{
 "query": "adapalene / benzoyl peroxide / clindamycin",
 "ingredient": "adapalene / benzoyl peroxide / clindamycin",
 "slug": "adapalene-benzoyl-peroxide-clindamycin",
 "rxcui": "2668193",
 "brands": [
  "Cabtreo"
 ],
 "names": [
  "adapalene / benzoyl peroxide / clindamycin"
 ],
 "components": [
  {
   "ingredient": "adapalene",
   "slug": "adapalene",
   "grade": "B",
   "total": 87,
   "scores": {
    "safety": "A",
    "evidence": "D",
    "regulatory": "A",
    "conflict": "A",
    "options": "A"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "05/31/1996",
   "first_approval": "19960531"
  },
  {
   "ingredient": "benzoyl peroxide",
   "slug": "benzoyl-peroxide",
   "grade": "B",
   "total": 81,
   "scores": {
    "safety": "A",
    "evidence": "D",
    "regulatory": "B",
    "conflict": "A",
    "options": "F"
   },
   "boxed": false,
   "controlled": false,
   "first_approval_fmt": "04/22/2022",
   "first_approval": "20220422"
  },
  {
   "ingredient": "clindamycin",
   "slug": "clindamycin",
   "grade": "B",
   "total": 76,
   "scores": {
    "safety": "C",
    "evidence": "D",
    "regulatory": "B",
    "conflict": "A",
    "options": "A"
   },
   "boxed": true,
   "controlled": false,
   "first_approval_fmt": "02/22/1970",
   "first_approval": "19700222"
  }
 ],
 "classes": [],
 "alternatives": [],
 "label": {},
 "faers": null,
 "faers_base": {
  "total": 20692304,
  "serious_share": 0.5742697381596559,
  "death_share": 0.09102355155810585
 },
 "recalls": [],
 "recall_total": 0,
 "drugsfda": {
  "first_approval": "19700222",
  "first_approval_fmt": "",
  "anda": 0,
  "nda": 0,
  "rems": false,
  "labeling_recent": 0
 },
 "trials": null,
 "pubmed": null,
 "payments": {
  "year": "2024",
  "usd": 352653.24,
  "records": 6922,
  "by_name": [
   [
    "Cabtreo",
    352653.24
   ]
  ],
  "names_checked": [
   "adapalene / benzoyl peroxide / clindamycin",
   "Cabtreo"
  ],
  "source": "bulk-index"
 },
 "partd": null,
 "mdl": [],
 "dsc": [],
 "settlements": [],
 "prescrire": null,
 "eml": null,
 "exposure": null,
 "scores": {
  "safety": {
   "score": 65,
   "letter": "C",
   "why": [
    "Graded by its riskiest ingredient, clindamycin (65)",
    "Carries an FDA boxed warning, the strongest warning the FDA issues (-30)",
    "2,166 FDA reports naming it as the suspect drug per million Medicare fills, 0.8x the median drug on this site",
    "Death share in reports is near or below the FAERS average (0.8x)",
    "Off-label use is among the five most-reported items: widely used beyond its approved evidence (-5)"
   ],
   "weight": 0.35
  },
  "evidence": {
   "score": 52,
   "letter": "D",
   "why": [
    "Graded by its riskiest ingredient, adapalene (52)",
    "132 randomized trials and 9 systematic reviews/meta-analyses indexed in PubMed",
    "No Cochrane review found (-5)",
    "'Drug ineffective' is the single most-reported item about this drug in FAERS (-5)"
   ],
   "weight": 0.25
  },
  "regulatory": {
   "score": 81,
   "letter": "B",
   "why": [
    "Graded by its riskiest ingredient, benzoyl peroxide (81)",
    "Recalls since 2016: 0 Class I, 3 Class II, 0 Class III (-9)",
    "Approved within the last 5 years: long-term safety is not yet known (-10)"
   ],
   "weight": 0.15
  },
  "conflict": {
   "score": 85,
   "letter": "B",
   "why": [
    "Graded by its riskiest ingredient, adapalene (100)",
    "Pharma paid doctors $0 tied to this drug last year: negligible",
    "Not named in any pending federal MDL",
    "For the combination product itself:",
    "Pharma paid doctors $352,653 tied to this drug last year (-15)",
    "Not named in any pending federal MDL"
   ],
   "weight": 0.15
  },
  "options": {
   "score": 40,
   "letter": "F",
   "why": [
    "Graded by its riskiest ingredient, benzoyl peroxide (40)",
    "No generic version approved: brand-only pricing (-30)",
    "No same-class alternatives found: little leverage to switch (-30)"
   ],
   "weight": 0.1
  }
 },
 "total": 65,
 "grade": "C",
 "questions": [
  "This is a fixed combination of adapalene and benzoyl peroxide and clindamycin. Why both together, instead of only the one I need?",
  "The most-reported problems in FDA's adverse event data are dry skin, skin burning sensation, acne. How would we recognize and handle those?",
  "Why this one over isotretinoin, tretinoin, trifarotene? What would make you pick one of those instead?",
  "What result are we expecting, by when, and what is the plan if it does not happen?",
  "If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)",
  "The most-reported problems in FDA's adverse event data are dry skin, acne, erythema. How would we recognize and handle those?",
  "There is no generic. Is there an older generic in the same class that works as well for my situation?",
  "This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?",
  "The most-reported problems in FDA's adverse event data are drug hypersensitivity, rash, diarrhoea. How would we recognize and handle those?",
  "Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?",
  "Why this one over amphotericin b, chloramphenicol, erythromycin? What would make you pick one of those instead?"
 ]
}