Inform Your Physician Before Taking This Drug If

• you have a history of allergy to any drug.

• you have a history of drug-induced colitis.

• you are allergic by nature: hay fever, asthma, hives, eczema.

• you have a history of previous yeast infections.

• you have myasthenia gravis.

• you have impaired liver or kidney function.

• you plan to have surgery under general anesthesia in the near future.

Possible Side-Effects (natural, expected and unavoidable drug actions) Superinfections (see Glossary).

Possible Adverse Effects (unusual, unexpected and infrequent reactions) If any of the following develop, consult your physician promptly for guidance.

Mild Adverse Effects

Allergic Reactions: Skin rashes (3% to 5%), hives.

Nausea, vomiting, mild diarrhea (3% to 30%), stomach pain.

Multiple joint pains (rare). Serious Adverse Effects

Allergic Reactions: Severe skin reactions: erythema multiforme (Stevens-Johnson syndrome).

Toxic liver reaction with jaundice.

Severe colitis with persistent diarrhea (0.01% to 10%); stools may contain blood and/or mucus.

Rare reduction of white blood cell and platelet counts.

Possible Effects on Sexual Function: None reported.

Possible Delayed Adverse Effects: Severe colitis with diarrhea (pseudo-membranous colitis) may begin several weeks after discontinuing this drug.

Adverse Effects That May Mimic Natural Diseases or Disorders

Liver reactions may suggest viral hepatitis.

Multiple joint pains may suggest the onset of arthritis.

Natural Diseases or Disorders That May Be Activated by This Drug

Crohn's disease, ulcerative colitis, myasthenia gravis.

Possible Effects on Laboratory Tests

Complete blood cell counts: decreased white cells and platelets; increased

eosinophils (allergic reaction). Liver function tests: uncommon, mild and transient increases in liver

enzymes (ALT/GPT, AST/GOT, alkaline phosphatase).

CAUTION

1. Troublesome and persistent diarrhea can develop in sensitive in­- dividuals. If diarrhea persists longer than 24 hours, discontinue this drug and consult your physician for guidance.

2. If surgery under general anesthesia is planned while taking this drug, the choice of anesthetic must be considered carefully to prevent excessive muscle relaxation and associated impairment of breathing.

Precautions for Use

By Infants and Children: Safety and effectiveness for use by those under 1 month of age have not been established. Use with caution.

By Those over 60 Years of Age: Observe closely for the possible development of diarrhea (more common in this age group). Also observe for the possible development of yeast infection of the skin in the genital and anal regions, a form of superinfection. Report such developments promptly to your physician.

Advisability of Use During Pregnancy

Pregnancy Category: В (tentative). See Pregnancy Code inside back cover. Animal studies: No birth defects due to this drug found in mouse or rat

studies. Human studies: Information from adequate studies of pregnant women

is not available. Use this drug only if clearly needed. Ask your physician

for guidance.

Advisability of Use if Breast-Feeding

Presence of this drug in breast milk: Yes. Avoid drug or refrain from nursing.

Habit-Forming Potential: None.

Effects of Overdosage: Nausea, vomiting, cramping, diarrhea.

Possible Effects of Long-Term Use

Superinfections, especially from yeast organisms. Severe colitis with persistent diarrhea.

Suggested Periodic Examinations While Taking This Drug (at physician's

discretion) Complete blood cell counts, liver function tests.

While Taking This Drug, Observe the Following

Foods: No restrictions.

Alcohol: No interactions expected.

Tobacco Smoking: No interactions expected. Other Drugs

Clindamycin taken concurrently with

• antidiarrheal drugs (diphenoxylate, loperamide, paregoric) may result in worsening of the underlying colitis because of impaired elimination of causative toxins.

• antimyasthenic drugs (ambenonium, neostigmine, pyridostigmine) may reduce their effectiveness in relieving the muscle weakness of myasthenia gravis.

The following drugs may decrease the effects of clindamycin

• chloramphenicol (Chloromycetin).

• erythromycin (E.E.S., E-Mycin, etc.).

Driving, Hazardous Activities: This drug may cause nausea and diarrhea. Restrict activities as necessary.

Aviation Note: The use of this drug may be a disqualification for piloting. Consult a designated Aviation Medical Examiner.

Exposure to Sun: Use caution until sensitivity is determined.

Discontinuation: If tolerated satisfactorily, take the full course prescribed. When used to treat infections that may predispose to rheumatic fever or nephritis, take continually in full dosage for no less than 10 days.

Special Storage Instructions: Oral solution should be kept at room temperature; do not refrigerate.

Observe the Following Expiration Times: Do not take the oral solution if it.

TEXT 9. Read the following text and make up a dialogue using information from the text.