Clinmax IM administration should be used undiluted.
Clinmax IV administration should be diluted.
Adults: Clinmax (IM or IV administration): The usual daily adult dosage of Clinmax for infections of the intraabdominal area, female pelvis, and other complicated or serious infections is 2400-2700 mg given in 2, 3, or 4 equal doses. Less complicated infections due to more susceptible microorganisms may respond to lower doses such as 1200-1800 mg/day administered in 3 or 4 equal doses.
Doses of up to 4800 mg daily have been used successfully.
Single IM doses of greater than 600 mg are not recommended.
Clinmax hydrochloride capsules (oral administration): 600-1800 mg/day divided in 2, 3 or 4 equal doses. To avoid the possibility of esophageal irritation, Clinmax HCl capsules should be taken with a full glass of water.
Children (>1 month): Clinmax (IM or IV administration): 20-40 mg/kg/day in 3 or 4 equal doses.
Clinmax hydrochloride capsules or Clinmax palmitate solution (oral administration): To avoid the possibility of esophageal irritation, Clinmax HCl capsules should be taken with a full glass of water. Doses of 8-25 mg/kg/day in 3 or 4 equal doses. In children weighing ≤10 kg, ½ teaspoon (37.5 mg) of Clinmax palmitate solution three times a day should be considered the minimum recommended dose.
Neonates (<1 month): Clinmax (IM or IV administration): 15-20 mg/kg/day in 3 or 4 equal doses. The lower dosage may be adequate for small premature infants.
Elderly: Pharmacokinetic studies with Clinmax have shown no clinically important differences between young and elderly subjects with normal hepatic function and normal (age-adjusted) renal function after oral or intravenous administration. Therefore, dosage adjustments are not necessary in the elderly with normal hepatic function and normal (age-adjusted) renal function.
Renal Impairment: Clinmax dosage modification is not necessary in patients with renal insufficiency.
Hepatic Impairment: Clinmax dosage modification is not necessary in patients with hepatic insufficiency.
Indications:Treatment of Beta-Hemolytic Streptococcal Infections: Refer to the dosage recommendations above under Dosage in Adults, Dosage in Children and Dosage in Neonates. Treatment should be continued for at least 10 days.
Inpatient Treatment of Pelvic Inflammatory Disease: Clinmax 900 mg (IV) every 8 hrs daily plus an antibiotic with an appropriate gram negative aerobic spectrum administered IV, eg, gentamicin 2 mg/kg followed by 1.5 mg/kg every 8 hrs daily in patients with normal renal function. Continue (IV) drugs for at least 4 days and at least 48 hrs after the patient improves. Then continue oral Clinmax hydrochloride 450-600 mg q6h daily to complete 10-14 days total therapy. Treatment of Chlamydia trachomatis Cervicitis: Clinmax hydrochloride capsules orally 450-600 mg 4 times daily for 10-14 days.
Treatment of Toxoplasmic Encephalitis in Patients with AIDS: Clinmax IV or Clinmax hydrochloride orally 600-1200 mg every 6 hrs for 2 weeks followed by 300-600 mg orally every 6 hrs. The usual total duration of therapy is 8 to 10 weeks. The dose of pyrimethamine is 25 to 75 mg orally each day for 8 to 10 weeks. Folinic acid 10 to 20 mg/day should be given with higher doses of pyrimethamine.
Treatment of Pneumocystis carinii Pneumonia in Patients with AIDS: Clinmax IV 600 to 900 mg every 6 hrs or 900 mg IV every 8 hrs or Clinmax hydrochloride 300 to 450 mg orally every 6 hrs for 21 days and Primaquine 15 to 30 mg dose orally once daily for 21 days. Treatment of Acute Streptococcal Tonsillitis/Pharyngitis: Clinmax hydrochloride capsules 300 mg orally twice daily for 10 days.
Treatment of Malaria: Clinmax hydrochloride capsules or Clinmax palmitate solution (oral administration).
