Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% 10 mg/g; .25 mg/g Gel — NDC 21922-050-07 (Billing 21922-0050-07)
This is a package of Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% 10 mg/g; .25 mg/g Gel from Encube Ethicals, Inc., marketed since Sep 2023 and currently FDA-listed; retail pharmacies pay about $3.51 per g (NADAC). It is the main listing for this product, which comes in 2 package sizes.
NDC database record
One package, one record: these facts belong to NDC 21922-050-07 alone.
- Record
- FDA NDC Directory package listing · Human prescription drug
- Code segments
- 21922 labeler · 050 product · 07 package
- Package marketed since
- Sep 4, 2023
- Sample package
- No — commercial package
- Listing certified through
- Dec 31, 2026
- Barcode (UPC)
- 0321922050073, 0321922050059
- Medicaid fills, this package
- 247 prescriptions in the last four reported quarters
- FDA record last changed
- Jul 24, 2026
Identity & classification
Regulatory identifiers FDA, NLM and CMS codes for this package
Drug-database identifiers Medi-Span GPI and First Databank GCN / HICL / AHFS classification
- GSN (GCN sequence number): 061775
- GCN: 97560
- GPI-14 (Medi-Span): 90059902654020
- HICL (First Databank): 034216
- AHFS class code: 08:12.28.20
- RxCUI (RxNorm): 882548
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 1, 2026
- FDA label on DailyMed · label index refreshed Oct 5, 2026
- RxNorm (NLM RxNav) · catalog refreshed Oct 1, 2026
- Medi-Span GPI (licensed)
- First Databank (licensed) · refreshed Oct 1, 2026
RxNorm drug class
This medicine belongs to the Retinoid class.
Where does this data come from?
- RxClass (NLM) · catalog refreshed Oct 1, 2026
Clinical
Topical clindamycin is used to treat acne. Clindamycin is in a class of medications called lincomycin antibiotics. It works by slowing or stopping the growth of bacteria that cause acne and by decreasing swelling.
Read the full MedlinePlus article ↗- It treats acne vulgaris, which is common acne, in people 12 and older. It combines an antibiotic (clindamycin) with a retinoid (tretinoin). The two work together to calm acne bacte...
- Use a pea-sized amount once a day in the evening or at bedtime. Dot it on your chin, cheeks, nose and forehead, then gently rub it over your face. Keep it away from your eyes, mout...
- Skin irritation is the most common: redness, flaking, itching, burning, stinging and dryness. Some people also had cold-like symptoms or a sore throat in studies. Tell me or your d...
- Stop it and call if you get significant diarrhea, especially bloody diarrhea, or bad stomach cramps. Clindamycin can cause a serious bowel problem called colitis. It can even show...
Patient education
Supplement & herbal interactions
Where does this data come from?
- MedlinePlus (NLM) · refreshed Oct 1, 2026
- FDA label on DailyMed · label index refreshed Oct 5, 2026
Ask a licensed pharmacist directly — free, answered by our team.
Pricing
A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.
| Price system | Per g | Per package |
|---|---|---|
| Retail pharmacies payNADAC · weekly | $3.506 | $210.38 / 60 g |
| Medicaid paysCMS SDUD · 12 mo | $5.60 | $335.84 / 60 g |
| Medicare drug plans payPart D · Q2 2026 | $6.94 | $416.42 / 60 g |
Where does this data come from?
- CMS NADAC weekly file · file of Sep 30, 2026
- CMS ASP pricing files · refreshed Sep 20, 2026
- CMS Medicaid State Drug Utilization Data · through Q1 2026
- CMS Part D plan pricing files · refreshed Sep 24, 2026
- VA National Acquisition Center price file
Packaging — all sizes for this product
| Package NDC | Description | Per unit | Per pack | Marketing start | Marketing end | Status |
|---|---|---|---|---|---|---|
| 21922-0050-05 21922-050-05 | 1 TUBE in 1 CARTON / 30 g in 1 TUBE | $4.31 / g | $129.36 | 2023-09-04 | — | Active |
| 21922-0050-07 You're viewing this Main listing | 1 TUBE in 1 CARTON / 60 g in 1 TUBE | $3.51 / g | $210.38 | 2023-09-04 | — | Active |
This pack has the lowest per-g cost of the 2 priced pack sizes ($3.51 NADAC).
In Medicaid, this is the most-dispensed pack of this product — about 55% of fills over the last four reported quarters. See all packs ↓
Pack size FAQ
What quantity is in this package?
What NDC number is used to bill for this package of Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% 10 mg/g; .25 mg/g Gel?
Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.
Therapeutic equivalents
| Product | Labeler | Pack | NADAC/unit | TE | Status | Price vs. this |
|---|---|---|---|---|---|---|
| Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% 10 mg/g; .25 mg/gthis 21922-0050-07 | Encube | 1 tube | $3.506 | AB2 | Availability likely | — |
| Clindamycin Phosphate and Tretinoin 12 mg/g; .25 mg/g 00472-1790-30 | Actavis | 1 tube | $4.312 | AB1 | Availability likely | +23% |
| Clindamycin Phosphate and Tretinoin 10 mg/g; .25 mg/g 73473-0306-30 | Solaris | 1 tube | $4.312 | AB2 | Availability likely | +23% |
| Clindamycin Phosphate 1.2% and Tretinoin 0.025% 12 mg/g; .25 mg/g 68682-0300-30 | Oceanside | 1 tube | $6.545 | AB1 | FDA listed | +87% |
| Ziana 12 mg/g; .25 mg/g 99207-0300-30 | Bausch | 1 tube | — | AB1 | FDA listed | — |
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 1, 2026
- FDA Orange Book · refreshed Oct 3, 2026
- CMS NADAC weekly file · file of Sep 30, 2026
Availability & generic status
This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.
