Clindamycin and Nicotinamide Gel: Uses, How to Apply, Side Effects (2026)

• Updated 23 October 2026
• Reviewed by Sudhanshu Singhal
• 16 min read
• 33 sources

The MRPs above are as shown by the e-pharmacy Tata 1mg on 23 October 2026; 1mg itself states that MRP may vary by batch, prices change over time, and the MRP printed on the pack always governs. All these pages show the composition Clindamycin (1% w/w) + Nicotinamide (4% w/w) and "Prescription required".

What is clindamycin phosphate 1% + nicotinamide 4% gel?

It is a topical gel that combines an antibiotic and a form of vitamin B3 in a single tube; the facts below come from the official labels of each ingredient.

The clindamycin part

Clindamycin is a lincosamide antibiotic that inhibits bacterial protein synthesis by binding the 50S ribosomal subunit. Clindamycin phosphate, the salt used in gels, is inactive in vitro and is converted to active clindamycin in the body (Dalacin T SmPC 5.1). In acne, the UK Zindaclin SmPC states that clindamycin phosphate is hydrolysed in the skin, that its action is primarily bacteriostatic, and that it reduces the number of surface and follicular P. acnes, one of the aetiological factors of acne.

Absorption through the skin is low — the Cleocin T label reports serum levels of 0–3 ng/mL after repeated topical use, with less than 0.2% of the dose recovered in urine.

The nicotinamide part

Nicotinamide (niacinamide) is the physiologically active form of niacin, vitamin B3. The Freederm SmPC states that nicotinamide has shown beneficial effects on inflammatory acne, considered to be related to its significant anti-inflammatory activity, and its patient leaflet puts it plainly: nicotinamide is not an antibiotic, it is related to an essential vitamin in our diet, and it reduces swelling, redness and tenderness of spots. A 2024 review describes niacinamide as anti-inflammatory, cites antimicrobial activity against C. acnes, and notes that several clinical studies report reduced sebum production with 2%–5% preparations, though the mechanism of the sebum effect remains unknown.

A 1995 randomised trial in 76 patients with moderate inflammatory acne compared 4% nicotinamide gel with 1% clindamycin gel twice daily for 8 weeks and reported improvement in 82% versus 68% of patients, with the authors describing the efficacy as comparable.

Forms and strengths sold in India

In India the combination is sold as a gel with Clindamycin (1% w/w) + Nicotinamide (4% w/w), in tubes of 10 g, 15 g, 20 g and 30 g, and the e-pharmacy pages carry "Prescription required". One name check is worth making: Clindac A 1% Gel (Alkem, 20 g) contains clindamycin alone, while Alkem's combination product is Clindac AN.

What is it used for?

The labels of the two ingredients state their uses: the US Cleocin T label for topical clindamycin states that it is indicated in the treatment of acne vulgaris; the UK Dalacin T SmPC says clindamycin is indicated for the treatment of acne vulgaris; the UK Zindaclin SmPC states mild to moderate acne vulgaris; and the Freederm SmPC for nicotinamide 4% gel states the topical treatment of mild to moderate inflammatory acne vulgaris.

The Freederm leaflet describes that condition as inflamed pimples (papules) and pus-filled spots (pustules), mainly on the face, back and chest, and says the gel is suitable for use by adults, children and the elderly. The NHS names clindamycin among the antibiotics applied to the skin that kill the bacteria that cause inflammation and pus in acne, under treatments supplied on a prescription from a GP or specialist. The indication printed on the pack you buy governs, and only a doctor can decide whether this gel is right for your skin.

How to apply as stated in the labels

The labels of clindamycin and nicotinamide gels give these directions; use the gel exactly as your doctor prescribes and as your own pack directs.

• Cleocin T (gel, lotion, solution), DailyMed, revised 11/2025: apply a thin film twice daily to the affected area. No treatment duration is stated.
• Dalacin T lotion, SmPC 4.2: apply a thin film twice daily to the affected area, shaking the bottle well. No duration is stated.
• Zindaclin 1% Gel, SmPC 4.2 and 4.4: a thin film once daily for adults and adolescents; not indicated for children below 12 years; no duration stated; responses may not be seen for 4–6 weeks.
• Zindaclin leaflet: wash as normal, rinse well and pat dry, then apply a small amount in a thin layer to the whole of the area where you usually get the spots, and use it for as long as your doctor tells you. The leaflet says do not apply to areas where you do not usually get spots, do not just dab it onto individual spots, do not use a thick layer, and do not use it to stop getting acne, "it does not work that way". Avoid the eyes, inside the nose and the mouth; if the gel gets there, wash straight away with plenty of water. If a dose is missed, use it when remembered and do not double up.
• Freederm SmPC 4.2 and 4.4: apply twice daily to the affected area after washing with warm water and soap, using enough gel to cover the area; the same dose is stated for adults, children and the elderly. If excessive dryness, irritation or peeling occurs, the label advises reducing to one application per day or every other day.
• Freederm leaflet: wash, pat dry, then apply a thin film and gently massage it in over and around the affected skin areas; on sensitive skin, test a small area and wait 24 hours before using it on larger areas.

