DUAC
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DUAC (DUAC).
DUAC (clindamycin 1% / benzoyl peroxide 5%) combines clindamycin, a lincosamide antibiotic that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, and benzoyl peroxide, a keratolytic and antimicrobial agent that releases free radical oxygen, reducing Propionibacterium acnes and comedones.
| Metabolism | Clindamycin is primarily metabolized by the liver via CYP3A4 to inactive and active metabolites; benzoyl peroxide is metabolized to benzoic acid and excreted renally. |
| Excretion | Renal excretion of unchanged clindamycin (10%) and metabolites; biliary/fecal excretion of inactive metabolites; approximately 90% of dose recovered in urine and feces over 6 days. |
| Half-life | Terminal elimination half-life of clindamycin is 2.4 hours in adults with normal renal function; prolonged to 3.7-5.1 hours in hepatic impairment; clinical context: dosing interval may need adjustment in severe hepatic disease. |
| Protein binding | Clindamycin is 92-94% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | Volume of distribution of clindamycin is approximately 0.6-1.0 L/kg; clinical meaning: extensive tissue distribution including bone, skin, and abscesses, but limited CNS penetration. |
| Bioavailability | Topical gel formulation: systemic bioavailability is approximately 1-4% of applied dose; oral bioavailability of clindamycin hydrochloride is 90%. |
| Onset of Action | Topical application: onset of clinical improvement in acne vulgaris is typically within 2-4 weeks of daily use. |
| Duration of Action | Duration of action for topical clindamycin: sustained effect with continued application; clinical notes: full therapeutic effect may require 8-12 weeks; bacterial resistance may develop with prolonged use. |
Clindamycin 1% / benzoyl peroxide 5% gel: apply a thin film to affected areas twice daily (morning and evening).
| Dosage form | GEL |
| Renal impairment | No dose adjustment required for renal impairment. Use caution in severe impairment due to potential systemic absorption of clindamycin. |
| Liver impairment | No specific hepatic adjustment guidelines. Use caution in severe hepatic impairment due to clindamycin component. |
| Pediatric use | Approved for children ≥12 years: same as adult dosing. For <12 years, safety and efficacy not established. |
| Geriatric use | No specific geriatric dose adjustment. Use caution due to potential age-related skin fragility and increased systemic absorption. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DUAC (DUAC).
| Breastfeeding | Not known if clindamycin or benzoyl peroxide are excreted in breast milk; M/P ratio not available. Caution; risk of diarrhea in infant. |
| Teratogenic Risk | No evidence of fetal harm in animal studies; lack of human data. Avoid first trimester if possible; use only if clearly needed in second and third trimesters. |
| Fetal Monitoring | None specific; monitor for local irritation. |
■ FDA Black Box Warning
None
| Serious Effects |
["History of regional enteritis, ulcerative colitis, or antibiotic-associated colitis","Hypersensitivity to clindamycin, benzoyl peroxide, or any component of the formulation"]
| Precautions | ["Clostridium difficile-associated diarrhea (CDAD) has been reported with nearly all antibacterial agents, including clindamycin; discontinue if severe diarrhea occurs.","Avoid contact with eyes, mouth, lips, and mucous membranes.","May cause skin irritation, dryness, or peeling."] |
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| Fertility Effects | No reported effects on fertility. |