in adults, Clinex is an effective and acceptable alternative for postexposure prophylaxis or treatment of cutaneous anthrax; it is also a first-line option, in combination with other antimicrobials, for the treatment of systemic anthrax. Alternative regimens have also been suggested for other patient populations with anthrax, including injectable drug users who develop injectional anthrax.

Streptococcal (group A) pharyngitis and chronic carriage

Based on the IDSA guidelines for the diagnosis and management of group A streptococcal pharyngitis, Clinex is an effective and recommended alternative agent for the treatment of streptococcal pharyngitis and an option for treatment of chronic group A streptococcal carriage.

Surgical prophylaxis

Based on the American Society of Health-System Pharmacists (ASHP) clinical practice guidelines for antimicrobial prophylaxis in surgery, Clinex, given as an alternative antibiotic in patients with beta-lactam allergy requiring surgical prophylaxis, is effective and recommended for a number of surgical procedures.

Toxoplasma gondii encephalitis and pneumonitis (treatment/long-term maintenance)

Based on the US Department of Health and Human Services guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents and the American Society of Transplantation Infectious Diseases Community of Practice guidelines on parasitic infections in solid organ transplantation, Clinex (with pyrimethamine and leucovorin) is an effective and recommended alternative regimen for the treatment and long-term maintenance therapy of Toxoplasma gondii encephalitis and pneumonitis.

Clinex description

Clinex is a semisynthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin.

Clinex phosphate is a water soluble ester of Clinex and phosphoric acid.

Clinex phosphate is L-threo-α-D-galacto-Octopyranoside, methyl 7-chloro-6, 7, 8-trideoxy-6-[[(1-methyl-4-propyl-2-pyrrolidinyl)carbonyl] amino]-1-thio-, 2-(dihydrogen phosphate), (2S-trans)-.

The molecular formula is C₁₈H₃₄CIN₂O₈PS and the molecular weight is 504.96.

Clinex hydrochloride is the hydrated hydrochloride salt of Clinex. Clinex hydrochloride is Methyl 7-chloro-6, 7, 8-trideoxy-6-(1-methyl-trans-4-propyl-L-2-pyrrolidinecarboxamido)-1-thio-L-threo-α-D-galacto-octopyranoside monohydrochloride.

Clinex palmitate hydrochloride is a water soluble salt of ester of Clinex and palmitic acid. Clinex palmitate hydrochloride is Methyl 7-chloro-6, 7, 8-trideoxy-6-(1-methyl-trans-4-propyl-L-2-pyrrolidinecarboxamido)-1-thio-L-threo-α-D-galacto-octopyranoside 2-palmitate monohydrochloride.

Clinex dosage

Clinex Dosage

Generic name: Clinex PHOSPHATE 10mg in 1g

Dosage form: aerosol, foam

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Clinex Foam is for topical use only, and not for oral, ophthalmic, or intravaginal use.

Apply Clinex Foam once daily to affected areas after the skin is washed with mild soap and allowed to fully dry. Use enough to cover the entire affected area.

If there has been no improvement after 6 to 8 weeks or if the condition becomes worse, treatment should be discontinued.

The contents of Clinex Foam are flammable; avoid fire, flame and/or smoking during and immediately following application.

More about Clinex (Clinex topical)

• Side Effects
• During Pregnancy or Breastfeeding
• Dosage Information
• Drug Interactions
• Support Group
• Pricing & Coupons
• 0 Reviews - Add your own review/rating
• Generic Availability

Consumer resources

• Clinex
• Clinex foam
• Clinex

  Topical (Advanced Reading)

• Other brands: Clinex T, Clindagel, Clinex Vaginal, Clindesse, More (8) »

Professional resources

• Clinex (FDA)
• Clinex Phosphate topical (AHFS Monograph)

Related treatment guides

• Acne
• Perioral Dermatitis

Clinex interactions

See also:
What other drugs will affect Clinex?

With simultaneous use of Clinex with theophylline, aminophylline, caffeine, there is an increase in their concentration in blood plasma and thus increases the risk of toxic effects.

Erythromycin increases the concentrations of cyclosporine in the blood plasma and may increase the risk of nephrotoxicity.

Drugs that block tubular secretion prolongs T1/2 of erythromycin.

Incompatible with lincomycin, Clinex and chloramphenicol (antagonism).

Clinex reduces the bactericidal action of beta-lactam antibiotics (penicillins, cephalosporins, carbapenems).

With simultaneous use of erythromycin increases the concentration of theophylline.

At the same time receiving chemotherapy, which is carried metabolism in the liver (carbamazepine, valproic acid, hexobarbital, phenytoin, alfentanil, dizopiramid, lovastatin, bromocriptine), may increase the concentration of these drugs in plasma (an inhibitor of microsomal liver enzymes).

IV injection of erythromycin increases the effects of ethanol (accelerating gastric emptying and decrease the duration of alcohol dehydrogenase in the gastric mucosa).

Erythromycin reduces the clearance of triazolam and midazolam and therefore may increase the pharmacological effects of benzodiazepines.

At the same time taking with terfenadine or astemizole may develop arrhythmias (fibrillation and ventricular flutter, ventricular tachycardia, until death); with dihydroergotamine or non hydrated ergot alkaloids may vasoconstriction to spasm, dysesthesia.

With simultaneous application Clinex slows elimination (increases the effect) of methylprednisolone, felodipine and anticoagulants of cumarine series.

In a joint appointment with lovastatin increased rhabdomyolysis.

Erythromycin increases the bioavailability of digoxin.

Erythromycin reduces the effectiveness of hormonal contraceptives.

Clinex side effects

See also:
What are the possible side effects of Clinex?

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

A total of 439 subjects with mild to moderate acne vulgaris were treated once daily for 12 weeks with Clinex Foam.

The incidence of adverse reactions occurring in ≥1% of the subjects in clinical trials comparing Clinex Foam and its vehicle is presented in Table 1.

Table 1: Adverse Reactions Occurring in ≥1% of Subjects

In a contact sensitization study, none of the 203 subjects developed evidence of allergic contact sensitization to Clinex Foam.

Postmarketing Experience

The following adverse reactions have been identified during post approval use of Clinex Foam: application site pain, application site erythema, diarrhea, urticaria, abdominal pain, hypersensitivity, rash, abdominal discomfort, nausea, seborrhea, application site rash, dizziness, pain of skin, colitis (including pseudomembranous colitis), and hemorrhagic diarrhea. 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.

Abdominal pain and gastrointestinal disturbances, as well as gram-negative folliculitis, have also been reported in association with the use of topical formulations of Clinex.

Orally and parenterally administered Clinex have been associated with severe colitis, which may end fatally.

Clinex contraindications

See also:
What is the most important information I should know about Clinex?

You should not use this medication if you are allergic to Clinex or lincomycin (Bactramycin, L-Mycin, Lincocin).

Do not take Clinex together with erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole, and others).

Before using Clinex, tell your doctor if you have kidney disease, liver disease, an intestinal disorder such as colitis or Crohn's disease, or a history of asthma, eczema, or allergic skin reaction.

Take this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clinex will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking Clinex and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using Clinex. You may need to stop using the medicine for a short time.

Active ingredient matches for Clinex:

Clindamycin in Bangladesh, Hong Kong, Indonesia.

Clindamycin HCl in Indonesia.

References

1. PubChem. "clindamycin". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
2. DrugBank. "clindamycin". http://www.drugbank.ca/drugs/DB01190 (accessed September 17, 2018).
3. MeSH. "Protein Synthesis Inhibitors". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology