minocycline hydrochloride
minocycline hydrochloride
Pharmacologic class: Tetracycline
Therapeutic class: Anti-infective
Pregnancy risk category D
Action
Binds reversibly to 30S ribosome, inhibiting bacterial protein synthesis
Availability
Capsules: 50 mg, 75 mg, 100 mg
Capsules (pellet-filled): 50 mg, 100 mg
Microspheres (sustained-release): 1 mg
Suspension: 50 mg/5 ml
Tablets: 50 mg, 75 mg, 100 mg
Indications and dosages
➣ Infections caused by susceptible organisms
Adults: Initially, 200 mg P.O. then 100 mg P.O. q 12 hours or 50 mg P.O. q 6 hours
Children ages 8 and older: 4 mg/kg P.O. followed by 2 mg/kg q 12 hours
➣ Gonorrhea in penicillin-sensitive patients
Adults: Initially, 200 mg P.O., then 100 mg q 12 hours for at least 4 days
➣ Uncomplicated gonococcal urethritis in men
Adults: 100 mg P.O. q 12 hours for 5 days
➣ Syphilis
Adults: Initially, 200 mg P.O., then 100 mg q 12 hours for 10 to 15 days
➣ Acne
Adults: 50 mg P.O. one to three times daily
Dosage adjustment
• Renal impairment
Contraindications
• Hypersensitivity to drug, its components, or tetracyclines
Precautions
Use cautiously in:
• sulfite sensitivity, renal disease, hepatic impairment, nephrogenic diabetes insipidus
• cachectic or debilitated patients
• pregnant (last half of pregnancy) or breastfeeding patients
• children younger than age 8 (not recommended).
Administration
• Ask patient about sulfite sensitivity before giving.
• Give with 8 oz. of water, with or without food.
• Know that drug is used in penicillin-sensitive patients.
Adverse reactions
CNS: headache
CV: pericarditis
EENT: pharyngitis
GI: nausea, vomiting, diarrhea, oral candidiasis, stomatitis, mouth ulcers
GU: bladder or vaginal yeast infection
Metabolic: eosinophilia, hemolytic anemia, thrombocytopenia
Skin: photosensitivity, rash
Other: dental caries; dental infection; gingivitis; periodontitis; tooth disorder, pain, or discoloration; superinfection; hypersensitivity reactions including anaphylaxis
Interactions
Drug-drug. Adsorbent antidiarrheals: decreased minocycline absorption
Antacids containing aluminum, calcium, or magnesium; calcium, iron, and magnesium supplements; sodium bicarbonate: decreased minocycline absorption
Cholestyramine, colestipol: decreased oral absorption of minocycline
Hormonal contraceptives: decreased contraceptive efficacy
Methoxyflurane: nephrotoxicity
Penicillin: interference with bactericidal action of penicillin
Sucralfate: blocked absorption of minocycline
Warfarin: increased anticoagulant effect
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, amylase, aspartate aminotransferase, bilirubin, blood urea nitrogen: increased levels
Hemoglobin, platelets, neutrophils, white blood cells: decreased levels
Urinary catecholamines: false elevation
Drug-food. Dairy products: decreased minocycline absorption
Drug-behaviors. Alcohol use: decreased antibiotic effect
Sun exposure: increased risk of photosensitivity reaction
Patient monitoring
• Assess patient's oral health closely for dental problems.
• Monitor patient for superinfection, especially oral, bladder, and vaginal yeast infections.
• Evaluate CBC and renal and liver function tests frequently.
See Watch closely for hypersensitivity reactions, including anaphylaxis.
Patient teaching
• Tell patient he may take with or without food, followed by a full glass of water. Instruct him to space doses evenly over 24 hours and to take one dose 1 hour before bedtime.
• Advise patient not to take with antacids or iron, calcium, or magnesium products.
See Instruct patient to immediately report fever, chills, skin rash, unusual bleeding or bruising, sore throat, or mouth pain or discomfort.
• Stress importance of good oral hygiene to minimize adverse oral and dental effects.
• Tell patient to complete entire course of therapy even after symptoms improve.
See Caution patient not to use outdated minocycline because it may cause serious kidney disease.
• Inform female patient that drug may make hormonal contraceptives ineffective. Urge her to use barrier contraception.
• Tell pregnant patient that drug may stain fetus' teeth if taken during last half of pregnancy.
• Advise female patient to tell prescriber if she is breastfeeding.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and behaviors mentioned above.