Clindamycin/benzoyl peroxide

Clindamycin/benzoyl peroxide
Combination of
ClindamycinAntibiotic
Benzoyl peroxideAntiseptic
Names
Trade namesBenzaclin, Duac. Onexton, others
Clinical data
Main usesAcne
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
Routes of
use		Topical
External links
AHFS/Drugs.comMultum Consumer Information
MedlinePlusa603021
Legal
License data
Legal status

Clindamycin/benzoyl peroxide is a topical gel used for the treatment of acne.[3] It is a fixed-dose combination of clindamycin, as the phosphate, an antibiotic, and benzoyl peroxide, an antiseptic.[3]

Common side effects include peeling, itching, and dryness of the skin where the gel was applied.[3]

Clindamycin/benzoyl peroxide was approved for medical use in the United States in 2000.[8][9][10] It is available as a generic medication.[11] In Canada it costs about 110 CAD for 3 months as of 2021.[12]

Medical uses

The gel is used on the skin to treat mild to moderate acne in people 12 years and older.[13]

Efficacy

There is an average 52% decrease in inflammatory acne lesions by week 12.[14]

The combination is less effective than benzoyl peroxide/salicylic acid after short-term treatment of two to four weeks, but the two treatments showed similar effectiveness after ten to twelve weeks.[15]

Pregnancy and lactation

Studies on whether or not the use of clindamycin/benzoyl peroxide gels is teratogenic or has adverse effects on nursing infants have not been performed. While oral clindamycin passes into breast milk, no such data are available for clindamycin in gel form. Limited data regarding topical clindamycin and benzoyl peroxide have shown no safety problems.[13][3]

Contraindications

The gel is not recommended for those who are allergic to clindamycin, benzoyl peroxide, any components of the formulation, or lincomycin.[13][16] Individuals previously diagnosed with regional enteritis, ulcerative colitis, or antibiotic-associated colitis are also recommended not to use it.[5]

Side effects

Common side effects are peeling, itching, redness, dryness, burning, and dermatitis. Benzoyl peroxide bleaches hair, clothes, towels, bedclothing, and the like. Prolonged exposure to natural or artificial sun light (UV rays) is not recommended because the gel may cause photosensitivity.[13][16] Irritation due to benzoyl peroxide can be reduced by avoiding harsh facial cleansers and wearing sunscreen prior to sun exposure.[17]

Clinical studies have shown systemic absorption of clindamycin through topical application, in some cases leading to diarrhea, bloody diarrhea, and colitis. Reports of anaphylaxis were also seen. However, the sources of these reports were personal accounts without controls and of an unknown population, thus it is difficult to attribute their cause to the clindamycin/benzoyl peroxide gel.[16]

Interactions

No formal interaction studies have been done. Combination with topical products containing alcohol or astringents, as well as skin peelings, may increase the irritant effect of clindamycin/benzoyl peroxide. Topical erythromycin may antagonise the effect of clindamycin, although this has only be demonstrated in in vitro studies. Topical tretinoin and other retinoids may be inactivated by benzoyl peroxide or increase its irritant effect.[13][16]

Pharmacology

Mechanism of action

Clindamycin phosphate is a water-soluble ester of the semi-synthetic antibiotic clindamycin, which is synthesized from lincomycin. Like the macrolide antibiotics, it acts as a bacteriostatic agent by interfering with the 50S subunit of the ribosome of Cutibacterium acnes, inhibiting bacterial protein synthesis and preventing bacteria from replicating.[13][18] C. acnes plays a role in the development of acne.[19]

Benzoyl peroxide also kills C. acnes, but by releasing free radical oxygen species, thus oxidizing bacterial proteins. Also, it dries out the area by reducing sebum production, prevents clogged pores, and is a keratolytic agent.[13] Since benzoyl peroxide is an oxidizer, not an antibiotic, it is not subject to C. acnes resistance unlike clindamycin.[15][20]

Both ingredients have been shown to reduce the number of acne lesions with statistical significance.[15]

Pharmacokinetics

Clindamycin phosphate is an inactive prodrug. It is quickly activated to clindamycin by hydrolysis. After four weeks of application during a study, 0.043% of the used clindamycin dose were found in the blood. Benzoyl peroxide is only absorbed through the skin after reduction to benzoic acid, which is subsequently metabolized to hippuric acid and eliminated via the kidneys.[13]

Society and culture

Brand names

The combination is sold under various brand names including Acanya,[4] Benzaclin,[3] Duac,[6] and Onexton.[5]

Patent

Dow Pharmaceuticals filed the patent for Onexton, and the United States Patent and Trademark Office issued the patent on 16 October 2012. On 24 November 2014, the US Food and Drug Administration (FDA) approved the new drug application (NDA) No. 050819 for Onexton, with Dow Pharmaceutical as the holder.[21] The patent is set to expire on 5 August 2029.[22]

Lawsuits

On 12 January 2016,[23] Dow Pharmaceutical Sciences and Valeant Pharmaceuticals North America LLC filed a lawsuit against Taro USA and Taro Industries, an Israel-based corporation. The lawsuit was filed for infringement upon their Onexton patent, by Taro attempting to submit an abbreviated new drug application (ANDA) to the Food and Drug Administration (FDA) for its generic 3.75% benzoyl peroxide and 1.2% clindamycin phosphate topical gel. The court concluded that Taro was guilty of attempting to submit an ANDA patent request before the Onexton patent expired.[21] Perrigo settled its patent litigation with Valeant and Dow.[24]

References

  1. ↑ "Duac Once Daily 10 mg/g + 30 mg/g Gel - Summary of Product Characteristics (SmPC)". (emc). 30 April 2021. Archived from the original on 4 February 2022. Retrieved 26 August 2022.
  2. ↑ "Clindamycin + Benzoyl Peroxide 10mg/g + 50mg/g Gel - Summary of Product Characteristics (SmPC)". (emc). 14 June 2021. Archived from the original on 22 September 2021. Retrieved 26 August 2022.
  3. 1 2 3 4 5 6 "Benzaclin- clindamycin phosphate and benzoyl peroxide gel". DailyMed. 16 February 2017. Archived from the original on 19 January 2022. Retrieved 26 August 2022.
  4. 1 2 "Acanya- clindamycin phosphate and benzoyl peroxide gel". DailyMed. 30 September 2020. Archived from the original on 24 March 2021. Retrieved 26 August 2022.
  5. 1 2 3 "Onexton- clindamycin phosphate and benzoyl peroxide gel". DailyMed. 6 April 2020. Archived from the original on 26 August 2022. Retrieved 26 August 2022.
  6. 1 2 "Duac (clindamycin phosphate and benzoyl peroxide) Gel, 1.2%/5%for topical use Initial U.S. Approval: 2000". DailyMed. 15 April 2015. Archived from the original on 26 August 2022. Retrieved 26 August 2022.
  7. ↑ "Regulatory Update -- Stiefel, a GSK company announces a new, alternate, fixed-dose combination of Duac (clindamycin 1% and benzoyl peroxide 3%) gains positive recommendation for approval in Europe" (Press release). GlaxoSmithKline. 4 March 2013. Archived from the original on 4 December 2020. Retrieved 26 August 2022 – via PR Newswire.
  8. ↑ "Drug Approval Package: BenzaClin (Clindamycin 1% and Benzoyl Peroxide 5%) NDA #50-756". U.S. Food and Drug Administration (FDA). 24 December 1999. Archived from the original on 2 April 2021. Retrieved 26 August 2022.
  9. ↑ "Drug Approval Package: Duac (clindamycin, benzyoyl) NDA #050741". U.S. Food and Drug Administration (FDA). 27 April 2003. Archived from the original on 11 April 2021. Retrieved 26 August 2022.
  10. ↑ "Drug Approval Package: Acanya (clindamycin phosphate 1.2% and benzoyl peroxide 2.5%) Gel NDA #050819". U.S. Food and Drug Administration (FDA). 29 October 2009. Archived from the original on 14 May 2021. Retrieved 26 August 2022.
  11. ↑ "Perrigo Receives FDA Approval and Commences Launch of Clindamycin Phosphate and Benzoyl Peroxide 1.2% / 5% Gel" (Press release). Perrigo Company. 27 June 2012. Archived from the original on 26 August 2022. Retrieved 26 August 2022 – via PR Newswire.
  12. ↑ Ton, Joey (19 April 2021). "#288 Clearing up the Evidence for Topical Acne Combination Products". CFPCLearn. Archived from the original on 28 March 2023. Retrieved 15 June 2023.
  13. 1 2 3 4 5 6 7 8 Haberfeld H, ed. (2016). Austria-Codex (in Deutsch). Vienna: Österreichischer Apothekerverlag. Indoxyl 10 mg/g + 50 mg/g Gel.
  14. ↑ "Onexton gel for acne". The Medical Letter on Drugs and Therapeutics. 57 (1476): 124–5. August 2015. PMID 26305525.
  15. 1 2 3 Seidler EM, Kimball AB (July 2010). "Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne". Journal of the American Academy of Dermatology. 63 (1): 52–62. doi:10.1016/j.jaad.2009.07.052. PMID 20488582.
  16. 1 2 3 4 "Onexton (Valeant Pharmaceuticals North America LLC): FDA Package Insert". MedLibrary.org. Archived from the original on 26 August 2022. Retrieved 2016-11-19.
  17. ↑ Koda-Kimble MA, Alldredge BK, eds. (2013). Applied Therapeutics: The Clinical Use of Drugs (10th ed.). Baltimore: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 949. ISBN 978-1609137137.
  18. ↑ "Lincosamides, Oxazolidinones, and Streptogramins". Merck Manual of Diagnosis and Therapy. Merck & Co. November 2005. Archived from the original on 2 December 2007. Retrieved 2007-12-01.
  19. ↑ Kim J (2005). "Review of the innate immune response in acne vulgaris: activation of Toll-like receptor 2 in acne triggers inflammatory cytokine responses". Dermatology. 211 (3): 193–8. doi:10.1159/000087011. PMID 16205063. S2CID 21459334.
  20. ↑ Simonart T (December 2012). "Newer approaches to the treatment of acne vulgaris". American Journal of Clinical Dermatology. 13 (6): 357–64. doi:10.2165/11632500-000000000-00000. PMID 22920095. S2CID 12200694.
  21. 1 2 Dow Pharmaceutical Sciences, Inc. and Valeant Pharmaceuticals North America LLC v. Taro Pharmaceuticals U.S.A., INC. and Taro Pharmaceutical Industries LTD. United States District Court District of New Jersey. 01 Dec. 2016. Print.
  22. ↑ Approved Drug Products With Therapeutic Equivalence Evaluations (36th ed.). U.S. Food and Drug Administration. 19 November 2016.
  23. ↑ Chuderewicz MA. "Case 2:16-cv-00217-SRC-CLW". Archived from the original on 16 April 2018. Retrieved 15 April 2018.
  24. ↑ "Perrigo Announces Patent Litigation Settlement for the Generic Version of Onexton Gel" (Press release). Perrigo Company. 26 October 2017. Archived from the original on 26 October 2017. Retrieved 26 August 2022 – via PR Newswire.
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