Clindamycin interactions to avoid

Some side effects of clindamycin, including constipation, diarrhea, nausea,and gastrointestinal (GI) problems, can intensify when combined with certain medications

By Stephanie Melby, Pharm.D. | Oct. 17, 2023

Clindamycin is a generic prescription medication that is a commonly used antibiotic. Also available as a brand name medication called Cleocin, clindamycin can treat various bacterial infections. Some common types of infections treated with clindamycin include lower respiratory infections, intra-abdominal infections, gynecological infections like yeast infections or bacterial vaginosis, bone and joint infections, and skin infections. Additionally, clindamycin can be used to treat acne and pelvic inflammatory disease. Clindamycin is also prescribed sometimes by dentists to prevent infections such as endocarditis (an infection of the heart’s inner lining). Categorized as a lincosamide antibiotic, clindamycin works by preventing bacterial growth by inhibiting bacterial protein synthesis. Clindamycin is available in various dosage forms, including capsules, oral solution, vaginal cream and gel, topical lotion and gel, and intravenous (IV) injections administered in a hospital setting.

While clindamycin can be an effective treatment option for some people, there are drug interactions that are important to be aware of and avoid. Medications that are prescription-only and over-the-counter (OTC) can have dangerous drug interactions with other medications, certain foods, alcohol, and supplements. Drug interactions may cause unwanted side effects, make a certain drug less effective, or increase the action of a drug. As a medication that treats infections, drug interactions with clindamycin are very important to avoid as people could be at risk of infections persisting or worsening. Some interactions may increase the amount of clindamycin in the body, causing increased side effects like abdominal pain, nausea, vomiting, or diarrhea. Antibiotics can increase the risk of an infection called C. difficile (Clostridioides difficile/Clostridium difficile) in the colon, the longest part of the large intestine. Clindamycin has been frequently associated with antibiotic-associated diarrhea due to an overgrowth of C. difficile. Although this infection has been documented with almost all antibiotics, the most frequent offenders include clindamycin, ampicillin, amoxicillin, and cephalosporins.

Key takeaways:

Clindamycin can cause gastrointestinal (GI) side effects, including nausea, vomiting, diarrhea, and abdominal pain. Certain drug interactions can further increase these common side effects of clindamycin.
Clindamycin is an antibiotic that treats various bacterial infections, and certain drug interactions can make clindamycin less effective, leading to possible untreated infections.
Skin sensitivities can occur with various antibiotics, and potential clindamycin side effects include skin rashes and itchy skin reactions. Some drug interactions can further increase the skin side effects of clindamycin.
Dose adjustments may be necessary to avoid or lessen the effects of certain drug interactions with clindamycin.
Certain vaccines interact with clindamycin, which can cause a diminished vaccine effect.
If a dangerous mixture of medications has been consumed, seek immediate medical help or contact Poison Control for help.

Clindamycin–drug interactions

There are a variety of drugs that can interact with clindamycin and cause different unwanted effects. While some drugs may worsen clindamycin side effects, others may make clindamycin less effective.

CYP3A4 inducers

Drug metabolism can undergo various pathways, and cytochrome P450 (CYP) enzymes play an important role in this process. CYP enzymes can affect drug responses by influencing drug action, safety, bioavailability, and drug resistance through metabolism. There are a variety of CYP enzymes, and drugs may inhibit or induce the enzymes. CYP3A4 inducers are medications that speed up the metabolism of a drug and can make it less effective in the body. When clindamycin is mixed with a CYP3A4 inducer, the levels of clindamycin in the body can go down and lead to an untreated infection. Prescribers may suggest pausing or lowering the dose of certain CYP3A4 medications while people undergo clindamycin treatment. If taken together, people should be aware of symptoms of their infection not improving and contact their healthcare provider if symptoms worsen.

