IntravenousSusceptible infectionsAdult: Initially, 200 mg followed by 100 mg 12 hrly. Max: 400 mg/day.
Child: >8 yr Initially, 4 mg/kg, then 2 mg/kg 12 hrly not to exceed the usual adult dose.
OralSusceptible infectionsAdult: 200 mg daily in divided doses.
OralMycobacterium marinum infectionsAdult: 100 mg 12 hrly for 6-8 wk.
OralAsymptomatic meningococcal carriersAdult: 100 mg 12 bid for 5 days, followed by a course of rifampicin.
OralAcneAdult: 50 mg bid or 100 mg once daily. ≥45 kg: 1 mg/kg once daily as modified-release preparation.
OralSyphilisAdult: 200 mg initially, followed by 100 mg 12 hrly for 10-15 days.
OralNongonococcal urethritisAdult: 100 mg 12 hrly for at least 7 days.
OralUncomplicated gonorrhoeaAdult: Initially, 200 mg, followed by 100 mg 12 hrly for a min of 4 days, follow-up cultures should be done w/in 2-3 days after completion of therapy.
OralUncomplicated urethral gonorrhoea in menAdult: 100 mg 12 hrly for 5 days.
Topical/CutaneousPeriodontitisAdult: As extended-release powder: Insert the unit-dose cartridge subgingivally into the base of periodontal pocket as an adjunct to scaling and root planing. Each cartridge contains 1 mg of minocycline. This should be done by a dental healthcare provider and is not meant for self administration.
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Oral, Intravenous:
Reduce dose or increase dosing interval. Max: 200 mg/day.
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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.
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Intravenous:
Add 5 mL of sterile water for inj and immediately further dilute to a vol of 500-1,000 mL w/ NaCl inj, dextrose inj, dextrose and NaCl inj, Ringer's inj, or lactated Ringer's inj.
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Ca-containing soln except lactated Ringer’s, allopurinol, amifostine, soln containing ACTH, aminophylline, amobarbital Na, amphotericin B, bicarbonate infusion mixtures, carbenicillin, cephalothin Na, cefazolin Na, chloramphenicol succinate, colistin sulfate, hydromorphone, iodine Na, methicillin Na, meperidine, morphine, novobiocin, pemetrexed, propofol, penicillin, pentobarbital, phenytoin Na, polymyxin, prochlorperazine, Na ascorbate, sulfadiazine, sulfisoxazole, thiotepa, thiopental Na, vitamin K (Na bisulfate or Na salt), whole blood.
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Hypersensitivity to minocycline and other tetracyclines. Concurrent use w/ methoxyflurane. Lactation.
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Patient w/ history of predisposition to oral candidiasis, pre-existing SLE and myasthenia gravis. Hepatic and renal impairment. Pregnancy.
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Haemolytic anaemia, thrombocytopenia, neutropenia, brownish-black microscopic discolouration of thyroid tissue, thyroid cancer, hyperaesthesia, paraesthesia, headache, dizziness, vertigo, ataxia, bulging fontanelles in infants and benign intracranial HTN in adults, discolouration of the conjunctiva and lacrimal secretions, impaired hearing, tinnitus, pericarditis, pulmonary infiltration, pulmonary eosinophilia, anorexia, nausea, vomiting, diarrhoea, dyspepsia, dysphagia, oesophagitis, oesophageal ulceration, increases in LFT values, hepatitis, acute hepatic failure, jaundice, hyperbilirubinaemia, erythema multiforme, exfoliative dermatitis, photosensitivity, alopecia, hyperpigmentation, rash, acute renal failure, discolouration of teeth, buccal mucosa and tongue.
Potentially Fatal: Drug Rash w/ Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson syndrome, Clostridium difficile-associated disease, hypersensitivity syndrome (comprising eosinophilia, fever, rash), lupus-like and serum sickness-like syndrome (both comprising arthralgia, fever, joint stiffness or swelling).
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May impair ability to drive or operate machinery. Avoid prolonged exposure to sunlight.
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Monitor LFT, BUN, renal function, CBC. If treatment continues for longer than 6 mth, monitor every 3 mth for hepatotoxicity, pigmentation and SLE.
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Symptoms: Dizziness, nausea and vomiting. Management: Symptomatic and supportive treatment.
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Impaired absorption by concomitant admin w/ Ca-containing antacids and other divalent or trivalent cations (e.g. Al, bismuth, Fe, Mg, Zn). May decrease effectiveness of oral contraceptives. May interfere w/ the bactericidal action of penicillins. May potentiate the effect of anticoagulants. Increased risk of nephrotoxicity w/ diuretics. Increased risk of pseudotumour cerebri w/ retinoids (e.g. isotretinoin). Increased risk of ergotism w/ ergot alkaloids.
Potentially Fatal: Concurrent use w/ methoxyflurane may result to fatal renal toxicity.
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May cause false elevations in urinary catecholamine levels due to interference w/ fluorescence test.
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Description:
Mechanism of Action: Minocycline inhibits protein synthesis by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It is active against Streptococcus aureus, Neisseria meningitidis, various enterobacteria, Acinetobacter, Bacteroides, Haemophilus and Nocardia spp., and some mycobacteria.
Pharmacokinetics:
Absorption: Readily and almost completely absorbed from the GI tract. Time to peak plasma concentration: W/in 1-4 hr.
Distribution: Widely distributed in body tissues and fluids w/ high concentrations in the hepatobiliary tract, lungs, sinuses and tonsils, as well as in tears, saliva and sputum. Relatively poor CSF penetration, crosses the placenta and enters breast milk. Plasma protein binding: Approx 75%.
Metabolism: Undergoes minimal hepatic metabolism, converted mainly to 9-hydroxyminocycline.
Excretion: Via urine (approx 8-13%) and faeces (approx 20-30%) as unchanged drug. Elimination half-life: 15-23 hr (IV), 11-22 hr (oral).
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Store between 20-25°C. Protect from light, moisture and excessive heat.
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Anon. Minocycline. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 19/06/2014. Arestin Powder (OraPharma, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 19/06/2014. Buckingham R (ed). Minocycline. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/06/2014. Joint Formulary Committee. Minocycline Hydrochloride (EENT). British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/06/2014. Joint Formulary Committee. Minocycline. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/06/2014. McEvoy GK, Snow EK, Miller J et al (eds). Minocycline Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 19/06/2014. Minocin Injection (Rempex Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 19/06/2014. Minocin Pellet-Filled Capsules, Intravenous and Oral Suspension. U.S. FDA. https://www.fda.gov/. Accessed 19/06/2014.
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