Where does this data come from?
- FDA Orange Book · refreshed Oct 3, 2026
Inactive Ingredients / Excipients
Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.
🧪 Avoiding an ingredient? See Clindamycin / Tretinoin inactive ingredients by manufacturer: every current product's list side by side, so you can ask your pharmacy for the version that does not list it.
💡 Tap an ingredient (hover on desktop) to see what it is and why it’s used.
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UNII XF417D3PSL
Anhydrous citric acid is a sour, crystalline powder derived from citric acid with water removed. In medicines, it acts as a buffer to control pH, adds tartness to improve taste, and helps tablets disintegrate.
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UNII 1P9D0Z171K
BHT is a synthetic antioxidant that prevents fats and oils in medicines from breaking down and becoming rancid. It helps keep the product stable and effective during storage.
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UNII 4Q93RCW27E
A synthetic polymer made from acrylic acid that's crosslinked for stability. It acts as a thickener and gelling agent in creams and gels, helping the medicine spread evenly and maintain its texture.
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UNII 7FLD91C86K
Edetate disodium is a chemical compound that binds and removes certain metal ions. In medicines, it acts as a preservative and stabilizer by preventing metals like calcium from interfering with the product's shelf life and consistency.
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UNII 6HQ855798J
Laureth-4 is a synthetic detergent made from lauryl alcohol and ethylene oxide. It acts as an emulsifier and solubilizer, helping blend oil and water-based ingredients and improve how the body absorbs the active drug.
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UNII A2I8C7HI9T
Methylparaben is a preservative derived from benzoic acid that prevents growth of bacteria, fungi, and mold in medicines. It extends the product's shelf life and maintains safety during storage.
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UNII 6DC9Q167V3
Propylene glycol is a clear liquid derived from petroleum or vegetable sources. It acts as a solvent, humectant, and preservative in medicines, helping dissolve active ingredients and maintain product stability.
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UNII 023C2WHX2V
Tromethamine is a chemical buffer that helps maintain the proper acidity level in liquid medicines. It neutralizes acids and stabilizes the solution so the medication remains effective and safe throughout its shelf life.
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UNII 059QF0KO0R
Water is a liquid solvent that dissolves and mixes ingredients together in liquid medicines, syrups, and injections. It helps distribute the active drug evenly throughout the product.
9 inactive ingredients listed in the exact product block matched to this NDC.
Where does this data come from?
ingredient classCode="IACT" elements from the exact product block matched by this NDC. Label-section narrative from DailyMed / the openFDA label index is shown separately when available.- FDA label on DailyMed · label index refreshed Oct 5, 2026
- FDA openFDA NDC Directory · synced Oct 1, 2026
Inactive ingredient FAQ
Are inactive ingredients the same for every manufacturer?
Why might an inactive ingredient be missing?
Can inactive ingredients matter?
Manufacturer & labeler
More NDCs from Encube Ethicals, Inc. labeler code 21922
- TRETINOIN .8 mg/g Gel NDC 21922-043-40
- Diclofenac Sodium 10 mg/g Gel NDC 21922-044-09
- Mesalamine 4 g/60mL Suspension NDC 21922-045-47
- Metronidazole Vaginal Gel 65 mg/5g Gel NDC 21922-046-41
- Nitroglycerin 4 mg/g Ointment NDC 21922-048-05
- Fluorouracil 2 g/40g Cream NDC 21922-049-17
- Adapalene Gel USP, 0.3% 3 mg/g Gel NDC 21922-051-06
- Adapalene and Benzoyl Peroxide Gel, 0.1%/2.5% 1 mg/g; 25 mg/g Gel NDC 21922-052-50
- CICLOPIROX 80 mg/mL Solution NDC 21922-053-51
- Nitroglycerin 20 mg/g Ointment NDC 21922-054-05
- TRETINOIN .1 mg/g Gel NDC 21922-056-04
- TRETINOIN .25 mg/g Gel NDC 21922-057-04
Where does this data come from?
- FDA openFDA NDC Directory · synced Oct 1, 2026
- Drugs@FDA
Full prescribing information FDA SPL
🎯 Indications and Usage ▾
1 INDICATIONS AND USAGE Clindamycin phosphate and tretinoin gel is indicated for the topical treatment of acne vulgaris in patients 12 years or older. Clindamycin phosphate and tretinoin gel is a lincosamide antibiotic and retinoid combination product indicated for the topical treatment of acne vulgaris in patients 12 years or older. (1)
⏱️ Dosage and Administration ▾
2 DOSAGE AND ADMINISTRATION Clindamycin phosphate and tretinoin gel should be applied once daily in the evening, gently rubbing the medication to lightly cover the entire affected area. Approximately a pea-sized amount will be needed for each application. Avoid the eyes, lips, and mucous membranes.
Clindamycin phosphate and tretinoin gel is not for oral, ophthalmic, or intravaginal use. Apply a pea-size amount once daily in the evening lightly covering the entire affected area. Avoid the eyes, lips, and mucous membranes.
