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Minocycline

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Minocycline, Minocin, Minocycline-Induced Hyperpigmentation, Solodyn, Ximino

  • See Also
  1. Tetracyclines
  • Indications
  1. Community Acquired MRSA Skin Infections
  2. Moderate to severe inflammatory Acne Vulgaris
  3. Rheumatoid Arthritis (not FDA approved)
  • Contraindications
  1. Pregnancy
  2. Children age <8 years
  • Mechanism
  1. See Tetracyclines
  2. Bacteriostatic
  3. Tetracyclines are Protein synthesis inhibitors, binding the 30S ribosomal subunit of susceptible Bacteria
  4. Prevents elongated peptide chains from forming from Amino Acid residues
    1. Inhibits Amino Acid-linked tRNA from binding at the Ribosomal A Site
  • Dosing
  • Systemic
  1. Maximum total daily dose: 200 mg
  2. Community Acquired MRSA Skin Infections
    1. Adult
      1. Load: 200 mg orally or IV for first dose
      2. Next: 100 mg orally or IV two times daily for 5 to 10 days
    2. Child (age >8 years old)
      1. Load: 4 mg/kg orally or IV for first dose
      2. Next: 2 mg/kg orally or IV two times daily for 5 to 10 days
  3. Acne Vulgaris
    1. General
      1. Use with topical Benzoyl Peroxide and avoid >12 week course to prevent Antibiotic Resistance
    2. Extended Release (Solodyn or Ximino)
      1. Age >12 years old and weight >=45 kg
      2. Take 1 mg/kg orally once daily whole (do not cut, split or chew)
    3. Immediate Tablets (off-label for adults only)
      1. Take 50 mg orally twice daily
  4. Rheumatoid Arthritis (off label)
    1. Take 100 mg orally twice daily
  • Dosing
  • Topicals
  1. Acne Vulgaris
    1. Minocycline 4% Foam (Amzeeq)
  2. Rosacea
    1. Minocycline 1.5% Foam (Zilxi)
      1. Very expensive (nearly $500 for 30 grams)
      2. No evidence of benefit over other Rosacea topicals
      3. (2021) Presc Lett 28(6): 36 [PubMed]
  • Drug Interactions
  1. Food
    1. Minocycline can be taken with milk or food (unlike Tetracycline)
    2. Take with a full glass of water to prevent Pill Esophagitis
    3. Do not take with Antacids or Calcium supplements within 2 hours of dose
  2. Warfarin
    1. Increases INR
  • Precautions
  1. Use Sunscreen with these agents due to Drug-induced Photosensitivity
  2. Pill Esophagitis
    1. Take with a full glass of water
  3. Renal Function
    1. Monitor Renal Function in known Chronic Kidney Disease
  • Adverse Effects
  1. Generally well tolerated
  2. Does not generally cause photosensitivity
  3. Minocycline-Induced Hyperpigmentation
    1. Blue-gray or muddy brown Hyperpigmentation resulting from Minocycline-iron complex skin deposition
    2. Distribution: Face, arms, legs (esp. shins)
    3. Highest risk in long-term dosing for chronic infection or Rheumatoid Arthritis (risk increases with longer duration)
    4. Uncommon with low dose Acne Vulgaris use
    5. Hyperpigmentation often persists even after Minocycline is discontinued (limited therapies, e.g. laser)
    6. Jain (2019) Am Fam Physician 100(4): 239-240 [PubMed]
  4. Rare adverse effects
    1. Lupus-Like Syndrome (1:20,000)
    2. Vertigo or Dizziness
    3. Oral Mucosa pigmentation (blue-black pigmentation)
    4. Hypersensitivity Syndrome within 1-3 months
    5. Delayed Arthralgias or Polyarthritis
  5. Pseudotumor Cerebri
    1. Rare Tetracycline class effect
  • Safety
  1. Pregnancy Category D
  2. Unknown safety in Lactation
  • Resources
  1. Minocycline Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=37baf13f-cc65-44a1-93d9-e5213875af1a
  • References
  1. (2019) Tarascon Pharmacopeia, accessed 3/31/2019
  2. LoVecchio (2019) Crit Dec Emerg Med 33(3): 28