Clindamycin and Tretinoin (Topical)

Clindamycin/tretinoin is a prescription only gel that is used to treat patients that suffer from acne vulgaris. It is applied via the topical route - directly onto the affected area.

Overview

The drug combination contains the antibiotic clindamycin, which works to kills any bacteria present on the skin that may contribute to the formation and the spread of acne. It also contains tretinoin, which is part of a family of drugs called the retinoids. These drugs contain vitamin A, which helps to reduce the amount of oil that is released by the oil glands in the skin, while also helping your skin to restore itself. Retinoids have been known for decades to improve the look and feel of the skin, including improved softness, plumpness and reducing fine lines and wrinkles.

Acne vulgaris is a very common and chronic skin condition that can affect people of all ages. It is caused by the hair follicles on the skin becoming clogged up with oil, dirt and dead skin cells. Acne vulgaris is largely a visual condition, which is characterized by red nodule spots filled with puss, although it can also be very painful in severe cases. Acne spots can take a number of forms - Large red spots, whiteheads or blackheads. Spots often leave scarring on the skin and sometimes pucks in severe cases.

Clindamycin/tretinoin is usually prescribed to patients along with recommendations of lifestyle changes, such as advice on skincare regimes and diet. Acne vulgaris is thought to be largely caused by hormonal changes; however, a number of other factors, such as poor diet, skin irritations, allergies to skincare ingredients, poor hygiene and stress, are all thought to contribute.

Clindamycin and tretinoin topical gel is also marketed and sold under its brand names Veltin and Ziana in the United States.

Type of medication

  • topical gel

Conditions treated

  • Acne vulgaris

Side effects

There are various side effects that could be experienced as a result of using Clindamycin/tretinoin cream. These side effects are usually very mild and fairly uncommon. However, there are certain side effects that may mean you should not continue to use Clindamycin/tretinoin as it may not be compatible with your skin.

Common side effects include the following. Tell your doctor if your side effects persist or if they feel particularly unpleasant.

  •  Dry or flaky skin
  •  Skin rash
  •  Swelling to the skin around the affected area
  •  Redness of the skin
  •  Itchiness of the skin
  •  Skin that feels hot or warm to touch
  •  Change in colour of the skin
  •  Abdominal cramps
  •  Diarrhea
  •  Blood in the stools

There are also some less common side effects that patients may experience as a result of using this gel to treat their acne vulgaris. These side effects may be a sign of a more serious underlying condition developing, so you should report these to your doctor is they persist or become very unpleasant. They are:

  •  Persistent cough
  •  Headaches
  •  Aching muscles
  •  Pains around the cheeks and sensitive eye area
  •  Persistent sore throat
  •  Difficulty breathing
  •  Shortness of breath, even after very mild exertion
  •  Blocked up nose
  •  Excessive tiredness
  •  Weak feeling in muscles and bones
  •  Tight feeling in the chest
  •  Wheezing

Dosage

The dosage prescribed of Clindamycin/tretinoin is usually the same for all patients; you should apply a thin layer to the entire affected area of skin, once per day.

When applying Clindamycin/tretinoin to acne-infected skin, you must follow the usage instructions correctly to avoid the acne spreading or any of the spots becoming infected.

First, wash your hands thoroughly and make sure the area you are applying the gel to is clean and dry. Put a small, pea-sized amount of the gel on the end of your finger and gently spread a thin, even layer over the affected area. Once you have coated the entire area, allow the solution to dry on the skin. Do not put any other substance on top of the gel before it has dried. Thoroughly wash your hands after each application and make sure that the nozzle of the bottle does not come into contact with the skin.

Apply this solution to the whole area once per day around the same time each day.

Major drug interactions

Before you start using Clindamycin and tretinoin as a treatment for acne, your doctor will discuss all the treatment options with you to determine the most appropriate one. This decision will be made partly based on any other medication that you may be taking to treat your conditions. These drugs have been found to have an interaction with the gel, so combinations should be avoided:

* adapalene / benzoyl peroxide topical
* aminolevulinic acid topical
* ammoniated mercury / salicylic acid topical
* atracurium
* benzocaine / resorcinol topical
* benzoic acid / salicylic acid topical
* benzoyl peroxide topical
* benzoyl peroxide / clindamycin topical
* benzoyl peroxide / clindamycin / sodium hyaluronate topical
* benzoyl peroxide / erythromycin topical
* benzoyl peroxide / hydrocortisone topical
* benzoyl peroxide / salicylic acid topical
* benzoyl peroxide / sodium hyaluronate topical
* benzoyl peroxide / sulfur topical
* benzoyl peroxide / urea topical
* cisatracurium
* coal tar / lactic acid / salicylic acid topical
* coal tar / salicylic acid topical
* coal tar / salicylic acid / sulfur topical
* doxacurium
* doxycycline / salicylic acid topical
* hydrocortisone / salicylic acid / sulfur topical
* isotretinoin
* methoxsalen
* methyl aminolevulinate topical
* metocurine
* mivacurium
* pancuronium
* pipecuronium
* pyrithione zinc / salicylic acid topical
* rapacuronium
* resorcinol topical
* resorcinol / sulfur topical
* rocuronium
* salicylic acid topical
* salicylic acid / sodium thiosulfate topical
* salicylic acid / sulfur topical
* salicylic acid / urea topical
* succinylcholine
* sulfacetamide sodium / sulfur topical
* sulfacetamide sodium / sulfur / urea topical
* sulfur topical
* tubocurarine
* vecuronium
* verteporfin

