Home › Forums › General Discussion › Oral Clindy when unable to get the IVs
- This topic has 21 replies, 8 voices, and was last updated 6 years ago by Calida.
March 23, 2017 at 12:25 am #458324
Hello RB friends. I apologize for not preparing my health issues, meds, etc in my profile yet. I am hoping to get this done as soon as my life gives me a break. I have Difuse SD. I started AP with DR F then switched to DR S where I actually began the AP. I had 2 iv rounds, 4-5 months apart. (Oh, I also found thru igenix, later, that I had Chronic Lyme and Cos., for years! Got the treatment). To get to the point, I am unable to get the Iv Clindy now. Although DR. S will send the IVs, he is generally away ths time of year and he is almost fully retired. I have been waiting for months. Not to be impatient but I need to get the oral clindy from my local doc as I am progressing. My last Ivs were 2 yrs ago. I went off the oral meds over a year ago. I started up again with Azithro 250mg/day for the last 3 weeks (DILE W/ mino & doxy). Since I am unable to get the IV’s right now, would anyone know the recommended dosage for oral clindy, frequency, and at what interval? 1x /week/mo, etc? All my AP books are in storage as I am moving so I trust RBF to hopefully direct me or give me their opinion(Btw, it was a mistake for me to stop the original AP, another long story)?. I am familiar with oral clndy and the c-diff risks yet it is necessary for me to start this and would like to get the script from my local doctor asap. I am on Theralac daily and detox often. I have been plowing thru the posts and had read a few different amts and frequencies listed. Any recomendations on this would be appreciated! Thank you! Excuse the typos.
takingMarch 23, 2017 at 1:40 am #458325lynnie_sydneyParticipant
Sorry to hear you are in a it of trouble symptom-wise.
This is an excerpt from the original Pulsed Protocol re Clindamycin in our Resources – Recommended Reading section:
Clindamycin IM – 300 mg. clindamycin can be administered intramuscularly (IM) once daily for one to two weeks followed by 300 mg. weekly, monthly or at 6 week intervals as needed and tolerated by the patient. Because it remains in the tissues longer, a lower dose is effective.
Clindamycin IV – The IVs should be started at a low dose (300 mg) and gradually increased as needed to avoid the development of resistance in the bacterial L-forms that might be present. If this resistance develops, the patient will not respond as well to the antibiotic therapy.
IV therapy is begun gradually at 300 mg. given in 250 cc 5% dextrose solution administered by IV drip over a 45 minute period for the first two days. The next two days, the dose is increased to 600 mg. and finally to 900 mg on subsequent days if no adverse reaction is observed.
IV or IM therapy with clindamycin is continued at spaced intervals according to the patient’s need. It can be given once weekly or twice a month, again titrated to patient need. If weekly or monthly IVs are not possible for the patient, then a series can be administered at more widely spaced intervals such as every six months and later on an annual basis until the laboratory values return to normal.
Oral Clindamycin – Some physicians have had success using clindamycin orally (i.e. 1200 mg.) in a single weekly dose instead of in IV or IM.
Be well! Lynnie
Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)March 23, 2017 at 11:25 am #458332
I should have explored the site further before posting, so sorry! Just not at the top of my game. Thank you again and hope you are doing well 🙂
SunnyMarch 23, 2017 at 5:50 pm #458334Lynne G.SDParticipant
I used oral and IVs and found the oral worked just as well.I used the same dosage as the IVs.It is hard on the stomach so make sure to take it with a mealMarch 29, 2017 at 10:10 pm #458375katerParticipant
I have diffuse SD also. Yes unfortunate you discontinued treatment totally- I have heard it is more difficult to control the second time round. I have reduced to 100 mg mino a day, plus LDN and LDI for this last year.and seem able to maintain on that. I do clindy IV for about 3 days or 4 every 6 months. When I first began AP I was on a combo of oral mino and clindy. The clindy was 1200mg a day I think 3 days a week if memory serves me. I have heard the IM route is good also and less gut issue. So you feel the Zith is not bringing it back in control or just too early to tell yet? I have no idea if Zith and clindy are even compatible- would need to research that one. Hoping you get it all under control again!
Systemic Scleroderma since 2010. Lyme and Myco P. AP and many other antibiotics and treatments since Nov. 2011. Presently mostly in remission other than fatigue.
Teva Minocycline 100mg a day. Dessicated tyroid, LDN 4.5, LDI, hawthorne, curcurmin, berberine,, caprylex, reishi mushroom, liver protect, zinc,, fish oils, magnesium, vit K2, d3, bcomp, E, CMarch 29, 2017 at 10:53 pm #458376
Hi Lynne G.
Thank you for chiming in. I am glad to hear about the ppl using the oral Clindy. Are you doing it once a week? with mini or Zithro? It is encouraging to hear it is working well!
