A fixed-dose combination of a lincosamide antibiotic (Clindamycin) and an imidazole antifungal (Clotrimazole) used primarily for the treatment of mixed bacterial and fungal vaginal infections, specifically bacterial vaginosis complicated by vulvovaginal candidiasis. Clindamycin targets anaerobic and gram-positive bacteria, while Clotrimazole acts against Candida species and other fungi.
Adult: One vaginal tablet inserted intravaginally, preferably at bedtime, for 3 consecutive days. For severe or recurrent infections, a 7-day course may be prescribed.
Note: 1. Wash hands before and after use. 2. Use the applicator provided. Load one tablet into the applicator. 3. Lie on back with knees bent. 4. Gently insert the applicator deep into the vagina and push the plunger to release the tablet. 5. Clean the applicator with mild soap and water. 6. Use during menstruation is not recommended. 7. Complete the full course even if symptoms improve.
The combination provides a dual antimicrobial action. Clindamycin binds to the 50S subunit of the bacterial ribosome, inhibiting protein synthesis, particularly effective against anaerobic bacteria and gram-positive cocci. Clotrimazole inhibits the synthesis of ergosterol, a critical component of the fungal cell membrane, by inhibiting the cytochrome P450-dependent enzyme lanosterol 14α-demethylase. This leads to increased membrane permeability and cell death.
Pregnancy: Category B (US FDA). Clindamycin: No well-controlled studies in pregnant women. Clotrimazole: Extensive vaginal use in pregnancy has not shown increased fetal risk. Use in first trimester only if potential benefit justifies potential risk. Consult physician.
Driving: No known effects. However, if dizziness or headache occurs, caution is advised.
| Erythromycin, Chloramphenicol | Antagonistic antibacterial effect; both bind to 50S ribosomal subunit. | Moderate |
| Neuromuscular blocking agents (e.g., Pancuronium) | Clindamycin may enhance neuromuscular blockade. | Moderate |
| CYP3A4 Substrates (e.g., Cisapride, Terfenadine, Astemizole, Quinidine) | Absorbed clotrimazole may inhibit CYP3A4, increasing levels of these drugs and risk of toxicity (e.g., QT prolongation). | Major |
| Warfarin | Potential for increased anticoagulant effect (clotrimazole may inhibit warfarin metabolism). | Moderate |
| Kaolin | May reduce oral absorption of clindamycin (if taken systemically). Not relevant for vaginal route. | Minor |
Same composition (Clindamycin (100mg) + Clotrimazole (200mg)), different brands: