Key takeaways:
Clindamycin is an antibiotic medication that treats a variety of bacterial infections, often skin infections.
Clindamycin has fewer interactions than other antibiotics, but it still has a few to keep in mind. Some common clindamycin interactions include warfarin, certain heart medications, and several anti-seizure medications.
Before you take clindamycin, give your pharmacist and prescriber an updated list of medications you take. This will help them screen for interactions.
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It’s never ideal when a rash or itchy skin appears out of nowhere. Often, it’s a minor annoyance that can be fixed with over-the-counter medications or other at-home remedies. In other cases, you may need help from a healthcare professional to get your symptoms under control. And if bacteria are the culprit behind your symptoms, they may prescribe an antibiotic like clindamycin.
Clindamycin is a popular medication that treats many bacterial infections. In fact, it’s one of the first pills you might take for a skin infection. It’s also a common alternative if you have a penicillin allergy and need another treatment option for your situation.
For the most part, clindamycin is well-tolerated. It also doesn’t have many drug interactions to worry about. But if you take any other medications or supplements, there are still a few potential interactions to keep in mind. Some clindamycin interactions may contribute to an undertreated infection. Others may worsen your risk for side effects.
Here, we’ll discuss various clindamycin interactions, most of which apply to the oral version only. The topical version is less prone to interactions.
Good to know: To minimize the risk of an interaction, make sure your prescriber and pharmacist have an updated list of all medications you take. This list should include prescription medications, over-the-counter medications, and any dietary supplements you take. This will help them prevent interactions from happening in the first place.
1. Medications that worsen clindamycin side effects
After you take a dose of clindamycin, it’s broken down (metabolized) by certain enzymes (proteins) in your liver. But some medications block these enzymes, making clindamycin linger in your body for longer. This increases the likelihood of clindamycin side effects.
These medications are notorious for getting in the way of these enzymes:
Heart medications like amiodarone (Pacerone) and verapamil
Heartburn medications like cimetidine (Tagamet HB)
Antibiotics like clarithromycin
Antifungal medications like itraconazole (Sporanox)
Antiviral medications like ritonavir (Norvir)
If you’re taking any of these medications with clindamycin, certain side effects may be more likely to happen. These include diarrhea, nausea and vomiting, skin rashes, and more. If you’re experiencing bothersome side effects like these or side effects that don't go away, reach out to your healthcare team right away.
2. Medications that make clindamycin less effective
Some medications cause certain enzymes in your body to be overactive. This can make clindamycin less effective because your body is breaking it down faster than usual. As a result, this can lead to an undertreated infection. Antibiotic resistance is also possible. Make sure to keep an eye out for these medications:
Anti-seizure medications, such as carbamazepine (Tegretol), phenobarbital, and phenytoin (Dilantin, Phenytek)
Antibiotics like rifampin
Dietary supplements like St. John’s wort
Rifampin’s interaction with clindamycin is especially noteworthy. Studies have found that rifampin can significantly decrease the amount of clindamycin in your body. Because of this, your prescriber may instruct you to take higher doses of clindamycin while taking rifampin. They may also recommend dose adjustments for other medications that can make clindamycin less effective.
3. Warfarin
Warfarin (Coumadin, Jantoven) is a blood thinner that treats and prevents blood clots. A lab test called an international normalized ratio (INR) can help you tell if your blood is too thick or thin while taking warfarin.
There isn’t much data about the interaction, but clindamycin has the potential to enhance warfarin’s effects. This is thought to be due to clindamycin killing vitamin K-producing bacteria in your gut. And having less vitamin K can increase your bleeding risk with warfarin.
Potential side effects: Clindamycin may cause side effects, including diarrhea, nausea, or throat irritation. Most side effects are mild and improve over time.
Alternative to penicillin: Clindamycin is an FDA-approved antibiotic that’s a viable alternative for people with a penicillin allergy.
Out-of-pocket expenses: Here’s how much you can expect to pay for clindamycin if you don’t have insurance or are underinsured.
Even with this risk, you should still be able to take warfarin with clindamycin. But while you’re taking both medications, your prescriber may monitor your INR more frequently to make sure your warfarin dosage is safe and effective for you. Let them know if you notice new or unusual bleeding or bruising during treatment.
