Clindamycin (Vaginal) (Dalacin Vaginal Cream)

1. Health Canada Product Monograph — Clindamycin (Vaginal)

• Local treatment of bacterial vaginosis, diagnosed by the presence of a thin, milky discharge with a fishy odor, vaginal pH greater than 4.5, and clue cells on microscopy, or confirmed by Gram stain showing decreased Lactobacillus and predominance of Gardnerella vaginalis/Bacteroides-type morphotypes.
• Not effective against trichomoniasis or candidiasis; confirm the diagnosis before treating, since symptoms overlap with other causes of discharge.

• Has been studied in the second trimester of pregnancy; reproduction studies in animals at doses well above the vaginal dose revealed no impaired fertility or fetal harm.
• There are no adequate, well-controlled studies in the first trimester of human pregnancy — use only if clearly needed in the first trimester.
• Not the preferred option when the specific goal is preventing adverse pregnancy outcomes associated with bacterial vaginosis (such as preterm birth) — an oral metronidazole or oral clindamycin regimen is preferred in that situation instead.

• Systemic absorption after vaginal application is low (roughly 4% of the dose). Data specific to breastfeeding after vaginal application are limited; oral/injectable clindamycin does appear in breast milk in small amounts, so weigh benefit against risk if breastfeeding.

• No specific dosing adjustment is described for older adults.

• Not indicated for pediatric use; this is a vaginal product formulated and studied in adult women.

• One applicatorful (5 g, delivering approximately 100 mg clindamycin) inserted intravaginally once daily at bedtime for 7 consecutive nights.
• Can be used at any time relative to the menstrual cycle, but treatment should ideally be delayed until any current menstrual period has finished.
• Insert using the applicator provided; wash the applicator with mild soap and water after each use.

If overdose is suspected, seek emergency medical attention immediately or contact your regional Poison Control Centre without delay.

• No specific vaginal overdose syndrome is described, given the low systemic absorption; accidental oral ingestion by a child should still be treated as a potential exposure — contact Poison Control for guidance.

• Vulvovaginal irritation, itching, or burning.
• Candida (yeast) vaginitis or cervicitis — because clindamycin does not treat yeast, symptomatic overgrowth of Candida can occur during or after treatment.

Serious side effects require immediate discussion with the prescriber or emergency care.

• Severe diarrhea or colitis (including Clostridioides difficile-associated diarrhea) has been reported rarely with vaginal clindamycin, as with any clindamycin-containing product, due to some systemic absorption — seek care promptly for severe or persistent diarrhea during or after treatment.
• Hypersensitivity reactions, including rash and, rarely, more severe allergic reactions.

• Use with caution in patients with a history of antibiotic-associated colitis or inflammatory bowel disease, given the (low but nonzero) systemic absorption of clindamycin.

• Known hypersensitivity to clindamycin, lincomycin, or any component of the cream.
• History of clindamycin-associated colitis.

• No clinically significant systemic drug interactions are established at the low systemic exposure achieved with vaginal use.

• None known.

• Insert at bedtime to reduce leakage and maximize contact time with the vaginal mucosa overnight.

• Store at controlled room temperature (15-30°C). Protect from freezing.

• Complete all 7 nights even if symptoms improve early, to reduce the risk of relapse.
• This cream contains mineral oil, which can weaken latex condoms and vaginal diaphragms — avoid relying on these barrier methods during treatment and for 72 hours afterward; use an alternative method or abstain.
• Contact your pharmacist or prescriber if you develop new vaginal itching or thick discharge suggestive of a yeast infection, or if you develop severe or watery diarrhea.
• If pregnant, tell your prescriber — an oral regimen may be preferred instead, depending on why treatment is being given.