Clindamycin / Tretinoin

Clindamycin / tretinoin gel is an antibiotic-retinoid combination used to treat acne on the skin. All supported products are approved for the same indication:

• Treatment of acne vulgaris (common acne) in patients 12 years of age and older — supported by Clindamycin Phosphate 1.2% and Tretinoin 0.025% Gel, Clindamycin Phosphate and Tretinoin Gel, Veltin Gel, and Ziana Gel

This gel works through two different pathways at once. Clindamycin is an antibiotic that binds to a part of bacterial cells called the 50S ribosomal subunit, blocking bacteria — particularly Propionibacterium acnes, the main acne-linked bacterium — from making proteins they need to grow. Tretinoin, a retinoid, speeds up the natural turnover of skin cells lining the hair follicles, making it harder for pores to get plugged. It also reduces the stickiness of those cells so that existing plugs (comedones) are pushed out more easily.

One important note: bacteria can develop resistance to clindamycin over time — and resistance to clindamycin often goes hand in hand with resistance to erythromycin. This is why this gel should not be combined with erythromycin products, and why it should only be used for as long as prescribed.

All forms of clindamycin / tretinoin gel are applied to the face once daily in the evening or at bedtime. Use only a pea-sized amount — that's enough to cover the whole face. Gently spread it across the affected area and keep it well away from your eyes, mouth, the corners of your nose, lips, and mucous membranes. This is a topical gel only — do not take it by mouth, use it in your eyes, or use it vaginally.

• Veltin Gel: apply once daily in the evening, lightly covering the entire affected area
• Ziana Gel and Clindamycin Phosphate 1.2% and Tretinoin 0.025% Gel: apply once daily at bedtime, dotting onto chin, cheeks, nose, and forehead, then gently rubbing over the entire face

The most common side effects are local skin reactions at the application site. These include:

• Skin redness (erythema)
• Peeling or scaling
• Itching
• Burning or stinging
• Dry skin
• Nasopharyngitis (cold-like symptoms such as a runny or stuffy nose)
• Pharyngolaryngeal pain (sore throat)
• Cough

Seek medical attention right away if you develop severe, persistent, or bloody diarrhea, or bad stomach cramps — these could be signs of serious colitis (colon inflammation), which can be life-threatening.

• Serious colitis risk: Clindamycin — even applied to skin — can be absorbed into the body and has been linked to severe colon inflammation, including pseudomembranous colitis caused by Clostridium difficile. Stop the gel and call your doctor immediately if you have significant diarrhea, bloody diarrhea, or severe stomach cramps. Do not use anti-diarrhea medicines without medical advice — they can make this condition worse or last longer. Severe colitis can be fatal.
• Sun sensitivity: Tretinoin makes your skin much more sensitive to ultraviolet light. Avoid sunlight, sunlamps, and tanning beds while using this gel. Apply sunscreen and wear protective clothing (like a hat) every day. Do not use the gel on sunburned skin — wait until the burn has fully healed. Wind and cold weather can also irritate skin that is being treated.
• Antibiotic resistance: Using clindamycin over time may cause bacteria on your skin to become resistant to it and to related antibiotics like erythromycin. Use only as long as prescribed.

Tell your doctor and pharmacist about all products you use on your skin and any medicines you take. Key interactions to know:

• Erythromycin-containing products: Do not use alongside this gel — the two antibiotics work against each other and the combination reduces effectiveness
• Harsh or drying topical products: Medicated or abrasive soaps, astringents, products with high alcohol content, and heavily drying cleansers or cosmetics can increase skin irritation when used at the same time — use with caution
• Neuromuscular blocking agents (muscle-relaxing medicines used in medical procedures): Clindamycin can strengthen their muscle-relaxing effects — tell your doctor or anesthesiologist that you use this gel

This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

• Do not use if you have regional enteritis (Crohn's disease affecting the intestines), ulcerative colitis, or a past history of antibiotic-associated colitis — these are contraindications
• If you are pregnant or thinking about becoming pregnant, talk to your doctor first — oral tretinoin is known to cause birth defects in animals; while systemic absorption from this topical gel is minimal, the risk to a human fetus is not fully established
• If you are breastfeeding, discuss with your doctor — clindamycin given by mouth or injection has been found in breast milk; it is unknown whether it passes into milk from topical use
• Not for use in children under 12 years old — safety and effectiveness have not been established in this age group
• Older adults (65+) were not studied in sufficient numbers to know if they respond differently — talk to your prescriber
• If your job or lifestyle means you spend a lot of time outdoors in the sun, let your doctor know — extra sun protection will be essential

Studies show that very little of either ingredient is absorbed into the bloodstream when this gel is applied to the skin as directed. In one study, blood levels of tretinoin after 14 days of daily use were minimal, with undetectable levels in up to 92% of subjects at any given time point. Clindamycin plasma concentrations generally stayed at or below 3.5 ng/mL in most subjects, though one individual reached 13.1 ng/mL. Because absorption is so low, systemic (whole-body) effects are unlikely at normal doses — but the possibility of some absorption is why warnings about colitis still apply.

Store at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) . Protect from light. Protect from freezing.