Kate, thanks for your post. It is definitely unfortunate that I stopped the antibiotics. I haven’t been back on the zith for more than 5 weels but feel I need more.I have the unfortunate side effect of sadness so I cut back to 3x/week.That fixed it. I had tried Doxy, then mino in the past but I got DILE with them, therefore the change to zithro. I am hoping the two are compatible. I just got the oral today. I wasn’t thinking about IMs but that might be better. I already inject IM Glutathione twice a week, so that would be no problem for me. MY Doc suggested I start with 300mg the first week then increase each week until 1200mg. I am understanding that you both do/did the Clindy oral 1x/week? I do hope it works. If you’ve heard of Zithro being a problem with clindy, that would be great to know. When I was doing the IVs, I was on mino, but had the bad effects of lupus, but no problem with the IVs. fingers x’d! Thanks again to you both! SunnyMarch 29, 2017 at 11:03 pm #458377MazKeymaster
If you’ve heard of Zithro being a problem with clindy, that would be great to know.
Lovely to see you!
There is an interaction with zith and clindy, as follows:
Clindamycin may prolong the effects of neuromuscular-blocking drugs, such as succinylcholine and vecuronium. Its similarity to the mechanism of action of macrolides and chloramphenicol means they should not be given simultaneously, as this causes antagonism and possible cross-resistance.
As you’re pulsing zith, this might not be so much of an issue if there are a couple days between clindy and zith doses, but this is definitely worth cross-checking with the prescribing doc (do you mean “our” doc or another doc?).March 31, 2017 at 9:35 am #458382
I noticed that you cut back on your dose of azithromycin. How much are you taking now?
"Unthinking respect for authority is the greatest enemy of truth."
- Albert EinsteinApril 1, 2017 at 9:26 am #458385
Hi Maz! I have been on a trip and responded to your post but must have not submitted. I was exhausted while writing the last post. I meant to say that “I have started Zithro 5 weeks ago”. Then I reduced to 3 days a week because of side effects. My daughter stopped totally after 3 weeks as she became horribly depressed. Once she stopped, the depression lifted after a few days. Phew! So I’ll need to figure out what to do with her once she finishes school in May (She had Lyme (Ha! “Hadlyme”… another CT town…makes you wonder if our forefathers knew something more. Of all the towns with the “Lyme” name, Hadlyme might be the best town to be in, so to speak, lol!) and she has the same dx as me, Difuse SD, Homozygous MTHFR, etc.
Maz, i didnt get the Clindy from our doc. I got it from my integrated GP.Maybe Ishouldnt start the oral clindy. I had discussed IV Clindy (face to face)with our doc. He had me the Zithro and had said we could do the Iv Clindy but the logistics were not something I could do right now. I thought the oralmight be easier to try until I can get the Ivs. I wonder if our doc didnt get a chance to reseach the clindy / zithro at the same time. I also wonder if I should take the zith 3 daysin arowso I can take the oral clindy having two days btwn the zith.then in that case, the uneven dosing of zith may not be beneficial. Oh gosh! Maz thank you for giving me this info. Wouldnt it be great if we had more AP docs, more research, in more locations, so more people with Rheumatic issues had more choices. Thank goodness for Roadback, the admiistrators, and all the members! SunnyApril 1, 2017 at 9:36 am #458386
After 5 weeks of 250 Zithro each day, I cut back to 250, MWF. But now I will have to figure out an alternate to add to the Zithro instead of oral clindy.
SunnyApril 1, 2017 at 12:57 pm #458388MazKeymaster
Hi Maz! So I’ll need to figure out what to do with her once she finishes school in May (She had Lyme (Ha! “Hadlyme”… another CT town…makes you wonder if our forefathers knew something more. Of all the towns with the “Lyme” name, Hadlyme might be the best town to be in, so to speak, lol!) and she has the same dx as me, Difuse SD, Homozygous MTHFR, etc.
Ummm…could there be a more ironic town name in CT? haha! Hope your daughter can do something treatment-wise soon. If she can’t tolerate mino (like her Mom) then am sure Dr. M. will have something up his sleeve for her. Waiting with SD isn’t really an option, as I know you’ve unfortunately had to experience. Sorry my recall is not so great today…did she also try mino and was unable to tolerate it, even in low pulsed doses to start?
Did you see this article from last year? It may explain one of the many reasons why some Lyme patients aren’t getting diagnosed:
The ‘Swiss Agent’: Long-forgotten research unearths new mystery about Lyme disease
Maz, i didnt get the Clindy from our doc. I got it from my integrated GP.Maybe Ishouldnt start the oral clindy.
Perhaps you should at least check with the prescribing doc about your plan to pulse zith with clindy to get his/her insight on this, just to play it safe.
I had discussed IV Clindy (face to face)with our doc. He had me the Zithro and had said we could do the Iv Clindy but the logistics were not something I could do right now.
Yes, usually what folks will do when on IV clindy is to stop their zith for a couple weeks for the 5-day round. So Dr. M. is still able to provide IV clindy, but just that your logistics don’t allow for it? I see, I thought you meant that he wasn’t able to do it at the moment for some reason.
I thought the oralmight be easier to try until I can get the Ivs.