Warnings

Pregnancy

This drug is not advised for use by patients that are pregnant, and is also often not recommended for use by women of childbearing age. This is because there have been animal studies that have shown there to be a risk to a fetus. It might also impact on future ability to conceive. However, there is currently no data on the impact of the topical gel on human pregnancies.

Disease interactions

Prior to taking Clindamycin/tretinoin, you should tell our doctor about any other conditions or diseases that you have been diagnosed with, or think you may be suffering from. This is because there are some instances in which you should not take Clindamycin/tretinoin, as some conditions can cause an interaction with the drug.

There are three conditions or diseases that interact with Clindamycin/tretinoin:

  •  Eczema - patients that suffer from this condition should not be prescribed Clindamycin/tretinoin. This is because the topical gel can cause eczema to flare up and the skin to become particularly dry and patchy upon application
  • Sunburn - this medication should not be applied to skin that has been burnt by the sun. The gel can cause further burning and discomfort, can cause the skin to blister, and may prolong or heighten the effects of sunburn.
  • Colitis - there have been reports of patients developing this condition as a result of the clindamycin component of the gel. The condition can range from relatively mild to life-threatening. Symptoms of colitis include persistent diarrhea, stomach cramps and passing mucus or blood in the urine or stools. Doctors should proceed with caution when prescribing this gel to patients with a history of gastrointestinal diseases such as colitis.

Children under 12

There is currently no data to determine the potential impact of clindamycin and tretinoin in children under the age of 12. The gel is intended for use by those over the age of 12. For any patients under the age of 12 that have developed the acne vulgaris condition, doctors should proceed with caution in choosing this topical gel as a treatment. It may be more appropriate and safe to try a milder topical solution in the first instance.

Food and alcohol

It is not advisable to consume alcohol when taking this medication. The gel works best as part of a holistic treatment for acne, and alcohol has been thought to contribute towards flare ups of the condition.

Diet is also important in helping to improve the symptoms of acne vulgaris, and this medication works best when it is complemented by diets that are rich in alkaline and healthy fats. Patients should avoid sugary or fizzy drinks, over processed foods and empty carbohydrates.

Storage

Patients should make sure that they store their Clindamycin/tretinoin prescription according to its instructions. This topical gel should always be kept in its original tubing, and must not be stored in temperatures above 25 degrees centigrade. You must also keep the tube away from direct sunlight and heat sources. Also, do not put your Clindamycin/tretinoin gel in the fridge or freezer.

When not in use, you should always carefully put the cap back onto the tube. Make sure that the nozzle or the cap does not come into contact with the affected skin and wipe clean with an antiseptic wipe if contact is made. Always keep your prescription out of the reach and sight of children and keep it clearly labelled so that it does not get mixed up with other ailments.

Disposal

After you have finished with your prescription medication, you should dispose of any leftover gel. Do not flush the gel down the drain or toilet, unless your doctor instructs you to do so. The best way to dispose of any unwanted or unused medication you may have in your drug cabinet is to call up the FDA's take-back schemes, to see if there is a collection service available in your local area. These are simple, hassle-free collections that recycle or safely dispose of medications so that they do not get into the possession if anyone for whom they were not intended.

Summary

This cream has been found to be effective at reducing the appearance of acne on the skin. However, it is unlikely to clear up the condition completely. Those with severe acne may also be prescribed a treatment of hormonal tablets - such as some contraceptive pills like Dianette or Yasmin.

Clindamycin/tretinoin is usually also prescribed to acne sufferers along with advice on positively changing any lifestyle and diet factors that could aggravate the condition. The topical medication is often prescribed to those with mild to moderate acne as a sole treatment.

Various clinical studies have found this drug to be relatively safe to use, without the risk of very severe side effects. However, it is not suitable for all patients, as those with certain other skin diseases such as eczema could see their condition worsen as a result of applying the gel.

It is very important that patients follow the correct usage instructions with this medication. As with all topical medications, Clindamycin/tretinoin is most effective when the affected areas are thoroughly clean and dry, and hands are washed before and after application.

Providing these instructions are followed, and patients are upfront with their doctors about their medical histories, Clindamycin/tretinoin can improve the quality of life of acne sufferers - reducing both the discomfort and the appearance of acne vulgaris.