clindamyin


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clindamyin/tretinoin

(klin-da-mye-sin/tret-i-noin),

Veltin

(trade name)

Classification

Therapeutic: antiacne agents
Pharmacologic: lincosamides
Pregnancy Category: C

Indications

Topical treatment of acne vulgaris in children ≥12 yr.

Action

Clindamycin—interferes with bacterial protein synthesis.
Tretinoin—decreases microcomedome formation and extrusion of comedomes.
Clindamycin is active against Propionibacterium acnes.

Therapeutic effects

Decreased severity of acne.

Pharmacokinetics

Absorption: Some absorption of clindamycin follows topical administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile (improvement in acne)

ROUTEONSETPEAKDURATION
Topicaldays-wksunknownunknown

Contraindications/Precautions

Contraindicated in: Exposure to sunlight, ultraviolet lights, sunlamps and weather extremes; Regional enteritis, ulcerative colitis or history of antibiotic-associated colitis; Sunburn.
Use Cautiously in: Concurrent use of neuromuscular blocking agents; Lactation: Use cautiously, clindamycin may enter breast milk, consider discontinuing drug or breast-feeding taking into account importance of drug to mother; Pediatric: Safe and effective use in children <12 yr not established.

Adverse Reactions/Side Effects

Gastrointestinal

  • colitis (life-threatening)
  • diarrhea

Dermatologic

  • photosensitivity

Local

  • dryness (most frequent)
  • burning (most frequent)
  • scaling (most frequent)
  • dermatitis
  • erythema
  • exfoliation
  • irritation
  • pruritus
  • sunburn

Interactions

Drug-Drug interaction

Avoid concurrent use of erythromycin-containing products.Concurrent use with neuromuscular blocking agents may result in enhanced neuromuscular blockade.

Route/Dosage

Topical (Adults >12 yr) Apply once daily to affected areas.

Availability

Topical gel: clindamycin 1.2%/tretinoin 0.025% in 30 g tubes

Nursing implications

Nursing assessment

  • Assess skin lesions periodically during therapy.

Potential Nursing Diagnoses

Impaired skin integrity
Disturbed body image (Indications)

Implementation

  • Topical: Wash face gently with mild soap and water. Pat dry. Apply pea size amount once daily in the evening lightly covering the entire affected area. Avoid eyes, lips, and mucous membranes.

Patient/Family Teaching

  • Instruct patient on correct procedure for application. Advise patient not to apply more than pea size amount or more frequently than once daily; may increase irritation.
  • Inform patient medication may cause erythema, scaling, itching, burning or stinging. Use of products that are drying or abrasive will increase skin irritation.
  • Advise patient to use sunscreen daily and protective clothing and to avoid exposure to sunlight, sunlamps, and weather extremes (wind or cold) to prevent photosensitivity reactions or skin irritation.
  • Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient to stop medication and not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.
  • Notify health care professional of medication if surgery with general anesthesia is planned.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
  • Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

  • Decrease in severity of acne.