4. Certain live vaccines
Clindamycin may interact with certain live vaccines. Live vaccines are those that contain a living but weakened version of a virus. This interaction is mostly relevant for two travel vaccines:
Vaxchora: This is an oral vaccine that helps prevent cholera infections. It’s not a common vaccine. But you may receive it 10 days before traveling to an area where exposure to cholera is possible.
Vivotif: This is another oral vaccine. It helps prevent typhoid fever. You may receive Vivotif if you’re traveling to an area where exposure to the bacteria that causes typhoid fever is possible.
If you're taking an antibiotic like clindamycin when you receive either vaccine, they may not work as well. This could place you at-risk of developing cholera or typhoid fever infections while traveling. So you shouldn’t try to combine clindamycin with Vaxchora or Vivotif.
Keep in mind: Clindamycin doesn’t affect all live vaccines. For instance, there’s less of a concern about interactions with more common live vaccines in the U.S., such as the MMR and varicella vaccines.
5. Nerve blocking medications
Neuromuscular blocking agents (NMBAs) are medications that are sometimes used during surgeries and emergency situations. It may sound intimidating, but NMBAs temporarily cause paralysis. They interfere with brain signals that tell your muscles to move, which is helpful for certain medical procedures. Some common NMBAs include cisatracurium (Nimbex), rocuronium, and succinylcholine (Anectine).
Clindamycin can enhance the effects of NMBAs. It can make them work for longer than intended. In theory, this interaction could cause a longer state of paralysis than what your healthcare team originally intended.
To help manage this potential risk, make sure your surgery team knows that you’re taking clindamycin before your procedure.
Frequently asked questions
You can technically drink alcohol in moderation while taking clindamycin. But it’s best to limit or avoid it if you can. Alcohol doesn’t directly interact with clindamycin, but it can make side effects like nausea or upset stomach worse. Drinking heavily can also make it harder for your body to recover from an infection.
Take clindamycin exactly as prescribed and for the full course of treatment, which is usually between 7 and 14 days (depending on the infection you have). Some people may take it for shorter or longer than this, though, so make sure to defer to your prescriber’s directions.
Clindamycin is part of a group of antibiotics called lincosamides. This class is different from penicillin and macrolide antibiotics. Clindamycin is often used as an alternative for people who can’t take penicillin due to allergies.
No, clindamycin doesn’t contain penicillin. It’s a different type of antibiotic and is generally safe for people with penicillin allergies.
You can technically drink alcohol in moderation while taking clindamycin. But it’s best to limit or avoid it if you can. Alcohol doesn’t directly interact with clindamycin, but it can make side effects like nausea or upset stomach worse. Drinking heavily can also make it harder for your body to recover from an infection.
Take clindamycin exactly as prescribed and for the full course of treatment, which is usually between 7 and 14 days (depending on the infection you have). Some people may take it for shorter or longer than this, though, so make sure to defer to your prescriber’s directions.
Clindamycin is part of a group of antibiotics called lincosamides. This class is different from penicillin and macrolide antibiotics. Clindamycin is often used as an alternative for people who can’t take penicillin due to allergies.
No, clindamycin doesn’t contain penicillin. It’s a different type of antibiotic and is generally safe for people with penicillin allergies.
The bottom line
Clindamycin is an antibiotic medication that treats a variety of bacterial infections, but it may interact with some medications you may be taking. Common clindamycin interactions are with warfarin, certain heart medications, and several anti-seizure medications. Other interactions are also possible.
Before you start taking clindamycin, make sure your prescriber and pharmacist have an up-to-date list of medications that you take. This will help them screen for interactions before they happen.
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References
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Centers for Disease Control and Prevention. (2024). About typhoid fever and paratyphoid fever.
Centers for Disease Control and Prevention. (2025). Cholera vaccines.
Cook, D., et al. (2023). Neuromuscular blockade. StatPearls.
Habboush, Y., et al. (2023). Antibiotic resistance. StatPearls.
Lee, J. H., et al. (2013). The synergistic effect of gentamicin and clindamycin on rocuronium-induced neuromuscular blockade. Korean Journal of Anesthesiology.
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Pfizer. (2024). Clindamycin capsules I.P. dalacin C [package insert].
Rice, P. J., et al. (2003). Antibacterial prescribing and warfarin: A review. British Dental Journal.
Stevens, D. L., et al. (2014). Executive summary: Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical Infectious Diseases.