(2) Not for oral, ophthalmic, or intravaginal use. (2)
💊 Dosage Forms and Strengths ▾
3 DOSAGE FORMS AND STRENGTHS Clindamycin phosphate and tretinoin gel 1.2%/0.025%, containing clindamycin phosphate 1.2% and tretinoin 0.025%, is off white to a yellow, opaque topical gel. Each gram of clindamycin phosphate and tretinoin gel 1.2%/0.025% contains, as dispensed, 10 mg (1%) clindamycin as clindamycin phosphate, and 0.25 mg (0.025%) tretinoin solubilized in an aqueous-based gel. Topical gel: clindamycin phosphate 1.2% and tretinoin 0.025% in 30-gram and 60-gram tubes.
(3)
⛔ Contraindications ▾
4 CONTRAINDICATIONS Clindamycin phosphate and tretinoin gel is contraindicated in patients with regional enteritis, ulcerative colitis, or history of antibiotic-associated colitis. Clindamycin phosphate and tretinoin gel is contraindicated in patients with regional enteritis, ulcerative colitis, or history of antibiotic- associated colitis. (4)
⚠️ Warnings and Cautions ▾
5 WARNINGS AND PRECAUTIONS Colitis: Clindamycin can cause severe colitis, which may result in death. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of clindamycin. Clindamycin phosphate and tretinoin gel should be discontinued if significant diarrhea occurs. (5.1) Ultraviolet Light and Environmental Exposure: Avoid exposure to sunlight, sunlamps, and weather extremes. Wear sunscreen daily. (5.2)
5.1Colitis Systemic absorption of clindamycin has been demonstrated following topical use. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical clindamycin. If significant diarrhea occurs, clindamycin phosphate and tretinoin gel should be discontinued.
Severe colitis has occurred following oral or parenteral administration of clindamycin with an onset of up to several weeks following cessation of therapy. Antiperistaltic agents such as opiates and diphenoxylate with atropine may prolong and/or worsen severe colitis. Severe colitis may result in death.
Studies indicate a toxin(s) produced by clostridia is one primary cause of antibiotic-associated colitis. The colitis is usually characterized by severe persistent diarrhea and severe abdominal cramps and may be associated with the passage of blood and mucus. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically.
5.2Ultraviolet Light and Environmental Exposure Exposure to sunlight, including sunlamps, should be avoided during the use of clindamycin phosphate and tretinoin gel. Patients with sunburn should be advised not to use the product until fully recovered because of heightened susceptibility to sunlight as a result of the use of tretinoin. Patients who may be required to have considerable sun exposure due to occupation and those with inherent sensitivity to the sun should exercise particular caution.
Daily use of sunscreen products and protective apparel (e.g., a hat) are recommended. Weather extremes, such as wind or cold, also may be irritating to patients under treatment with clindamycin phosphate and tretinoin gel.
🤒 Adverse Reactions ▾
6 ADVERSE REACTIONS Observed local treatment-related adverse reactions (≥ 1%) in clinical studies with clindamycin phosphate and tretinoin gel were application site reactions, including dryness, irritation, exfoliation, erythema, pruritus, and dermatitis. Sunburn was also reported. (6.1) To report SUSPECTED ADVERSE REACTIONS, contact Encube Ethicals Private Limited at 1-833-285-4151 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
6.1Adverse Reactions in Clinical Studies Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in clinical studies of a drug cannot be directly compared with rates in the clinical studies of another drug and may not reflect the rates observed in clinical practice. The safety data reflect exposure to clindamycin phosphate and tretinoin gel in 1,104 patients with acne vulgaris. Patients were 12 years and older and were treated once daily in the evening for 12 weeks.
Adverse reactions that were reported in ≥1% of patients treated with clindamycin phosphate and tretinoin gel are presented in Table 1 . Table 1. Treatment-Related Adverse Reactions Reported by ≥1% of Subjects Clindamycin Phosphate and Tretinoin Gel N = 1,104 n (%) Clindamycin Gel N = 1,091 n (%) Tretinoin Gel N = 1,084 n (%) Vehicle Gel N = 552 n (%) Patients with at least one adverse reaction 140 (13) 38 (3) 141 (13) 17 (3) Application site dryness 64 (6) 12 (1) 62 (6) 3 (1) Application site irritation 50 (5) 4 (<1) 57 (5) 5 (1) Application site exfoliation 50 (5) 2 (<1) 56 (5) 2 (<1) Application site erythema 40 (4) 6 (1) 39 (4) 3 (1) Application site pruritus 26 (2) 7 (1) 23 (2) 6 (1) Sunburn 11 (1) 6 (1) 7 (1) 3 (1) Application site dermatitis 6 (1) 0 (0) 8 (1) 1 (<1) Local skin reactions actively assessed at baseline and end of treatment with a score >0 are presented in Table 2 .
Table 2. Clindamycin Phosphate and Tretinoin Gel - Treated Patients with Local Skin Reactions Clindamycin Phosphate and Tretinoin Gel Vehicle Gel Local Reaction Baseline N = 476 (%) End of Treatment N = 409 (%) Baseline N = 219 (%) End of Treatment N = 209 (%) Erythema 24% 21% 31% 35% Scaling 8% 19% 14% 12% Dryness 11% 22% 18% 13% Burning 8% 13% 8% 4% Itching 17% 15% 22% 14% During the 12 weeks of treatment, each local skin reaction peaked at Week 2 and gradually reduced thereafter.
