Duac gel is out of stock. In recent weeks most Duac gels have not been available, except Duac 5% Once Daly gel (60g pack size only). After a few days, Duac gel was no longer available from most pharmacies. A few Duac alternative medicines for the treatment of acne may be considered. This post reviews Duac alternative medicines, which may be considered as a treatment choice during supply issues that Duac is currently going through.
What I Duac?
Duac (Duac Once Daily) is a pharmacy only medicine used in the treatment of acne. Duac Once Daily Gel combined two active ingredients, benzoyl peroxide and clindamycin.
Benzoyl peroxide has slight keratolytic properties, meaning it helps to treat acne lesions. Benzoyl peroxide helps to reduce sebum production, which is associated with acne and is an effective non-antibiotic agent against some bacteria including P. acnes (Santer et al, 2018).
Clindamycin is an antibiotic. Acne is commonly treated with antibiotics, which reduce inflammation caused by bacteria (Farrah & Tan, 2016) and kill the bacteria (antimicrobial effect).
Two Duac Once Daily gels are currently licensed in the UK:
- Duac Once Daily gel 5%, contains 1% of clindamycin and 5% benzoyl peroxide
- Duac Once Daily gel 3%, contains 1% of clindamycin and 3% benzoyl peroxide
What are first-line recommendations for acne treatment?
Duac Once Daily gel is one of few prescription-only medicines available for the treatment of acne. Duac can be offered as a first-line treatment (preferred treatment) for mild to moderate acne. NICE guidelines, which sets recommendations for the management of different conditions recommend the following medicines as first-line treatment (NICE, 2021):
For the treatment of any acne severity:
- Combination of topical adapalene with benzoyl peroxide (Epiduo®)
- Combination of topical tretinoin with topical clindamycin (Treclin gel)
For the treatment of mild to moderate acne:
- topical benzoyl peroxide with topical clindamycin (Duac Once Daily gel)
For the treatment of moderate to severe acne:
- topical adapalene with topical benzoyl peroxide (Epiduo) together with an oral antibiotic, for example, lymecycline or doxycycline
- topical azelaic acid (Skinoren cream or Finacea gel)
Duac Once Daily gel offers a unique combination of two active ingredients which together offer an effective treatment of acne.
What to do when Duac is out of stock?
The immediate reaction to the ‘out of stock’ situation is to ring pharmacies around to see if out of stock medication may be available. This may bring some success, however with common medicines, such as Duac gel it would be just luck to find any remaining stock. Calling 2-3 pharmacies would be sufficient. Asking how long a medication has been out of stock could be a reasonable question, which may give an idea of the overall situation. Regarding Duac gel, a week after it went out of stock, most pharmacies did not have any stock remaining. I am making this assumption based on the number of phone calls to the pharmacy, we have recently been receiving (up to 5 calls a day).
Pharmacy teams usually do not know how long medication will be out of stock.
For patients who are not concerned with the cost, it would be reasonable to check a few online pharmacies for stock availability. Duac can be purchased online, from different pharmacies. The supply of Duac gel from online pharmacies is offered usually as a private service, which means patients pay for the cost of medication and the cost of a private prescription issued by a doctor (usually final price combines both).
Patients who cannot get Duac gel should contact their GP and ask for a prescription for an alternative medication.
Duac alternative medicines for acne
From a broad perspective, most of the first-line treatments recommended by NICE (see paragraph on first-line treatments) could be used as alternatives to Duac. Unfortunately, Duac Once Daily Gel is the only medicine with a combination of benzoyl peroxide and clindamycin, which means no other alternative medicine can be found with the combination of the same active ingredients.
1. Epiduo® gel (adapalene & benzoyl peroxide)
Epiduo® is a prescription-only medication that combines two active ingredients, adapalene and benzoyl peroxide. It can be considered a first-line treatment for acne. Adapalene has retinoid-like properties. Retinoids (derivatives of vitamin A)are effective drugs in the treatment of acne. The exact mechanism of action of adapalene is beyond the scope of this post, however, adapalene produces an anti-inflammatory effect, decreases and clears microcomedones – blackheads and whiteheads (Piskin & Uzunali, 2007). Epiduo® gel is available in two different strengths:
- Epiduo 0.1%/2.5% Gel
- Epiduo 0.3% / 2.5% gel
Epiduo gel cannot be used in pregnancy. Women planning a pregnancy should not use Epiduo either.
