Minocycline

Minocycline is used to treat moderate to severe acne in people 12 years and older. It helps to reduce the number of pimples. Minocycline belongs to a class of drugs known as tetracycline antibiotics. It works by stopping the growth of bacteria that may make acne worse.

Minocycline treats acne that is thought to be caused by a bacterial infection. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

Minocycline is also used to treat many different bacterial infections, such as urinary tract infections, severe acne, gonorrhea, tick fever, chlamydia, and others.

Minocycline is available under the following different brand names: Dynacin, Minocin, Minocin Kit, Solodyn, and Ximino.

Dosage Forms and Strengths

Tablet/capsule

• 50 mg
• 75 mg
• 100 mg

Tablet

• 45 mg
• 55 mg
• 65 mg
• 80 mg
• 90 mg
• 105 mg
• 115 mg
• 135 mg

Injection, intravenous

• 100 mg/vial

Dosage Considerations – Should be Given as Follows:

Acne Vulgaris

Adults:

• 50-100 mg orally twice daily
• Solodyn (extended-release tablet): 1 mg/kg orally once/day
• Administer therapy for 12 weeks
• Extended-release tablets
  • 45-49 kg: 45 mg once/day (1-0.92 mg/kg)
  • 50-59 kg: 55 mg once/day (1.1-0.93 mg/kg)
  • 60-71 kg: 65 mg once/day (1.08-0.92 mg/kg)
  • 72-84 kg: 80 mg once/day (1.11-0.95 mg/kg)
  • 85-96 kg: 90 mg once/day (1.06-0.94 mg/kg)
  • 97-110 kg: 105 mg once/day (1.08-0.95 mg/kg)
  • 111-125 kg: 115 mg once/day (1.04-0.92 mg/kg)
  • 126-136 kg: 135 mg once/day (1.07-0.99 mg/kg)

Pediatric:

Children under 12 years

• Safety and efficacy not established
• Immediate-release products: 4 mg/kg orally initially (not to exceed 200 mg), THEN 2 mg/kg/day orally every 12 hours; not to exceed 400 mg/day
• Solodyn (extended-release tablet): 1 mg/kg orally once/day
• Administer therapy for 12 weeks
• Extended-release tablets
  • 45-49 kg: 45 mg once/day (1-0.92 mg/kg)
  • 50-59 kg: 55 mg once/day (1.1-0.93 mg/kg)
  • 60-71 kg: 65 mg once/day (1.08-0.92 mg/kg)
  • 72-84 kg: 80 mg once/day (1.11-0.95 mg/kg)
  • 85-96 kg: 90 mg once/day (1.06-0.94 mg/kg)
  • 97-110 kg: 105 mg once/day (1.08-0.95 mg/kg)
  • 111-125 kg: 115 mg once/day (1.04-0.92 mg/kg)
  • 126-136 kg: 135 mg once/day (1.07-0.99 mg/kg)

Purulent Cellulitis (Off-label)

• Community acquired MRSA: 200 mg orally initially
• Maintenance: 100 mg orally twice daily for 5-10 days

Chlamydial or Ureaplasma Urealyticum

• Uncomplicated infection: 100 mg orally every 12 hours for at least 7 days

Gonococcal Infection

• Uncomplicated infection: 100 mg orally every 12 hours for at least 7 days

• Uncomplicated infection in males (no anorectal infections or presence of urethritis: 200 mg orally initially)
• Maintenance: 100 mg orally twice daily for at least 4 days
• Uncomplicated gonococcal urethritis in men: 100 mg orally every 12 hours for 5 days

Meningococcal Carrier State

• 100 mg orally every 12 hours for 5 days

Urethral, Endocervical, or Rectal Infections

• Caused by C. trachomatis or U. urealyticum (uncomplicated infection): 100 mg orally every 12 hours for 7 days

Mycobacterium marinum

• 100 mg orally every 12 hours for 6-8 weeks

Syphilis

• 200 mg orally initially, followed by 100 mg every 12 hours for 10-15 days

Rheumatoid Arthritis (Off-label)

• 100 mg orally twice daily

Infective Endocarditis

• 100 mg intravenously (IV) twice daily for at least 5 weeks

Infections, General Dosing

• Adult: 200 mg orally/IV initially, THEN 100 mg orally/IV every 12 hours; not to exceed 400 mg/day, OR
• Alternatively, 200 mg orally initially, THEN 100 mg orally every 12 hours; OR 100-200 mg initially; THEN 50 mg orally q6hr
• Children 8 years and under: Not recommended, unless unable to take other, alternate antibiotics
• Children over 8 years: 4 mg/kg orally/IV initially; not to exceed 200 mg; THEN 2 mg/kg orally/IV every 12 hours; not to exceed adult dose; not to exceed 100 mg orally/IV every 12 hours for 5-10 days

Dosing Considerations

Susceptible organisms

• Acinetobacter baumannii, Actinomyces spp, Afipia felis, Bacteroides spp, Bartonella bacilliformis, Borrelia recurrentis, Brucella spp, Burkholderia cepacia, Klebsiella granulomatis, Campylobacter jejuni, Chlamydia spp, Clostridium spp, Coxiella burnetii, Eikenella corrodens, Escherichia coli, Entamoeba spp, Francisella tularensis, Haemophilus ducreyi, Legionella pneumophila, Leptospira interrogans, Listeria monocytogenes, Mycoplasma hominis, Mycoplasma pneumoniae, Neisseria meningitidis, Neisseria gonorrhoeae, Nocardia asteroides, Prevotella melaninogenica, Propionibacterium acnes, Rickettsiae, Shigella spp, MRSA, Streptococcus pneumoniae, Streptococcus pyogenes, Treponema pallidum, Ureaplasma urealyticum, Vibrio cholerae, Yersinia pestis, Yersinia enterocolitica, Yersinia pseudotuberculosis, mycobacteria other than tuberculosis