Yes, oral would be easier if IVs aren’t do-able, but just not at the same time with zith. As you’re pulsing, there may be a way to fit it in, even if longer pulses were approved by your doc. E.g. I have done two weeks on and a week off for Lyme treatments. If this type of protocol is used (in higher dose Lyme protocols, the intention is to stir up the bugs to shock them, build a decent herx, then give the body a brief rest), then doing alternating weeks with non-compatible antibiotics might be a reasonable thing to ask about. For instance, two weeks zith, a week off, then a week of oral clindy, week off, repeat. This would need some experienced oversight, too, though, as the goal is to stir up the bugs.
I wonder if our doc didnt get a chance to reseach the clindy / zithro at the same time.
I feel pretty confident that he knows his antibiotics, but it might be more a logistical (staffing?) thing on his end for the moment. It’s such a busy office.
I also wonder if I should take the zith 3 days in a row so I can take the oral clindy having two days btwn the zith.
I think it might depend on the half-life of these two antibiotics. Zith can remain in the body for a good week or so (10 days?), so you’d have to check on that.
then in that case, the uneven dosing of zith may not be beneficial.
Unfortunately, combining these two antibiotics would really need some expert insight on how to do it properly, so you (a) don’t do yourself an injury and (b) don’t create a situation where you’d lose efficacy of your staple antibiotic, especially as you can’t use mino.
Oh gosh! Maz thank you for giving me this info. Wouldnt it be great if we had more AP docs, more research, in more locations, so more people with Rheumatic issues had more choices. Thank goodness for Roadback, the admiistrators, and all the members!
That’s really lovely, Sunny, and I don’t know what I would have done or would still do without RBF, too, so you’re echoing my daily sentiments, as well. Btw, did you find the new SD research section, recently loaded? It will have research added, over time, as it becomes available, but it’s a healthy start and may help patients who are seeing docs who aren’t conversant with the rationale for using AP for SD.April 1, 2017 at 1:53 pm #458389
Thank you again for all your help! Yes, K was able to take the mino without getting DILE. I suggested this to her after the zithro didn’t work but she does not want to start anything until the exams and comps are over. I had suggested that she just pulse the mino but she is so gun-shy right now. I am still going to leave a message for Dr M. and let him know about the zithro side effect and ask for the mino for her. Not doing anything as she is progressing here is not good. I am also going to ask him what she can do about the bad nerve pains in her spine. She has been taking 600mgs of ibupro 2-3x a day and some days she tries 2 alleves every 6 hours instead but hasn’t had good results. I also have the obvious concern about the gastro effects of these meds. Narcotics are not an option for her considering her need to be focused and studying every waking hour. I KNOW DR had mentioned LDN to me but I am not sure for her.
As far as the IVS for Clindy, Dr. S was going to send them to me and I was going to see if our doc would give them to me. He said no. When I saw him in the office in March, he explained that he couldn’t give another doctor’s medicine to his patient. I totally understood that. Then he did say that if he ordered it, it could be done. But he did say they would have to work out the timing because of staff and the hours, etc. I haven’t pursued it as I have been in the middle of this project I had mentioned to you. I will be in touch once I get home.
And yes, I would need some expert advice on how to do the zith and the oral clindy. Since the normal protocol calls for 1200mg OF Clindy once a week for oral, I don’t know how you could do this effectively with zithro. Maybe I need to try a diff abx other than zith that would work. Or I just need to get the ivs some how! Darned DILE!!
And no, I haven’t had the opportunity to check the new section on SD. Thanks for pointing that out. I hope to get my own time back soon to explore this great site. I have always spread the word to people who might benefit from this great resource. I have of course shared this site years ago with my regular doctor who is open-minded and always thinks out of the box so that she can provide her patients with all tx options. She in turn has shared with other doctors. RBF is a blessing to me and I hope to have more time soon to devote to it. Thanks again! SunnyApril 1, 2017 at 8:01 pm #458394
After 5 weeks of 250 Zithro each day, I cut back to 250, MWF.
Considering your diagnosis and treatment history, that dose may not be strong enough for you. Here are two doses I’ve seen people using:
1. 250 mg per day for five days, followed by a 5-day break.
2. 500 mg QOD; e.g., 500 mg on M/W/F or 500 mg on Tu/Th/Sat
Of those two, the second one makes more sense to me. Also, since you feel that azithromycin by itself isn’t going to be effective enough for you, it makes me wonder if bacterial antibiotic resistance might be the cause of that.
"Unthinking respect for authority is the greatest enemy of truth."
- Albert EinsteinApril 1, 2017 at 10:37 pm #458396
Hi Phil. Thank you for the information. I think the 2 one might work best for me. The script was written
for 250/bid but I started 1 a day. Then reduced to MWF /250. Maybe after another week of my current dose, I could handle taking 500/m/w/f. Would you suggest taking 500 at one time or 250 separately on each of the three days? Thanks again, SunnyApril 2, 2017 at 9:14 am #458400
Because it has a long half-life, azithromycin is usually taken only once a day.
"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein
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