🔄 Drug Interactions ▾
7 DRUG INTERACTIONS Clindamycin phosphate and tretinoin gel should not be used in combination with erythromycin-containing products because of its clindamycin component. (7.1)
7.1Erythromycin Clindamycin phosphate and tretinoin gel should not be used in combination with erythromycin-containing products due to possible antagonism to the clindamycin component. In-vitro studies have shown antagonism between these 2 antimicrobials. The clinical significance of this in-vitro antagonism is not known.
7.2Neuromuscular Blocking Agents Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. Therefore, clindamycin phosphate and tretinoin gel should be used with caution in patients receiving such agents.
👥 Use in Specific Populations ▾
8 USE IN SPECIFIC POPULATIONS Pediatric Use: The efficacy and safety have not been established in pediatric patients below the age of 12 years. (8.4)
8.1Pregnancy Pregnancy Category C. There are no well-controlled studies in pregnant women treated with clindamycin phosphate and tretinoin gel. Clindamycin phosphate and tretinoin gel should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
A limit teratology study performed in Sprague Dawley rats treated topically with clindamycin phosphate and tretinoin gel or 0.025% tretinoin gel at a dose of 2 mL/kg during gestation days 6 to 15 did not result in teratogenic effects. Although no systemic levels of tretinoin were detected, craniofacial and heart abnormalities were described in drug-treated groups. These abnormalities are consistent with retinoid effects and occurred at 16 times the recommended clinical dose assuming 100% absorption and based on body surface area comparison.
For purposes of comparison of the animal exposure to human exposure, the recommended clinical dose is defined as 1 g of clindamycin phosphate and tretinoin gel applied daily to a 50-kg person. Clindamycin : Reproductive developmental toxicity studies performed in rats and mice using oral doses of clindamycin up to 600 mg/kg/day (480 and 240 times the recommended clinical dose based on body surface area comparison, respectively) or subcutaneous doses of clindamycin up to 180 mg/kg/day (140 and 70 times the recommended clinical dose based on body surface area comparison, respectively) revealed no evidence of teratogenicity.
Tretinoin: Oral tretinoin has been shown to be teratogenic in mice, rats, hamsters, rabbits, and primates. It was teratogenic and fetotoxic in Wistar rats when given orally at doses greater than 1 mg/kg/day (32 times the recommended clinical dose based on body surface area comparison). However, variations in teratogenic doses among various strains of rats have been reported.
In the cynomologous monkey, a species in which tretinoin metabolism is closer to humans than in other species examined, fetal malformations were reported at oral doses of 10 mg/kg/day or greater, but none were observed at 5 mg/kg/day (324 times the recommended clinical dose based on body surface area comparison), although increased skeletal variations were observed at all doses. Dose-related teratogenic effects and increased abortion rates were reported in pigtail macaques. With widespread use of any drug, a small number of birth defect reports associated temporally with the administration of the drug would be expected by chance alone.
Thirty cases of temporally associated congenital malformations have been reported during 2 decades of clinical use of another formulation of topical tretinoin. Although no definite pattern of teratogenicity and no causal association have been established from these cases, 5 of the reports describe the rare birth defect category, holoprosencephaly (defects associated with incomplete midline development of the forebrain). The significance of these spontaneous reports in terms of risk to fetus is not known.
8.3Nursing Mothers It is not known whether clindamycin is excreted in human milk following use of clindamycin phosphate and tretinoin gel. However, orally and parenterally administered clindamycin has been reported to appear in breast milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
It is not known whether tretinoin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when clindamycin phosphate and tretinoin gel is administered to a nursing woman.
8.4Pediatric Use Safety and effectiveness of clindamycin phosphate and tretinoin gel in pediatric patients below the age of 12 years have not been established. Clinical… [Excerpted — this section continues on DailyMed.]
🤰 Pregnancy ▾
8.1Pregnancy Pregnancy Category C. There are no well-controlled studies in pregnant women treated with clindamycin phosphate and tretinoin gel. Clindamycin phosphate and tretinoin gel should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
A limit teratology study performed in Sprague Dawley rats treated topically with clindamycin phosphate and tretinoin gel or 0.025% tretinoin gel at a dose of 2 mL/kg during gestation days 6 to 15 did not result in teratogenic effects. Although no systemic levels of tretinoin were detected, craniofacial and heart abnormalities were described in drug-treated groups. These abnormalities are consistent with retinoid effects and occurred at 16 times the recommended clinical dose assuming 100% absorption and based on body surface area comparison.
For purposes of comparison of the animal exposure to human exposure, the recommended clinical dose is defined as 1 g of clindamycin phosphate and tretinoin gel applied daily to a 50-kg person. Clindamycin : Reproductive developmental toxicity studies performed in rats and mice using oral doses of clindamycin up to 600 mg/kg/day (480 and 240 times the recommended clinical dose based on body surface area comparison, respectively) or subcutaneous doses of clindamycin up to 180 mg/kg/day (140 and 70 times the recommended clinical dose based on body surface area comparison, respectively) revealed no evidence of teratogenicity.