Uncomplicated Malaria/P. falciparum: Adults: Quinine sulfate: 650 mg orally three times daily for 3 or 7 days plus Clinmax: 20 mg base/kg/day orally divided three times daily for 7 days. Children: Quinine sulfate: 10 mg/kg orally three times daily for 3 or 7 days plus Clinmax: 20 mg base/kg/day orally divided three times daily for 7 days.
Severe Malaria: Adults: Quinidine gluconate: 10 mg/kg loading dose IV over 1-2 hrs, then 0.02 mg/kg/min continuous infusion for at least 24 hrs (for alternative dosing regimen please refer to quinidine label). Once parasite density <1% and patient can take oral medication, complete treatment with oral quinine, dose as above, plus Clinmax: 20 mg base/kg/day orally divided three times daily for 7 days. If patient not able to take oral medication, give 10 mg base/kg Clinmax loading dose IV followed by 5 mg base/kg IV every 8 hrs. Avoid rapid IV administration. Switch to oral Clinmax (oral dose as above) as soon as patient can take oral medication. Treatment course=7 days.
Children: Quinidine gluconate: Same mg/kg dosing and recommendations as for adults plus Clinmax: 20 mg base/kg/day orally divided three times daily for 7 days. If patient not able to take oral medication, give 10 mg base/kg Clinmax loading dose IV followed by 5 mg base/kg IV every 8 hrs. Avoid rapid IV administration. Switch to oral Clinmax (oral dose as above) as soon as patient can take oral medication. Treatment course=7 days.
Prophylaxis of Endocarditis in Patients Sensitive to Penicillin: Clinmax hydrochloride capsules or Clinmax palmitate solution (oral administration).
Adults: 600 mg 1 hr before procedure; children: 20 mg/kg 1 hr before procedure. Alternatively, when parenteral administration is required: Clinmax 600 mg IV 1 hr before procedure. Prophylaxis of Infection in Head and Neck Surgery: Clinmax 900 mg diluted in 1000 mL normal saline for use as an intraoperative irrigant in contaminated head and neck surgery prior to wound closure.
Dilution and IV Infusion Rates: The concentration of Clinmax in diluent for infusion should not exceed 18 mg/mL and infusion rates should not exceed 30 mg per minute. The usual infusion rates are as follows:.
Administration of >1200 mg in a single 1-hr infusion is not recommended.
Before using Clinmax, tell your doctor if you are using any of the following drugs:
This list is not complete and other drugs may interact with Clinmax. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
With simultaneous use of Clinmax with theophylline, aminophylline, caffeine, there is an increase in their concentration in blood plasma and thus increases the risk of toxic effects.
Erythromycin increases the concentrations of cyclosporine in the blood plasma and may increase the risk of nephrotoxicity.
Drugs that block tubular secretion prolongs T1/2 of erythromycin.
Incompatible with lincomycin, Clinmax and chloramphenicol (antagonism).
Clinmax reduces the bactericidal action of beta-lactam antibiotics (penicillins, cephalosporins, carbapenems).
With simultaneous use of erythromycin increases the concentration of theophylline.
At the same time receiving chemotherapy, which is carried metabolism in the liver (carbamazepine, valproic acid, hexobarbital, phenytoin, alfentanil, dizopiramid, lovastatin, bromocriptine), may increase the concentration of these drugs in plasma (an inhibitor of microsomal liver enzymes).
IV injection of erythromycin increases the effects of ethanol (accelerating gastric emptying and decrease the duration of alcohol dehydrogenase in the gastric mucosa).
Erythromycin reduces the clearance of triazolam and midazolam and therefore may increase the pharmacological effects of benzodiazepines.
At the same time taking with terfenadine or astemizole may develop arrhythmias (fibrillation and ventricular flutter, ventricular tachycardia, until death); with dihydroergotamine or non hydrated ergot alkaloids may vasoconstriction to spasm, dysesthesia.
With simultaneous application Clinmax slows elimination (increases the effect) of methylprednisolone, felodipine and anticoagulants of cumarine series.
In a joint appointment with lovastatin increased rhabdomyolysis.
Erythromycin increases the bioavailability of digoxin.
Erythromycin reduces the effectiveness of hormonal contraceptives.
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Information checked by Dr. Sachin Kumar, MD Pharmacology