Zindaclin 1% Gel

ZINDACLIN is indicated for the treatment of mild to moderate acne vulgaris.

Adults and adolescents

Apply a thin film of ZINDACLIN once daily to the affected area.

Children

ZINDACLIN is not indicated for use in children below the age of 12 years.

Cutaneous use.

ZINDACLIN is contra-indicated in patients with a hypersensitivity to the active substance clindamycin or to any of the excipients in the medicinal product. Although cross-sensitisation to lincomycin has not been demonstrated, it is recommended that ZINDACLIN should not be used in patients who have demonstrated lincomycin sensitivity.

Oral and parenteral clindamycin, as well as most other antibiotics, have been associated with severe pseudomembranous colitis. Topical clindamycin has very rarely been associated with pseudomembranous colitis; however if diarrhoea occurs the product should be discontinued immediately.

Studies indicate a toxin(s) produced by Clostridium difficile is the major cause of antibiotic-associated colitis. Colitis is usually characterised by severe persistent diarrhoea and abdominal cramps. Should antibiotic associated colitis occur appropriate diagnostic and therapeutic measures (such as vancomycin treatment) should be taken immediately.

Responses may not be seen for 4-6 weeks.

Although the risk of systemic absorption following the administration of ZINDACLIN is low, the potential for the development of gastrointestinal adverse effects should be taken into account when considering treatment in patients with a previous history of antibiotic-associated colitis, enteritis, ulcerative colitis or Crohn's disease.

Prolonged use of clindamycin may cause resistance and/or overgrowth of non susceptible bacteria or fungi although this is a rare occurrence.

Cross resistance may occur with other antibiotics such as lincomycin and erythromycin. See Section 4.5.

Contact with the eyes or the mucous membranes of the nose and mouth should be avoided. In the event of accidental contact with the eyes or mucous membranes bathe the affected area with copious amounts of cool water.

No interactions have been reported with topical clindamycin.

For clindamycin applied cutaneously no clinical data on exposed pregnancies are available. Data on a limited number of pregnancies exposed to clindamycin administered by other routes indicate no adverse effects on pregnancy or on the health of the foetus/newborn child. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development. Caution should be exercised when prescribing to pregnant women.

Orally and parenterally administered clindamycin has been reported to appear in breast milk. It is not known whether clindamycin is excreted in human milk following use of ZINDACLIN. As a general rule, patients should not breastfeed while taking a drug since many drugs are excreted in human milk. Sensitisation and diarrhoea cannot be ruled out in nursed infants.

For use during pregnancy and lactation, benefit and possible risks have to be weighed carefully against each other.

None

Approximately 10% of patients can be expected to experience an adverse reaction. These reactions are typical of irritant dermatitis. The incidence of these is likely to increase if an excess of gel is used. Should irritation occur, the use of a moisturiser may be of benefit.

The table below shows all adverse reactions reported with ZINDACLIN in clinical trials. They are listed in decreasing order of incidence.

Whilst no case of severe diarrhoea or pseudomembranous colitis has been reported in clinical trials with ZINDACLIN, and only a small amount of clindamycin is absorbed percutaneously, pseudomembranous colitis has very rarely been reported with the use of other topical clindamycin products. Therefore a theoretical risk of pseudomembranous colitis with ZINDACLIN exists (please refer to Section 4.4).

Irritant dermatitis may occur when excessive quantities of ZINDACLIN are applied. The use of a suitable moisturiser may be of benefit in these cases. In subsequent applications a thin film of ZINDACLIN should be applied in accordance with the dosage instructions (see section 4.2).

Pharmacotherapetic group: Antiinfectives for treatment of acne

ATC code: D10A F01

ZINDACLIN contains clindamycin phosphate which is hydrolysed in the skin to the active constituent clindamycin. Clindamycin is a lincosamide antibiotic with primarily bacteriostatic action against Gram positive aerobes and wide range of anaerobic bacteria.

When clindamycin phosphate is applied cutaneously, clindamycin is found in comedone samples at sufficient levels to be active against most strains of Propionibacterium (P. acnes). It thus reduces the number of surface and follicular P.acnes, one of the aetiological factors of the disease.

As with all antibiotics, the long-term use of cutaneous clindamycin may lead to resistance.

In ZINDACLIN clindamycin phosphate binds with zinc to form a complex in a formulation which results in a reduced extent of absorption. A study with ZINDACLIN in vitro with human skin has shown penetration of radiolabelled clindamycin phosphate from the ZINDACLIN formulation to be less than 5% of the applied dose. When applied topically to patients with acne at the maximum anticipated clinical dose a very small amount, (median less than 2ng/ml) of clindamycin was measured in plasma.

Preclinical data for clindamycin reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity, genotoxicity or toxicity to reproduction.

Propylene glycol

Purified water

Ethanol

Zinc acetate dihydrate

Hydroxyethylcellulose

Sodium hydroxide

Not applicable.

2 years.

No special precautions for storage.

ZINDACLIN is packaged in 15g, 30g or 60g laminate tubes with a peelable membrane laminate or aluminium seal covering the orifice. The tube is fitted with a white opaque polypropylene screw cap.

Not applicable.