Indian product listings (for example Faceclin on Tata 1mg) describe external use only: a thin layer on the affected areas with clean, dry hands, washing hands before and after, with improvement taking several days to weeks.

Age limits and length of treatment

For children, the Cleocin T label states that safety and effectiveness in paediatric patients under 12 years have not been established, and Zindaclin is not indicated below 12 years. The NICE guideline NG198 offers a 12-week course of a first-line option and says positive effects can take 6–8 weeks to become noticeable. NICE also says antibiotic-containing treatments should not be continued beyond 6 months except in exceptional circumstances, with review every 3 months and the antibiotic stopped as soon as possible.

Guidance from India is in the same direction. The PRACT-India modified Delphi consensus of 14 dermatology experts (2025) states that topical antibiotics such as clindamycin can be used for a period of 3 months or less as a combination therapy, and that monotherapy with topical antibiotics should be avoided. In every case, use the gel only as prescribed by your doctor.

Side effects

The labels of clindamycin and nicotinamide gels report skin dryness, redness and irritation appear in those labels, along with a warning about diarrhoea and colitis with clindamycin.

Common side effects, with the frequencies the labels give

• Cleocin T gel (18 clinical studies, gel group n=148): dryness 23%, oiliness or oily skin 18%, burning 10%, itching 10%, erythema 7%. Its label also lists, without frequencies, abdominal pain, gastrointestinal disturbances, gram-negative folliculitis, eye pain and contact dermatitis with topical clindamycin.
• Dalacin T SmPC 4.8 lists folliculitis, pseudomembranous colitis, stinging of the eye, eye pain, gastrointestinal disorder, abdominal pain, seborrhoea, skin irritation, urticaria, dry skin and contact dermatitis; the frequency of each could not be read from the text.
• Zindaclin SmPC 4.8: about 10% of patients can be expected to have an adverse reaction, typically of irritant dermatitis, and it is more likely if too much gel is used. The leaflet gives frequencies: common (up to 1 in 10) — dry skin, redness, skin burning, irritation around the eyes, worsening of acne, itchy skin; uncommon (up to 1 in 100) — painful skin, scaly rash. An oil-free moisturiser may help.
• Freederm SmPC 4.8: the most frequently encountered adverse effect is dryness of the skin; less frequent are pruritus, erythema, burning sensation and irritation, with no numeric frequencies given. Its leaflet says local dryness occurs occasionally, and allergic reactions such as itching, redness, swelling or burning occur very occasionally.

Serious side effects

The Cleocin T label warns that oral and parenteral clindamycin has been associated with severe colitis which may result in patient death, that topical use results in systemic absorption, and that diarrhoea, bloody diarrhoea and colitis, including pseudomembranous colitis, have been reported with topical and systemic clindamycin. It states that when significant diarrhoea occurs the drug should be discontinued. Colitis is reported rarely with topical clindamycin.

The Dalacin T SmPC says diarrhoea and colitis have been reported infrequently with topical clindamycin and that the product should be discontinued if diarrhoea is significant or prolonged. The Zindaclin SmPC links topical clindamycin very rarely to pseudomembranous colitis and says the product should be discontinued immediately if diarrhoea occurs; its leaflet adds that if you get diarrhoea with blood and mucus, stop and call a doctor. If you develop significant diarrhoea, particularly bloody diarrhoea or diarrhoea with mucus, stop the gel and seek prompt medical advice.

Who should not use it, and interactions

The labels of each ingredient list these precautions; check the leaflet in your own pack and tell your doctor about any relevant history before you start.