Examples of CYP3A4 inducers:

Seizure Medications

Prostate Cancer Medications

Erleada (apalutamide)
Xtandi (enzalutamide)

Supplements

St. John’s Wort

CYP3A4 inhibitors

On the other hand, CYP3A4 inhibitors are medications that slow down the metabolism of a drug and can cause higher plasma concentrations of drugs. This inhibition can increase the chances of adverse drug reactions and affect therapeutic responses. When clindamycin is mixed with a CYP3A4 inhibitor, the levels of clindamycin in the body can increase and lead to worsened side effects. Prescribers may suggest pausing or lowering the dose of certain CYP3A4 medications while people undergo clindamycin treatment. If taken together, people should be aware of the potential side effects of clindamycin and contact their doctor if side effects worsen.

Examples of CYP3A4 inhibitors:

Emend (aprepitant)
Orladeyo (berotralstat)
Cardizem (diltiazem)
Multaq (dronedarone)
Erythromycin
Diflucan (fluconazole)
Lexiva (fosamprenavir Isavuconazonium sulfate)
Kisqali (ribociclib)
Verelan (verapamil)

Certain vaccines

Certain vaccines should not be administered while taking antibiotics like clindamycin, as the effect of the vaccine can be diminished. The cholera vaccine (Vaxchora) should be avoided in people receiving antibiotics and for another 14 days following oral antibiotics. The BCG vaccine is used for tuberculosis prevention and should be used cautiously in people receiving antibiotics like clindamycin because there is the potential for diminished vaccine effect. Another vaccine affected by a drug interaction with clindamycin is the oral typhoid vaccine, Vivotif. When getting vaccines, healthcare professionals will screen people for any contraindications or precautions people may have before getting their vaccine.

Examples of vaccines:

Nerve blocking medications

Nerve-blocking medications are used during procedures to help prevent and manage pain. Clindamycin may enhance the nerve-blocking effect of these drugs and cause them to last longer than expected. This could unexpectedly affect the healthcare team, so providing a full list of prescription medications, OTC drugs, and supplements to the healthcare providers before any procedure is important.

Examples of nerve-blocking medications:

Atracurium
Nimbex (cisatracurium)
Rocuronium
Anectine (succinylcholine)
Vecuronium

Clindamycin-food interactions

Sometimes interactions with food are an unexpected warning with medications. Grapefruit is a food that commonly interacts with medications like clindamycin.

Clindamycin and Grapefruit Juice

While part of a healthy diet, grapefruit juice is a common culprit of drug interactions as it is a CYP3A4 inhibitor and can increase the amount of certain drugs in the body. This inhibition could increase the chances of adverse drug reactions and affect therapeutic responses. When clindamycin is mixed with grapefruit juice, clindamycin in the body can increase and worsen adverse effects. Prescribers may suggest pausing daily use of grapefruit juice while people undergo clindamycin treatment or monitor for increased side effects. Talking with a healthcare provider or pharmacist about potential grapefruit juice interactions is important.

How to minimize Clindamycin interactions

It’s important that healthcare providers are aware of all medical conditions and have a medication list, including prescription drugs, OTC medications, herbal products, and supplements. Even OTC and supplement products can have dangerous drug interactions. People can also turn to pharmacists as they are great resources and can provide additional drug information and medical advice when picking up medication from the pharmacy.

Certain medical conditions can impact whether a drug will be safe or not for a person. Clindamycin should be used cautiously in people with GI diseases such as colitis, liver disease or impairment, or kidney impairment. Caution should also be used in older adults as they may be unable to tolerate diarrhea’s potentially serious side effects. People who have had allergic reactions (such as hives or swelling of the face) to clindamycin or a similar medication called lincomycin should not use clindamycin due to potential life-threatening effects.

Clindamycin is present in breast milk, so the decision to breastfeed will be determined by a doctor. Several considerations include the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the breastfeeding mother. Other antibiotics may be safer options while a woman is breastfeeding. It’s important to look for potential clindamycin side effects in an infant, such as GI disturbances, diarrhea, and bloody stools.

When to talk to a healthcare provider about Clindamycin interactions

While many serious drug interactions associated with clindamycin are included, several other potential drug interactions are not. To ensure safe drug management, people should communicate openly with their healthcare providers about all medical conditions, medications, and supplements. Alternative medication options to clindamycin may be better treatment options for some people.