5 Clindamycin Interactions You Should Know About

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 provider 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.

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Let’s discuss a few clindamycin interactions you should know. 

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 provider 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: 

• 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 healthcare provider 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 thinning medication 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.

Even with this risk, you should still be able to take warfarin with clindamycin. But while you’re taking both medications, your healthcare provider 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 live 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. However, Vaxchora is temporarily unavailable due to low demand.

• 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 provider originally intended.

To help manage this potential risk, make sure your healthcare provider or surgeon knows that you’re taking clindamycin before your procedure. 

When should I contact my healthcare provider about a clindamycin interaction?

To minimize the risk of an interaction, make sure your healthcare provider 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. 

If you’re concerned about a clindamycin interaction after you start taking it, contact your healthcare provider for guidance as soon as you can. They can help you manage any clindamycin-related side effects you may be experiencing. But if your symptoms feel severe, it’s better to seek medical attention right away.

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Written by:

Cole D. Luty, PharmD, BCPS

Cole D. Luty, PharmD, BCPS, is a licensed pharmacist. He earned his Doctor of Pharmacy degree from Butler University, and he’s board-certified in pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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