Tretinoin: Oral tretinoin has been shown to be teratogenic in mice, rats, hamsters, rabbits, and primates. It was teratogenic and fetotoxic in Wistar rats when given orally at doses greater than 1 mg/kg/day (32 times the recommended clinical dose based on body surface area comparison). However, variations in teratogenic doses among various strains of rats have been reported.
In the cynomologous monkey, a species in which tretinoin metabolism is closer to humans than in other species examined, fetal malformations were reported at oral doses of 10 mg/kg/day or greater, but none were observed at 5 mg/kg/day (324 times the recommended clinical dose based on body surface area comparison), although increased skeletal variations were observed at all doses. Dose-related teratogenic effects and increased abortion rates were reported in pigtail macaques. With widespread use of any drug, a small number of birth defect reports associated temporally with the administration of the drug would be expected by chance alone.
Thirty cases of temporally associated congenital malformations have been reported during 2 decades of clinical use of another formulation of topical tretinoin. Although no definite pattern of teratogenicity and no causal association have been established from these cases, 5 of the reports describe the rare birth defect category, holoprosencephaly (defects associated with incomplete midline development of the forebrain). The significance of these spontaneous reports in terms of risk to fetus is not known.
🧒 Pediatric Use ▾
8.4Pediatric Use Safety and effectiveness of clindamycin phosphate and tretinoin gel in pediatric patients below the age of 12 years have not been established. Clinical trials of clindamycin phosphate and tretinoin gel included 2,086 patients aged 12 through 17 years with acne vulgaris. [See Clinical Studies ( 14 ).]
🧓 Geriatric Use ▾
8.5Geriatric Use Clinical studies of clindamycin phosphate and tretinoin gel did not include sufficient numbers of subjects aged 65 and older to determine whether they respond differently from younger subjects.
🧬 Clinical Pharmacology ▾
12 CLINICAL PHARMACOLOGY
12.1Mechanism of Action Clindamycin : [See Microbiology ( 12.4 ).] Tretinoin : Although the exact mode of action of tretinoin is unknown, current evidence suggests that topical tretinoin decreases cohesiveness of follicular epithelial cells with decreased microcomedone formation. Additionally, tretinoin stimulates mitotic activity and increased turnover of follicular epithelial cells causing extrusion of the comedones.
12.3Pharmacokinetics In an open-label study of 17 patients with moderate-to-severe acne vulgaris, topical administration of approximately 3 grams of clindamycin phosphate and tretinoin gel once daily for 5 days, clindamycin concentrations were quantifiable in all 17 patients starting from 1 hour post-dose. All plasma clindamycin concentrations were ≤5.56 ng/mL on Day 5, with the exception of 1 subject who had a maximum clindamycin concentration of 8.73 ng/mL at 4 hours post-dose. There was no appreciable increase in systemic exposure to tretinoin, as compared with the baseline value.
The average tretinoin concentration across all sampling times on Day 5 ranged from 1.19 to 1.23 ng/mL compared with the corresponding baseline mean tretinoin concentration range of 1.16 to 1.30 ng/mL.
12.4Microbiology No microbiology studies were conducted in the clinical trials with this product. Mechanism of Action : Clindamycin binds to the 50S ribosomal subunit of susceptible bacteria and prevents elongation of peptide chains by interfering with peptidyl transfer, thereby suppressing protein synthesis. Clindamycin has been shown to have in-vitro activity against Propionibacterium acnes (P. acnes) , an organism that has been associated with acne vulgaris; however, the clinical significance of this activity against P. acnes was not examined in clinical studies with clindamycin phosphate and tretinoin gel.
P. acnes resistance to clindamycin has been documented. Inducible Clindamycin Resistance : The treatment of acne with antimicrobials is associated with the development of antimicrobial resistance in P. acnes as well as other bacteria (e.g., Staphylococcus aureus, Streptococcus pyogenes ). The use of clindamycin may result in developing inducible resistance in these organisms.
This resistance is not detected by routine susceptibility testing. Cross Resistance : Resistance to clindamycin is often associated with resistance to erythromycin.
🧬 Mechanism of Action ▾
12.1Mechanism of Action Clindamycin : [See Microbiology ( 12.4 ).] Tretinoin : Although the exact mode of action of tretinoin is unknown, current evidence suggests that topical tretinoin decreases cohesiveness of follicular epithelial cells with decreased microcomedone formation. Additionally, tretinoin stimulates mitotic activity and increased turnover of follicular epithelial cells causing extrusion of the comedones.
📦 How Supplied / Storage and Handling ▾
16 HOW SUPPLIED/STORAGE AND HANDLING How Supplied Clindamycin phosphate and tretinoin gel, 1.2%/0.025% supplied as off white to yellow, opaque topical gel is as follows: 30 g aluminum tubes NDC 21922-050-05 60 g aluminum tubes NDC 21922-050-07 Storage and Handling Store at 25°C (77°F); excursions permitted from 15°C to 30°C (59°F to 86°F). Protect from heat. Protect from light. Protect from freezing. Keep out of reach of children. Keep tube tightly closed.
📋 Description ▾
11 DESCRIPTION Clindamycin phosphate and tretinoin gel 1.2%/0.025%, is a fixed combination of 2 solubilized active ingredients in an aqueous-based gel. Clindamycin phosphate is a water soluble ester of the semi-synthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent antibiotic lincomycin. The chemical name for clindamycin phosphate 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-(dihydrogen phosphate).