• Contraindications, as each label states them: Cleocin T lists hypersensitivity to clindamycin or lincomycin, regional enteritis, ulcerative colitis, or antibiotic-associated colitis. Dalacin T lists hypersensitivity to clindamycin, lincomycin or any excipient, and a history of inflammatory bowel disease or antibiotic-associated colitis. Zindaclin lists hypersensitivity to clindamycin or an excipient, says the gel is not to be used in lincomycin sensitivity, and says the history of antibiotic-associated colitis, enteritis, ulcerative colitis or Crohn's disease should be taken into account. Freederm is contraindicated in hypersensitivity to any component.
• Interactions: the Freederm SmPC states "None known", and the Zindaclin SmPC reports no interactions with topical clindamycin. Because systemic clindamycin has neuromuscular blocking properties, the Cleocin T and Dalacin T labels advise caution when it is used with other neuromuscular blocking agents, and caution in atopic individuals.
• Antibiotic resistance: the Zindaclin SmPC warns that prolonged use of clindamycin may cause resistance, with possible cross-resistance to lincomycin and erythromycin; the Cleocin T label notes complete cross-resistance with lincomycin and occasional cross-resistance with macrolides and streptogramin B. NICE NG198 advises against monotherapy with a topical antibiotic for acne.
• Pregnancy: the Cleocin T and Dalacin T labels say clindamycin should be used during the first trimester of pregnancy only if clearly needed; Zindaclin states there are no clinical data for skin use in pregnancy and caution should be exercised; Freederm advises care during the first trimester. Ask your doctor before use in pregnancy.
• Breastfeeding: the Cleocin T label says it is not known whether clindamycin passes into milk after topical use, that the infant's gut should be monitored, and that if it is applied to the chest, infant ingestion should be avoided. The Zindaclin leaflet says you should not breastfeed while using it. Freederm notes that nicotinamide is excreted in breast milk.
• Alcohol and excipients: no source we read states anything about drinking alcohol with this gel. Some clindamycin gels contain ethanol as an excipient — the Zindaclin leaflet states about 20% w/w ethanol, which may cause a burning sensation on damaged skin, plus propylene glycol, and the Freederm excipients include ethanol. Check the pack of the product you use for its ingredients.
• Eyes, nose and mouth: keep the gel away from them; Zindaclin advises bathing the area with copious cool water if contact occurs, and Freederm states external use only, away from the eyes and mucous membranes.

Rules in India

In India this is a prescription medicine, because clindamycin is listed under Schedule H of the Drugs and Cosmetics Rules, 1945.

• Schedule H: the Drugs and Cosmetics Rules, 1945 (amended up to 30 September 2020) list item 119 "Clindamycin" in Schedule H, which also carries item 32 "Antibiotics". Rule 65(9)(a) states that substances in Schedule H shall not be sold by retail except on and in accordance with the prescription of a Registered Medical Practitioner. Nicotinamide does not appear in the Schedule H list in that text.
• Labelling: Rule 97(1)(b) prints the Rx symbol and the Schedule H warning for internal-use medicines, and Rule 97(2) requires "FOR EXTERNAL USE ONLY" on liquid external medicines. Each brand page on Tata 1mg shows "Prescription required".
• NLEM 2022: the National List of Essential Medicines 2022 (Gazette Extraordinary, 11 November 2022) lists clindamycin as capsule 150 mg, capsule 300 mg and injection 150 mg/mL at 6.2.2.5, and again in oral forms at 6.7.5.3, 6.9.3.1 and 6.10.1.5. No topical clindamycin form and no nicotinamide appear in the text. Benzoyl peroxide gel 2.5%–5% is listed at 11.4.1.
• Price control: no NPPA ceiling price was found for clindamycin gel or the clindamycin + nicotinamide combination. Neither is a scheduled NLEM 2022 formulation, so no NLEM ceiling applies.
• WHO AWaRe group: clindamycin is in the WHO ACCESS group of antibiotics (added 2021, changed 2023). The listed formulations are intravenous and oral, so the group applies to the antibiotic, not specifically to this gel.

Top brands in India

Several Indian companies market clindamycin phosphate 1% + nicotinamide 4% gel, and the table at the top of this page lists the brands we found on Tata 1mg on 23 October 2026. This is not a ranking, because no sales-rank source was found; all the pages show the same composition and "Prescription required". One name check again: Clindac A 1% Gel from Alkem contains clindamycin alone, while Alkem's combination is Clindac AN.

The Vibcare range

Vibcare Pharma markets Clinivib N (Grace division, 20 g tube, MRP ₹149.06) in the clindamycin phosphate 1% w/w + nicotinamide 4% w/w composition.

Vibcare Pharma appoints PCD franchise partners district by district, one partner per district, with monopoly rights confirmed in writing; a wholesale drug licence and GST registration are needed to start. See our Derma PCD franchise and PCD pharma franchise pages.

Frequently asked questions

Sources

Related reading

• PCD pharma franchise with Vibcare
• Vibcare Healthcare manufacturing
• About Vibcare Pharma