Related post: Duac vs Epiduo: Best treatment for acne?
2. Treclin gel (clindamycin & tretinoin)
Treclin gel for acne combines clindamycin (the same antibiotic found in Duac) and tretinoin. Tretinoin, as previously reviewed as adapalene, is classified as a retinoid with benefits already in the treatment of acne already listed (see the previous paragraph).
3. Benzoyl peroxide (Acnecide)
Benzoyl peroxide is available as gel and wash. Acnecide can not only be prescribed but also purchased over the counter from pharmacies. It could be assumed that Acnecide may not be as offer effective as preciously reviewed combination medicines, however, it may offer an alternative treatment during the out of stock period.
In theory, Acnecide could be prescribed with another topical clindamycin (Zindaclin® gel or Dalacin T® solution), although in practice I have never seen this sort of treatment approach.
4. Topical azelaic acid with oral lymecycline or doxycycline
A combination of azelaic acid with oral lymecycline or doxycycline (antibiotics) is perhaps less ‘alternative’ than previously reviewed medicine since none of the active ingredients found in Duac gel are not present.
Azelaic acid (Skinoren® cream or Finacea® gel) co-prescribed with an oral antibiotic such as lymecycline or doxycycline can be considered for the treatment of moderate to severe acne. Azelaic acid has been shown to be effective in the treatment of comedonal acne and acne characterised by inflammatory lesions. Its effectiveness is compared to topical benzoyl peroxide and tretinoin (Fitton & Goa, 1991).
To sum up, patients who need to get an alternative medication to Duac need to contact their GP who may prescribe an alternative medication. Medicines reviewed in this post are considered preferable in the treatment of acne.
Is Epiduo the same as Duac?
Epiduo and Duac are not the same, although both are used for the treatment of acne. Epiduo contains to active ingredients, adapalene and benzoyl peroxide, whereas Duac benzoyl peroxide and clindamycin phosphate. Both contain benzoyl peroxide, but second ingredient is different. Clindamycin (Duac) is an antibiotic, adapalene is a topical retinoid.
Is Duac better than benzoyl peroxide?
Duac can be considered a better medication than benzoyl peroxide since it contains an additional active ingredient - clindamycin. Clindamycin is classified as an antibiotic, giving an addition advantage in acne treatment.
Is Duac the same as Differin?
Duac and Differing are not the same, although both are used in the treatment of acne. Duac contains two active ingredients, clindamycin, an antibiotic and benzoyl peroxide. Differin contains one active ingredient, adapalene, which is a newer generation topical retinoid.
Farrah G, Tan E. The use of oral antibiotics in treating acne vulgaris: a new approach. Dermatol Ther. 2016 Sep;29(5):377-384. doi: 10.1111/dth.12370. Epub 2016 Jun 16. PMID: 27306750. Available at: https://doi.org/10.1111/dth.12370 Accessed on 17/04/2022
Fitton A, Goa KL. Azelaic acid. A review of its pharmacological properties and therapeutic efficacy in acne and hyperpigmentary skin disorders. Drugs. 1991 May;41(5):780-98. doi: 10.2165/00003495-199141050-00007. PMID: 1712709. Available at: https://doi.org/10.2165/00003495-199141050-00007 Accessed on 18/04/2022.
NICE (2021). Acne vulgaris: management. Available at: https://www.nice.org.uk/guidance/ng198/chapter/Recommendations#managing-acne-vulgaris Accessed on 17/04/2022
Piskin S, Uzunali E. A review of the use of adapalene for the treatment of acne vulgaris. Ther Clin Risk Manag. 2007;3(4):621-624. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374937/ Accessed on 17/04/2022
Santer, M., Francis, N. A., Platt, D., Eady, E. A., & Layton, A. M. (2018). Stemming the tide of antimicrobial resistance: implications for management of acne vulgaris. The British journal of general practice: the journal of the Royal College of General Practitioners, 68(667), 64–65. Available at: https://doi.org/10.3399/bjgp18X694457 Accessed on 17/04/2022