The structural formula for clindamycin phosphate is represented below: Molecular Formula: C 18 H 34 ClN 2 O 8 PS Molecular Weight: 504.97 The chemical name for tretinoin is all- trans 3,7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexen-1-yl)-2,4,6,8-nonatetraenoic acid. It is a member of the retinoid family of compounds. The structural formula for tretinoin is represented below: Molecular Formula: C 20 H 28 O 2 Molecular Weight: 300.44 Clindamycin phosphate and tretinoin gel contains the following inactive ingredients: anhydrous citric acid, butylated hydroxytoluene, carbomer homopolymer (type C), edetate disodium, laureth 4, methylparaben, propylene glycol, purified water, and tromethamine. str-clinda str-treti
💬 Information for Patients ▾
17 PATIENT COUNSELING INFORMATION See FDA-approved patient labeling ( Patient Information ).
17.1Instructions for Use At bedtime, the face should be gently washed with a mild soap and water. After patting the skin dry, apply clindamycin phosphate and tretinoin gel as a thin layer over the entire affected area (excluding the eyes and lips). Patients should be advised not to use more than a pea-sized amount to cover the face and not to apply more often than once daily (at bedtime) as this will not make for faster results and may increase irritation.
A sunscreen should be applied every morning and reapplied over the course of the day as needed. Patients should be advised to avoid exposure to sunlight, sunlamp, ultraviolet light, and other medicines that may increase sensitivity to sunlight. Other topical products with a strong drying effect such as abrasive soaps or cleansers may cause an increase in skin irritation with clindamycin phosphate and tretinoin gel.
17.2Skin Irritation Clindamycin phosphate and tretinoin gel may cause irritation such as erythema, scaling, itching, burning, or stinging.
17.3Colitis In the event a patient treated with clindamycin phosphate and tretinoin gel experiences severe diarrhea or gastrointestinal discomfort, clindamycin phosphate and tretinoin gel should be discontinued and a physician should be contacted. Manufactured by: Encube Ethicals Private Limited, Plot No C-1, Madkaim Industrial Estate, Ponda, Goa 403404, India. Distributed by: Encube Ethicals, Inc., 200 Meredith Drive, Suite 202, Durham, North Carolina (NC) 27713, United States (USA).
🍼 Nursing Mothers ▾
8.3Nursing Mothers It is not known whether clindamycin is excreted in human milk following use of clindamycin phosphate and tretinoin gel. However, orally and parenterally administered clindamycin has been reported to appear in breast milk. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
It is not known whether tretinoin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when clindamycin phosphate and tretinoin gel is administered to a nursing woman.
🧬 Pharmacokinetics ▾
12.3Pharmacokinetics In an open-label study of 17 patients with moderate-to-severe acne vulgaris, topical administration of approximately 3 grams of clindamycin phosphate and tretinoin gel once daily for 5 days, clindamycin concentrations were quantifiable in all 17 patients starting from 1 hour post-dose. All plasma clindamycin concentrations were ≤5.56 ng/mL on Day 5, with the exception of 1 subject who had a maximum clindamycin concentration of 8.73 ng/mL at 4 hours post-dose. There was no appreciable increase in systemic exposure to tretinoin, as compared with the baseline value.
The average tretinoin concentration across all sampling times on Day 5 ranged from 1.19 to 1.23 ng/mL compared with the corresponding baseline mean tretinoin concentration range of 1.16 to 1.30 ng/mL.
🔬 Clinical Studies ▾
14 CLINICAL STUDIES The safety and efficacy of clindamycin phosphate and tretinoin gel, applied once daily for the treatment of acne vulgaris, was evaluated in 12-week multi-center, randomized, blinded studies in subjects 12 years and older. Treatment response was defined as the percent of subjects who had a 2-grade improvement from baseline to Week 12 based on the Investigator’s Global Assessment (IGA) and a mean absolute change from baseline to Week 12 in 2 out of 3 (total, inflammatory and non-inflammatory) lesion counts.
The IGA scoring scale used in all the clinical trials for clindamycin phosphate and tretinoin gel is as follows: 0 Clear Normal, clear skin with no evidence of acne vulgaris. 1 Almost Clear Skin almost clear; rare non-inflammatory lesions present, with rare non-inflamed papules (papules must be resolving and may be hyperpigmented, though not pink-red) requiring no further treatment in the Investigator’s opinion. 2 Mild Some non-inflammatory lesions are present, with few inflammatory lesions (papules/pustules only, no nodulo-cystic lesions).
3 Moderate Non-inflammatory lesions predominate, with multiple inflammatory lesions evident; several-to-many comedones and papules/pustules, and there may or may not be 1 small nodulo-cystic lesion. 4 Severe Inflammatory lesions are more apparent; many comedones and papules/pustules, there may or may not be a few nodulo-cystic lesions. 5 Very Severe Highly inflammatory lesions predominate; variable numbers of comedones, many papules/pustules and nodulo-cystic lesions.
In Studies 1, 1,649 subjects were randomized to clindamycin phosphate and tretinoin gel, clindamycin gel, tretinoin gel, and vehicle gel. The median age of subjects was 17 years and 58% were females. At baseline, subjects had an average of 71 total lesions of which the mean number of inflammatory lesions was 25.5 lesions and the mean number of non- inflammatory lesions was 45.1 lesions.
