Contact of the gel with the mouth, eyes, lips, other mucous membranes, or irritated or broken skin should be avoided. Application to sensitive areas of the skin should be performed with appropriate caution. In the event of accidental contact, rinse the affected area with water.
Duac should be used with caution in patients with a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis.
Duac should be used with caution in atopic patients, in whom further drying of the skin may occur.
During the first weeks of treatment, most patients may experience increased peeling and reddening of the skin. Depending on the severity of these adverse reactions, patients may use a non-comedogenic moisturiser, temporarily reduce the frequency of gel application, or temporarily discontinue use; however, the efficacy of the product when used less often than once daily has not been established.
Concomitant topical acne therapy should be used with caution, as a cumulative irritant effect of greater severity may occur, particularly with the concurrent use of peeling, desquamating or abrasive agents.
If marked local irritation occurs (e.g. severe erythema, intense skin dryness and pruritus, severe stinging/burning), application of Duac should be discontinued.
Because benzoyl peroxide may cause increased sensitivity to sunlight, patients should avoid the use of sunbeds and intentional or prolonged exposure to sunlight, which should be avoided or at least minimised. If strong sunlight cannot be avoided, patients should be advised to use a sunscreen and to wear protective clothing.
If a patient experiences sunburn, the skin should first be allowed to recover before initiating treatment with Duac.
If prolonged or severe diarrhoea or abdominal cramps occur, treatment with Duac should be discontinued immediately, as these symptoms may be indicative of antibiotic-associated colitis. In such cases, the patient should be evaluated using appropriate diagnostic methods to detect the presence of Clostridium difficile and its toxin, including colonoscopy, and alternative treatment options should be considered in light of the suspected colitis.
The product may bleach hair or coloured fabrics. Contact with hair, textiles, furniture or floor coverings should be avoided.
Resistance to clindamycin
Patients who have recently used clindamycin or erythromycin, either systemically or topically, are more likely to harbour pre-existing antimicrobial resistance in Propionibacterium acnes and commensal flora (see section 5.1).
Cross-resistance
With antibiotic monotherapy, cross-resistance to other antibiotics, such as lincomycin and erythromycin, may develop (see section 4.5).
