Aknemin

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.