II. Indications
- Community Acquired MRSA Skin Infections
- Moderate to severe inflammatory Acne Vulgaris
- Rheumatoid Arthritis (not FDA approved)
III. Contraindications
- Pregnancy
- Children age <8 years
IV. Mechanism
- See Tetracyclines
- Bacteriostatic
- Tetracyclines are Protein synthesis inhibitors, binding the 30S ribosomal subunit of susceptible Bacteria
- Prevents elongated peptide chains from forming from Amino Acid residues
- Inhibits Amino Acid-linked tRNA from binding at the Ribosomal A Site
V. Dosing: Systemic
- Maximum total daily dose: 200 mg
- Community Acquired MRSA Skin Infections
- Adult
- Load: 200 mg orally or IV for first dose
- Next: 100 mg orally or IV two times daily for 5 to 10 days
- Child (age >8 years old)
- Load: 4 mg/kg orally or IV for first dose
- Next: 2 mg/kg orally or IV two times daily for 5 to 10 days
- Adult
-
Acne Vulgaris
-
General
- Use with topical Benzoyl Peroxide and avoid >12 week course to prevent Antibiotic Resistance
- Extended Release (Solodyn or Ximino)
- Age >12 years old and weight >=45 kg
- Take 1 mg/kg orally once daily whole (do not cut, split or chew)
- Immediate Tablets (off-label for adults only)
- Take 50 mg orally twice daily
-
General
-
Rheumatoid Arthritis (off label)
- Take 100 mg orally twice daily
VI. Dosing: Topicals
-
Acne Vulgaris
- Minocycline 4% Foam (Amzeeq)
-
Rosacea
- Minocycline 1.5% Foam (Zilxi)
- Very expensive (nearly $500 for 30 grams)
- No evidence of benefit over other Rosacea topicals
- (2021) Presc Lett 28(6): 36 [PubMed]
- Minocycline 1.5% Foam (Zilxi)
VII. Drug Interactions
- Food
- Minocycline can be taken with milk or food (unlike Tetracycline)
- Take with a full glass of water to prevent Pill Esophagitis
- Do not take with Antacids or Calcium supplements within 2 hours of dose
-
Warfarin
- Increases INR
VIII. Precautions
- Use Sunscreen with these agents due to Drug-induced Photosensitivity
-
Pill Esophagitis
- Take with a full glass of water
-
Renal Function
- Monitor Renal Function in known Chronic Kidney Disease
IX. Adverse Effects
- Generally well tolerated
- Does not generally cause photosensitivity
- Minocycline-Induced Hyperpigmentation
- Blue-gray or muddy brown Hyperpigmentation resulting from Minocycline-iron complex skin deposition
- Distribution: Face, arms, legs (esp. shins)
- Highest risk in long-term dosing for chronic infection or Rheumatoid Arthritis (risk increases with longer duration)
- Uncommon with low dose Acne Vulgaris use
- Hyperpigmentation often persists even after Minocycline is discontinued (limited therapies, e.g. laser)
- Jain (2019) Am Fam Physician 100(4): 239-240 [PubMed]
- Rare adverse effects
- Lupus-Like Syndrome (1:20,000)
- Vertigo or Dizziness
- Oral Mucosa pigmentation (blue-black pigmentation)
- Hypersensitivity Syndrome within 1-3 months
- Delayed Arthralgias or Polyarthritis
-
Pseudotumor Cerebri
- Rare Tetracycline class effect
X. Safety
- Pregnancy Category D
- Unknown safety in Lactation
XI. Resources
- Minocycline Tablet (DailyMed)
XII. References
- (2019) Tarascon Pharmacopeia, accessed 3/31/2019
- LoVecchio (2019) Crit Dec Emerg Med 33(3): 28
Images: Related links to external sites (from Bing)
Related Studies
| minocycline (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MINOCYCLINE 100 MG CAPSULE | Generic | $0.36 each |
| MINOCYCLINE 50 MG CAPSULE | Generic | $0.18 each |
| MINOCYCLINE 75 MG CAPSULE | Generic | $0.35 each |
| MINOCYCLINE HCL 100 MG TABLET | Generic | $1.29 each |
| MINOCYCLINE HCL 50 MG TABLET | Generic | $1.17 each |