The majority of subjects enrolled with a baseline IGA score of 3. The efficacy results at Week 12 are presented in Table 3 . Table 3 .
Efficacy Results at Week 12 Study 1 Clindamycin Phosphate and Tretinoin Gel N = 476 Clindamycin Gel N = 467 Tretinoin Gel N = 464 Vehicle Gel N = 242 Investigator’s Global Assessment Percentage of subjects achieving 2-Grade Improvement 36.3% 26.6% 26.1% 20.2% Percentage of subjects achieving an IGA of 0 or 1 with a 2-Grade Improvement 33.2% 24.0% 22.6% 17.8% Inflammatory Lesions: Mean absolute reduction 15.5 14.5 13.9
11.1Mean percentage (%) reduction 60.4% 56.5% 54.5% 43.3% Non-inflammatory Lesions: Mean absolute reduction 23.2 19.5% 22.1
17.0Mean percentage (%) reduction 51.0% 42.9% 47.3% 36.0% Total Lesions: Mean absolute reduction 38.7 34.0 36.0
28.1Mean percentage (%) reduction 55.0% 49.0% 50.5% 39.1% The safety and efficacy of clindamycin-tretinoin gel was also evaluated in 2 additional 12-week, multi-centered, randomized, blinded studies in patients 12 years and older. A total of 2,219 subjects with mild-to-moderate acne vulgaris were treated once daily for 12 weeks. Of the 2,219 subjects, 634 subjects were treated with clindamycin-tretinoin gel. These studies demonstrated consistent outcomes.
🧪 Nonclinical Toxicology ▾
13 NONCLINICAL TOXICOLOGY
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term animal studies have not been performed to evaluate the carcinogenic potential of clindamycin phosphate and tretinoin gel or the effect of Clindamycin Phosphate and Tretinoin Gel on fertility. Clindamycin phosphate and tretinoin gel was negative for mutagenic potential when evaluated in an in-vitro Ames Salmonella reversion assay. Clindamycin Phosphate and Tretinoin Gel was equivocal for clastogenic potential in the absence of metabolic activation when tested in an in-vitro chromosomal aberration assay.
Clindamycin : Once-daily dermal administration of 1% clindamycin as clindamycin phosphate in the gel vehicle (32 mg/kg/day, 13 times the recommended clinical dose based on body surface area comparison) to mice for up to 2 years did not produce evidence of tumorigenicity. Fertility studies in rats treated orally with up to 300 mg/kg/day of clindamycin (240 times the recommended clinical dose based on body surface area comparison) revealed no effects on fertility or mating ability. Tretinoin : In 2 independent mouse studies where tretinoin was administered topically (0.025% or 0.1%) 3 times per week for up to 2 years no carcinogenicity was observed, with maximum effects of dermal amyloidosis.
However, in a dermal carcinogenicity study in mice, tretinoin applied at a dose of 5.1 mcg (1.4 times the recommended clinical dose based on body surface area comparison) 3 times per week for 20 weeks acted as a weak promoter of skin tumor formation following a single application of dimethylbenz[α]anthracene (DMBA). In a study in female SENCAR mice, papillomas were induced by topical exposure to DMBA followed by promotion with 12-O-tetradecanoylphorbol-13-acetate or mezerein for up to 20 weeks. Topical application of tretinoin prior to each application of promoting agent resulted in a reduction in the number of papillomas per mouse.
However, papillomas resistant to topical tretinoin suppression were at higher risk for pre-malignant progression. Tretinoin has been shown to enhance photoco-carcinogenicity in properly performed specific studies, employing concurrent or intercurrent exposure to tretinoin and UV radiation. The photoco-carcinogenic potential of the clindamycin tretinoin combination is unknown.
Although the significance of these studies to humans is not clear, patients should avoid exposure to sun. The genotoxic potential of tretinoin was evaluated in an in-vitro Ames Salmonella reversion test and an in-vitro chromosomal aberration assay in Chinese hamster ovary cells. Both tests were negative.
In oral fertility studies in rats treated with tretinoin, the no-observed-effect-level was 2 mg/kg/day (64 times the recommended clinical dose based on body surface area comparison).
📄 Carcinogenesis, Mutagenesis, Impairment of Fertility ▾
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term animal studies have not been performed to evaluate the carcinogenic potential of clindamycin phosphate and tretinoin gel or the effect of Clindamycin Phosphate and Tretinoin Gel on fertility. Clindamycin phosphate and tretinoin gel was negative for mutagenic potential when evaluated in an in-vitro Ames Salmonella reversion assay. Clindamycin Phosphate and Tretinoin Gel was equivocal for clastogenic potential in the absence of metabolic activation when tested in an in-vitro chromosomal aberration assay.
Clindamycin : Once-daily dermal administration of 1% clindamycin as clindamycin phosphate in the gel vehicle (32 mg/kg/day, 13 times the recommended clinical dose based on body surface area comparison) to mice for up to 2 years did not produce evidence of tumorigenicity. Fertility studies in rats treated orally with up to 300 mg/kg/day of clindamycin (240 times the recommended clinical dose based on body surface area comparison) revealed no effects on fertility or mating ability. Tretinoin : In 2 independent mouse studies where tretinoin was administered topically (0.025% or 0.1%) 3 times per week for up to 2 years no carcinogenicity was observed, with maximum effects of dermal amyloidosis.
