Minocycline

Indications
 Oral
Susceptible infections
Adult: Initially, 200 mg followed by 100 mg every 12 hr. Alternatively, 100-200 mg initially, followed by 50 mg 4 times daily. Max: 400 mg/day.
Child: >8 yr: Initially, 4 mg/kg followed by 2 mg/kg every 12 hr.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Acne
Adult: 50 mg bid or 100 mg once daily. Alternatively, 1 mg/kg once daily as a modified-release preparation to patients weighing ≥45 kg.
Child: ≥12 yr: 45-59 kg: 45 mg once daily; 60-90 kg: 90 mg once daily; 91-136 kg: 135 mg once daily. Continue treatment for 12 wk.
Renal impairment: Reduce dose or increase dosing interval.
Oral
As part of multidrug therapy for multibacillary leprosy
Adult: Patients intolerant to rifampicin: Regimen includes clofazimine (50 mg daily), ofloxacin (400 mg daily), and minocycline (100 mg daily) for 6 mth, followed by a regimen of clofazimine (50 mg daily) and minocycline (100 mg daily) for at least an additional 18 mth. Patients intolerant to clofazimine: Once-mthly multiple-drug regimen includes rifampicin (600 mg), ofloxacin (400 mg) and minocycline (100 mg) for 24 mth.
Oral
Asymptomatic meningococcal carriers
Adult: 100 mg bid for 5 days followed by a course of rifampicin.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
As part of multidrug therapy for single-lesion paucibacillary leprosy
Adult: Regimen includes a single 600-mg dose of rifampicin, a single 400-mg dose of ofloxacin, and a single 100-mg dose of minocycline.
Child: 5-14 yr: Regimen includes a single 300-mg dose of rifampicin, a single 200-mg dose of ofloxacin, and a single 50-mg dose of minocycline; <5 yr: Appropriately adjust dose of each drug.
Oral
Nongonococcal urethritis
Adult: 100 mg every 12 hr for at least 7 days.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Uncomplicated gonorrhoea
Adult: Initially, 200 mg, followed by 100 mg every 12 hr for a min of 4 days; follow-up cultures should be done within 2-3 days after completion of therapy.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Uncomplicated urethral gonorrhoea in men
Adult: 100 mg every 12 hr for 5 days.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Mycobacterium marinum infections
Adult: 100 mg every 12 hr for 6-8 wk. Cutaneous infection: 100 mg bid for at least 3 mth; a min of 4-6 wk of therapy is necessary to ascertain whether or not the infection is responding.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Nocardiosis
Adult: 200 mg initially, followed by 100 mg every 12 hr in conjunction with a sulfonamide for 12-18 mth.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Rheumatoid arthritis
Adult: 100 mg bid.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Syphilis
Adult: 200 mg initially, followed by 100 mg every 12 hr for 10-15 days.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Oral
Cholera
Adult: Initially, 200 mg followed by 100 mg every 12 hr for 48-72 hr in conjunction with fluid and electrolyte replacement.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Intravenous
Susceptible infections
Adult: Initially, 200 mg followed by 100 mg every 12 hr by slow IV infusion.
Renal impairment: Reduce dose or increase dosing interval. Max total daily dose: 200 mg.
Intrapleural
As sclerosing agent to control pleural effusions associated with metastatic tumours
Adult: Dilute 300 mg in 40-50 ml of 0.9% sodium chloride inj and instil into the pleural space through a thoracostomy tube, followed by clamping of the tube and subsequent removal of the fluid.
Topical/Cutaneous
Periodontitis
Adult: As a modified-release subgingival gel: Insert into the periodontal pocket as an adjunct to scaling and root planing. Total number of cartridges to be used depends on the size, shape and number of pockets being treated.
Topical/Cutaneous
Periodontal infections
Adult: Apply 2% gel to affected area.
Contraindications
 Hypersensitivity to minocycline, other tetracyclines. Pregnancy and lactation.
Warnings / Precautions
 May cause photosensitivity; discontinue at the 1st signs of erythema. May impair ability to drive or operate machinery. Monitor renal, hepatic and haematologic functions during therapy. Hepatic and renal impairment. Children ≤8 yr. Oral forms should be taken with plenty of fluids with the patient in an upright position.
Adverse Reactions
 Oesophageal ulceration; vestibular disturbances e.g. dizziness or vertigo, tinnitus and decreased hearing; hyperpigmentation of the skin; SLE or lupus-like symptoms; GI disturbances; benign intracranial hypertension; abnormal LFTs, hyperbilirubinaemia or jaundice; teeth discolouration in children.
Potentially Fatal: Hypersensitivity syndrome. Hepatitis or liver damage. Pneumonitis.
Overdose Reactions
 Symptoms: Diabetes insipidus, nausea, anorexia, dizziness, vomiting, diarrhoea. Management: Symptom-directed and supportive; not dialysable.
Drug Interactions
 Oral absorption may be impaired by calcium-containing antacids and other divalent or trivalent cations. Decreases effectiveness of oral contraceptives. May increase plasma levels of lithium, theophylline. Pseudotumour cerebri may occur when used with isotretinoin. Additive facial pigmentation with ethinylestradiol.
Potentially Fatal: May increase effects of oral anticoagulants.
See Below for More minocycline Drug Interactions
Lab Interactions
 May cause false elevations in urinary catecholamines with fluorescence test.
Food Interactions
 May cause additive photosensitivity reactions with St John's wort and dong quai.
Mechanism of Actions
 Minocycline inhibits protein synthesis by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It is active against Streptococcus aureus, streptococci, Neisseria meningitidis, various enterobacteria, Acinetobacter, Bacteroides, Haemophilus and Nocardia spp, M. leprae and some mycobacteria.
Absorption: Absorbed readily from the GI tract (oral); absorption not significantly affected by food and milk.
Distribution: Protein-binding: 70-75%. Widely distributed in body tissues and fluids; high concentrations in hepatobiliary tract, lungs, sinuses, tonsils, tears, saliva, sputum. CSF (poor penetration). Crosses the placenta and enters breast milk.
Metabolism: Some hepatic metabolism; converted to 9-hydroxyminocycline.
Excretion: Via faeces (34%); via urine (5-10%). Elimination half-life: 11-26 hr; prolonged in renal impairment.
Administration
 May be taken with or without food. (May be taken w/ meals to reduce GI discomfort.)
Pellet-filled cap: Should be taken on an empty stomach. (Take w/ a full glass of water on an empty stomach at least 1 hr before or 2 hr after meals.)
Storage Conditions
 Oral: Store at 20-25°C. Protect from light, moisture and excessive heat.
ATC Classification
 J01AA08 - minocycline ; Belongs to the class of tetracyclines. Used in the systemic treatment of infections.
A01AB23 - minocycline ; Belongs to the class of local antiinfective and antiseptic preparations. Used in the treatment of diseases of the mouth.
Storage
 Oral: Store at 20-25°C. Protect from light, moisture and excessive heat.
Available As
  • Minocycline 100 mg
  • Minocycline 50 mg

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