From the FDA Drug Label
Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents.
The use of clindamycin in the setting of myasthenia gravis is not directly addressed in the drug label. However, considering its neuromuscular blocking properties, it may potentially worsen the condition.
- Caution is advised when using clindamycin in patients with neuromuscular disorders.
- The drug label recommends using clindamycin with caution in patients receiving other neuromuscular blocking agents. Given the potential risks, a conservative clinical decision would be to avoid using clindamycin in patients with myasthenia gravis, unless the benefits outweigh the risks and close monitoring is possible 1.
From the Research
Clindamycin can generally be used safely in patients with myasthenia gravis, as it does not significantly affect neuromuscular transmission at the neuromuscular junction. The standard dosing regimens for clindamycin (300-450 mg orally every 6 hours or 600-900 mg IV every 8 hours for adults, adjusted based on infection severity) can be followed without special modifications for myasthenia gravis patients. However, as with any medication in patients with chronic conditions, clinicians should monitor for any unexpected adverse effects. This recommendation is based on the understanding that certain antibiotics can exacerbate myasthenia gravis by interfering with neuromuscular transmission, as reported in cases with other antibiotics like azithromycin 2 and amoxicillin 3. In contrast, clindamycin is considered safer because it does not have a significant impact on neuromuscular transmission, unlike antibiotics such as aminoglycosides, fluoroquinolones, and macrolides. While using clindamycin, patients should still be monitored for its common side effects, including gastrointestinal disturbances and the potential for Clostridioides difficile infection. It's also important to note that myasthenia gravis can be triggered or worsened by infections, and treatment with immunosuppressive drugs implies a slightly increased risk for infections 4. Therefore, careful management and monitoring are crucial when using any medication in patients with myasthenia gravis.