However, in a dermal carcinogenicity study in mice, tretinoin applied at a dose of 5.1 mcg (1.4 times the recommended clinical dose based on body surface area comparison) 3 times per week for 20 weeks acted as a weak promoter of skin tumor formation following a single application of dimethylbenz[α]anthracene (DMBA). In a study in female SENCAR mice, papillomas were induced by topical exposure to DMBA followed by promotion with 12-O-tetradecanoylphorbol-13-acetate or mezerein for up to 20 weeks. Topical application of tretinoin prior to each application of promoting agent resulted in a reduction in the number of papillomas per mouse.
However, papillomas resistant to topical tretinoin suppression were at higher risk for pre-malignant progression. Tretinoin has been shown to enhance photoco-carcinogenicity in properly performed specific studies, employing concurrent or intercurrent exposure to tretinoin and UV radiation. The photoco-carcinogenic potential of the clindamycin tretinoin combination is unknown.
Although the significance of these studies to humans is not clear, patients should avoid exposure to sun. The genotoxic potential of tretinoin was evaluated in an in-vitro Ames Salmonella reversion test and an in-vitro chromosomal aberration assay in Chinese hamster ovary cells. Both tests were negative.
In oral fertility studies in rats treated with tretinoin, the no-observed-effect-level was 2 mg/kg/day (64 times the recommended clinical dose based on body surface area comparison).
📄 Patient Package Insert ▾
PATIENT INFORMATION Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% (kiln-duh-mai-suhn-faws-fayt-and-truh-ti-noh-uhn Gel, 1.2%/0.025%) _________________________________________________________________________________________________________ IMPORTANT: For use on skin only (topical use). Do not get Clindamycin Phosphate and Tretinoin Gel in your mouth, eyes, or vagina. _________________________________________________________________________________________________________ Read the Patient Information that comes with clindamycin phosphate and tretinoin gel before you start using it and each time you get a refill.
There may be new information. This leaflet does not take the place of talking with your doctor about your medical condition or your treatment. What is clindamycin phosphate and tretinoin gel?
Clindamycin phosphate and tretinoin gel is prescription medicine used on the skin to treat acne in people 12 years and older. It is not known if clindamycin phosphate and tretinoin gel is safe and effective in children under 12 years of age. Who should not use clindamycin phosphate and tretinoin gel?
Do not use clindamycin phosphate and tretinoin gel if you have: Crohn’s disease ulcerative colitis had inflammation of the colon (colitis) with past antibiotic use Talk to your doctor if you are not sure if you have one of these conditions. What should I tell my doctor before using clindamycin phosphate and tretinoin gel? Before using clindamycin phosphate and tretinoin gel, tell your doctor if you: have any allergies plan to have surgery with general anesthesia.
One of the medicines in clindamycin phosphate and tretinoin gel can affect how certain anesthesia medicines work. have any other medical conditions are pregnant or plan to become pregnant . It is not known if clindamycin phosphate and tretinoin gel may harm your unborn baby. are breastfeeding or plan to breastfeed . It is not known if clindamycin phosphate and tretinoin gel passes into your breast milk.
One of the medicines in clindamycin phosphate and tretinoin gel contains clindamycin. When clindamycin is taken by mouth or injection, it may pass into breast milk. You and your doctor should decide if you will take clindamycin phosphate and tretinoin gel or breastfeed.
You should not do both. Tell your doctor about all the medicines and skin products you use. Especially tell your doctor if you take medicine that contains erythromycin.
Clindamycin phosphate and tretinoin gel should not be used with products that contain erythromycin. Know the medicines you take. Keep a list of your medicines and show it to your doctor and pharmacist when you get a new medicine.
How should I use clindamycin phosphate and tretinoin gel? Use clindamycin phosphate and tretinoin gel exactly as prescribed. Your doctor will tell you how long to use clindamycin phosphate and tretinoin gel.
Do not apply clindamycin phosphate and tretinoin gel more than one time each day. Do not use too much clindamycin phosphate and tretinoin gel, because it may irritate your skin. Instructions for applying clindamycin phosphate and tretinoin gel: At bedtime, wash your face gently with a mild soap; rinse with water.
Pat the skin dry. Squeeze a pea-sized amount of medication onto one fingertip. Then, gently rub over the entire affected area.
Do not get clindamycin phosphate and tretinoin gel in your eyes, mouth, or on your lips. What should I avoid while using clindamycin phosphate and tretinoin gel? Limit your time in sunlight.
Avoid using tanning beds or sun lamps. If you have to be in sunlight, wear a wide-brimmed hat or other protective clothing. Apply a sunscreen every morning and re-apply during the day as needed.
Avoid wind and cold weather during treatment with clindamycin phosphate and tretinoin gel. These may be irritating to your skin. Avoid using abrasive soaps and cleansers.
These may cause increased skin irritation with clindamycin phosphate and tretinoin gel. What are the possible side effects of clin… [Excerpted — this section continues on DailyMed.]
📄 Package Label / Principal Display Panel ▾
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL CARTON LABEL - 30g NDC 21922-050-05 Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% For Topical use only Rx only CARTON LABEL - 60g NDC 21922-050-07 Clindamycin Phosphate and Tretinoin Gel 1.2%/0.025% For Topical use only Rx only cart-lab-30gm cart-lab-60gm