Kaolin Clindamycin

Warfarin absorption by rat intestine in vitro was reported not to be affected by kaolin. With clindamycin, the rate (but not the amount) of absorption was affected by kaolin. ... 

Albert KS, DeSante KA, Welch RD, DiSanto AR. Pharmacokinetic evaluation of a drug interaction between kaolin-pectin and clindamycin. J Pharm Sci 1978 67 1579-1582. 

Drug Interactions - Absorption half-life of the antibiotic, clindamycin, was prolonged in human subjects when a kaolin-pectin antidiarrheal suspension was coadministered, although the extent of absorption remained the same. On the other hand, both the rate and the extent of absorption of digoxin were lower when it was coadministered with the same kaolin-pectin suspension. Physical absorption and alterations in gut transit time appeared to partly explain the findings. 

Kaolin-pectin can markedly reduce the absorption of lincomycin. This can be avoided by giving the lincomycin two hours after the kaolin. The rate but not the extent of clindamycin absorption is altered by kaolin-pectin. However, note that diarrhoea is often an indication that these antibacterials should be withdrawn. 

About 85 mL of Kaopectate (kaolin-pectin) reduced the absorption of lincomycin 500 mg by about 90% in 8 healthy subjects. Giving the Kaopectate 2 hours before the antibacterial had little or no effect on its absorption, whereas when Kaopectate was given 2 hours after lincomycin, the absorption was reduced by about 50%. The absorption rate of clindamycin is markedly prolonged by kaolin, but the extent of its absorption remains unaffected. ... 

Information seems to be limited to this study, but the interaction between lincomycin and kaolin appears to be established and of clinical importance. For good absorption and a good antibacterial response separate their administration as much as possible, ideally giving the kaolin at least 2 hours before the antibacterial. Clindamycin appears to be a suitable alternative to lincomycin. 

---