minocycline (Minocin, Solodyn)
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Introduction
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
- 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]
- 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
- 200 mg IV/PO loading dose, then 100 mg every 12 hours
- children:
- 4 mg/kg, then 4 mg/kg/day divided every 12 hours
- maximum: 200 mg/day
- acne: 50 mg PO QD-TID, Solodyn: about 1 mg/kg QD
- 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)
Pharmacokinetics
- elimination 1/2life is 16 hours, prolonged with renal insufficiency
- 11% excreted unchanged in the urine
- most is excreted by non-renal routes
- well distributed to most body tissues & fluids, including CSF & saliva
- NO dosage adjustment necessary for renal insufficiency
elimination via liver
elimination via kidney
elimination by hemodialysis = -
Monitor
- liver function tests periodically[8]
Antimicrobial activity
- Neisseria gonorrhoeae (+/-)
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli (+/-)
- Acinetobacter species
- Francisella tularensis
- Brucella species
- Burkholderia[13]
- Chryseobacterium
- Achromobacter
- Alcaligenes
- Aeromonas[13]
- Stenotrophomonas maltophilia
Adverse effects
- common (> 10%)
- discoloration of teeth in children
- less common (1-10%)
- 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)
- other
- vestibular toxicity (vertigo, dizziness)
- loss of appetite
- blue-gray pigmentation of skin & mucous membranes[12]
- 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)
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Mechanism of action
More general terms
More specific terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/17408394
- ↑ 6.0 6.1 Lampl Y et al, Minocycline treatment in acute stroke. An open-label, evaluator-blinded study. Neurology 2007, 69:1404 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17909152
- ↑ 7.0 7.1 7.2 7.3 7.4 Medical Knowledge Self Assessment Program (MKSAP) 15, 17, 18. American College of Physicians, Philadelphia 2009, 2015, 2018.
- ↑ 8.0 8.1 Prescriber's Letter 17(7): 2010 Recommended Lab Monitoring for Common Medications Liver Function Test Scheduling Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260704&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Deprecated Reference
- ↑ 10.0 10.1 Muanda FT, Sheehy O, Berard A Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ 2017 May 1;189:E625-33 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28461374
- ↑ 11.0 11.1 Arshad J, Sayegh R. Scleral Discoloration from Minocycline Treatment. N Engl J Med 2018; 378:1537. April 19, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29669233 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1702031
- ↑ 12.0 12.1 12.2 Wang P, Farmer JP, Rullo J. Minocycline-Induced Hyperpigmentation JAMA Dermatol. 2021;157(8):992. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34232283 https://jamanetwork.com/journals/jamadermatology/fullarticle/2781708
- ↑ 13.0 13.1 13.2 Shortridge D, Arends SJR, Streit JM, Castanheira M. Minocycline activity against unusual clinically significant gram-negative pathogens. Antimicrob Agents Chemother 2021 Sep 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34491809 https://journals.asm.org/doi/10.1128/AAC.01264-21