Dosing Modifications

• Renal impairment: Reduce dose and/or frequency

Common side effects of minocycline include:

• Agrunolocytosis
• Central nervous system effects
• Clostridium difficile diarrhea
• Cough
• Discoloration of nails and skin
• Discoloration of teeth (in children)
• Dizziness
• Drowsiness
• Exfoliative dermatitis
• Fatigue
• Fever
• Gum discoloration
• Hair loss
• Hemolytic anemia
• Hepatic cholestasis
• Hepatitis
• Hives
• Hyperbilirubinemia
• Itching
• Lightheadedness
• Low blood platelet count (thrombocytopenia)
• Low white blood cell count (neutropenia)
• Mouth sores
• Muscle or joint pain
• Myocarditis
• Nausea
• Pancytopenia
• Pericarditis
• Pigmentation of skin and mucous membranes
• Rash
• Red, painful lumps under the skin
• Skin redness
• Skin swelling
• Spinning sensation (vertigo)
• Swollen tongue
• Thyroid cancer
• Thyroid discoloration
• Thyroid dysfunction
• Tired feeling
• Toxic epidermal necrolysis
• Unsteadiness
• Upset stomach
• Vasculitis
• Vestibular symptoms
• Vomiting
• Vulvovaginitis
• Yellowing skin and eyes (jaundice)

This is not a complete list of side effects and other serious side effects may occur. Call your doctor for information and medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

If your doctor has directed you to use this medication for your condition, your doctor or pharmacist may already be aware of any possible drug interactions or side effects and may be monitoring you for them. Do not start, stop, or change the dosage of this medicine or any medicine before getting further information from your doctor, healthcare provider or pharmacist first.

Severe Interactions of minocycline include:

• acitretin
• tretinoin

Minocycline has serious interactions with at least 54 different drugs.

Minocycline has moderate interactions with at least 32 different drugs.

Minocycline has mild interactions with at least 26 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains minocycline. Do not take Dynacin, Minocin, Minocin Kit, Solodyn, or Ximino if you are allergic to minocycline or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity

Effects of Drug Abuse

No information available

Short-Term Effects

• Lightheadedness and spinning sensation (vertigo) may occur; use caution when performing tasks that require mental alertness or operating heavy machinery.
• See "What Are Side Effects Associated with Using Minocycline?"

Long-Term Effects

• Prolonged use may result in fungal or bacterial superinfection.
• Tetracycline use during tooth development (last half of pregnancy through age 8 years) can cause tooth enamel hypoplasia or permanent teeth discoloration; more common with long-term use and with repeated, short courses.
• See "What Are Side Effects Associated with Using Minocycline?"

Cautions

Caution in significant renal impairment (may lead to azotemia, hyperphosphatemia, and acidosis; monitor BUN).

Adjust dose if renal impairment occurs.

Anaphylaxis reported; discontinue use and institute supportive therapy.

Prolonged use may result in fungal or bacterial superinfection.

Lupus, hepatitis, and vasculitis autoimmune syndromes reported with use; discontinue if lupus symptoms occur and assess liver function tests; ANA and CBC.

Discontinue therapy if pseudomembranous colitis occurs.

Risk of vestibular reactions.

Caution in hepatic impairment; discontinue if liver injury occurs.

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; use skin protection and avoid prolonged exposure to sunlight.

Reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy.

Tetracycline use during tooth development (last half of pregnancy through age 8 years) can cause tooth enamel hypoplasia or permanent teeth discoloration; more common with long-term use and with repeated, short courses; during pregnancy, may retard skeletal development and reduce bone growth.

Fanconi-like syndrome may occur with outdated tetracyclines.

Lightheadedness and spinning sensation (vertigo) may occur; use caution when performing tasks that require mental alertness or operating heavy machinery.

May increase BUN secondary to anti-anabolic effects.

Cases of drug rash with eosinophilia and systemic symptoms (DRESS) reported, some fatal; discontinue immediately.

Intracranial hypertension (pseudotumor cerebri) has been associated with use of tetracyclines including minocycline; avoid concomitant use of isotretinoin and minocycline; isotretinoin is also known to cause pseudotumor cerebri; although intracranial hypertension typically resolves after discontinuation of treatment, risk of permanent visual loss exists; seek ophthalmologic evaluation if visual disturbance occurs during treatment; since intracranial pressure can remain elevated for weeks after drug cessation, monitor until patient stabilizes.

A decrease in fibula growth rate observed in premature human infants given oral tetracycline in doses of 25 mg/kg every 6 hours.

Hyperpigmentation may occur in nails, bone, skin (including scars), eyes, sclerae, thyroid, oral cavity, visceral tissue, and heart valves.

Increased risk of ergotism when co-administered with ergot alkaloids.

Pregnancy and Lactation

• Use minocycline during pregnancy only in LIFE-THREATENING emergencies when no safer drug available. There is positive evidence of human fetal risk.
• Minocycline enters breast milk. Some manufacturers say do not nurse; however, the American Academy of Pediatric (AAP) considers nursing compatible due to calcium chelation of drug and prevention of its absorption; the long-term safety of prolonged exposure is unknown.