clindamycin phosphate + tretinoin: clinical use

Prescribing considerations

• Confirm that acne contains comedones with papules or pustules and that the patient is within the licensed age group.
• Counsel about early irritation, UV protection, pregnancy avoidance and antimicrobial resistance.
• Avoid simultaneous oral and topical antibiotics.
• Use caution in atopic patients and when substantial occupational sun exposure is unavoidable.

Contraindications and cautions

• Pregnancy or planning pregnancy
• Hypersensitivity to clindamycin, tretinoin, lincomycin or an excipient
• Regional enteritis, ulcerative colitis or previous antibiotic-associated colitis
• Personal or family history of skin cancer
• Acute eczema, rosacea or perioral dermatitis
• Pustular, deep cystic nodular, conglobate or fulminant acne

Monitoring

• Assess skin irritation, photosensitivity and clinical response.
• Ask about significant diarrhoea or abdominal cramps and investigate possible antibiotic-associated colitis when indicated.
• Monitor coagulation tests when clinically relevant in patients receiving vitamin K antagonists.
• Consider bacterial or fungal overgrowth, resistance or gram-negative folliculitis if lesions change or fail to respond.

Clinical pharmacology

Clindamycin phosphate is hydrolysed within the skin to active clindamycin, which inhibits susceptible bacterial protein synthesis. Tretinoin is comedolytic and anti-inflammatory, normalising follicular keratinisation and increasing epithelial turnover. Systemic exposure after topical use is generally low.

Formulation and product differences

• The selected product is a translucent yellow external-use gel. Its parabens, butylhydroxytoluene and polysorbate may cause local, delayed or allergic reactions in susceptible people.

Gel

Route: Cutaneous

Strengths: 1% + 0.025% w/w