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minocycline (Minocin, Solodyn, Emrosi)

Tradenames: Minocin, Solodyn. Indications: - bacterial infections caused by susceptible bacteria, - rickettsiae, chlamydiae, mycoplasma, spirochetes - urethritis, endocervical & rectal infections caused by Ureaplasma urealyticum & Neisseria gonorrhoeae - cholera, plague, tularemia, anthrax, brucellosis, listeriosis, leprosy, psittacosis, trachoma, typhus, rickettsialpox, Rocky Mountain spotted fever, borreliosis, Bartonella infection, syphylis, chancroid, lymphogranuloma venereum, donovanosis, yaws, - mycobacterial infections - acute otitis media - periodontitis - gingivostomatitis - pharyngitis - sinusitis - bronchitis, pneumonia - intra-abdominal infection - enterocolitis - cholangitis - proctitis - skin or soft tissue infection - eye infections - inclusion conjectivitis - some protozoan infections - meningococcus prophylaxis - MRSA colonization - disease-modifying agent for rheumatoid arthritis - treatment of moderate-severe inflammatory acne [7] - treatment of inflammatory lesions of rosacea [14] - reduction of inflammatory response in ischemic stroke [6] Contraindications: - avoid in pregnant women & children < 12 years of age [7] - most Pseudomonas aeruginosa & Enterobacteriaceae are resistant Caution: renal insufficiency Dosage: 1) 200 mg IV/PO loading dose, then 100 mg every 12 hours 2) children: a) 4 mg/kg, then 4 mg/kg/day divided every 12 hours b) maximum: 200 mg/day 3) acne: 50 mg PO QD-TID, Solodyn: about 1 mg/kg QD 4) ischemic stroke: (6-24 hour window) 500 mg PO QD for 5 days Tabs: 50, 100 mg Suspension: 50 mg/5 mL Solodyn 45 mg, 90 mg, 135 mg ($500/month, 2006) Antimicrobial activity: Gram positive - Streptococcus - Streptococcus group A - Streptococcus group B - Streptococcus group C - Streptococcus group G - Streptococcus pneumonia - Staphylococcus aureus (MSSA) - Staphylococcus aureus (MRSA) +/- Gram negative - Neisseria gonorrhoeae (+/-) - Moraxella catarrhalis - Haemophilus influenzae - Escherichia coli (+/-) - Acinetobacter species - Francisella tularensis - Brucella species - Burkholderia [13] - Chryseobacterium - Achromobacter - Alcaligenes - Aeromonas [13] - Stenotrophomonas maltophilia Atypical bacteria - Chlamydia species - Mycoplasma pneumonia - Rickettsia Anaerobes - Actinomyces - Bacteroides fragilis (+/-) - Bacteroides melaninogenicus - Clostridium species Pharmacokinetics: 1) elimination 1/2life is 16 hours, prolonged with renal insufficiency 2) 11% excreted unchanged in the urine 3) most is excreted by non-renal routes 4) well distributed to most body tissues & fluids, including CSF & saliva 5) NO dosage adjustment necessary for renal insufficiency Monitor: - liver function tests periodically [8] Adverse effects: 1) common (> 10%) - discoloration of teeth in children 2) less common (1-10%) - nausea, diarrhea, photosensitivity 3) uncommon (< 1%) - increased intracranial pressure, bulging fontanels in infants, paresthesia, rash, diabetes insipidus, vomiting, esophagitis, anorexia, abdominal cramps, acute renal failure, azotemia, superinfections, pericarditis, anaphylaxis, pruritus, pigmentation of nails, exfoliative dermatitis, hepatoxicity (rare) 4) other - vestibular toxicity (vertigo, dizziness) - loss of appetite - blue-gray pigmentation of skin & mucous membranes [12] - scleral discoloration [11,12] (images) - Stevens-Johnson syndrome (rare) - pANCA in 7% with chronic therapy for acne [5,7] - drug-induced lupus [7]** - 2-fold increased risk of miscarriage [10] ** appeared twice in MKSAP questions Drug interactions: (see tetracycline) Mechanism of action: 1) bacteriostatic 2) inhibits bacterial protein synthesis

Interactions

drug interactions

Specific

Minocycline Topical (Zilxi)

General

disease-modifying antirheumatic agent (DMARD) tetracycline (Achromycin, Sumycin, Bristacycline)

Properties

MISC-INFO: elimination route LIVER KIDNEY pregnancy-category D safety in lactation - elimination by hemodialysis -

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Sanford Guide to antimicrobial therapy 1997
  3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  5. Marzo-Ortega H et al, Is minocycline therapy in acne associated with antineutrophil cytoplasmic antibody positivity? A cross-sectional study. Br J Dermatolo 2007, 156:2005 PMID: 17408394
  6. Lampl Y et al, Minocycline treatment in acute stroke. An open-label, evaluator-blinded study. Neurology 2007, 69:1404 PMID: 17909152
  7. Medical Knowledge Self Assessment Program (MKSAP) 15, 17, 18. American College of Physicians, Philadelphia 2009, 2015, 2018.
  8. Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Liver Function Test Scheduling Detail-Document#: 260704 (subscription needed) http://www.prescribersletter.com
  9. Deprecated Reference
  10. Muanda FT, Sheehy O, Berard A Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017 May 1;189:E625-33 PMID: 28461374
  11. Arshad J, Sayegh R. Scleral Discoloration from Minocycline Treatment. N Engl J Med 2018; 378:1537. April 19, 2018 PMID: 29669233 http://www.nejm.org/doi/full/10.1056/NEJMicm1702031
  12. Wang P, Farmer JP, Rullo J. Minocycline-Induced Hyperpigmentation JAMA Dermatol. 2021;157(8):992. PMID: 34232283 https://jamanetwork.com/journals/jamadermatology/fullarticle/2781708
  13. Shortridge D, Arends SJR, Streit JM, Castanheira M. Minocycline activity against unusual clinically significant gram-negative pathogens. Antimicrob Agents Chemother 2021 Sep 7 PMID: 34491809 https://journals.asm.org/doi/10.1128/AAC.01264-21
  14. Ingram I FDA Approves New Option for Rosacea. Antibiotic Emrosi topped doxycycline, placebo in phase III trials MedPage Today November 4, 2024 https://www.medpagetoday.com/dermatology/generaldermatology/112743