What is minocycline?

From the Guidelines

Minocycline is a prescription antibiotic medication that belongs to the tetracycline class of antibiotics, and it is conditionally recommended for acne treatment based on moderate certainty evidence from recent studies, such as 1.

Key Points

• Minocycline is commonly used to treat various bacterial infections, particularly acne, urinary tract infections, respiratory infections, and certain sexually transmitted diseases.
• The typical adult dosage ranges from 50 to 100 mg taken twice daily, though this varies based on the condition being treated.
• Treatment duration depends on the infection but often continues for 7-14 days or longer for chronic conditions like acne.
• Minocycline should be taken with a full glass of water, and patients should remain upright for at least 30 minutes after taking it to prevent esophageal irritation.
• Common side effects include dizziness, nausea, skin discoloration, and increased sun sensitivity.
• It's essential to note that minocycline shouldn't be used during pregnancy or in children under 8 years old as it can affect bone and tooth development, as stated in 1.
• Patients should complete the full prescribed course even if symptoms improve before finishing the medication.

Important Considerations

• Minocycline has been associated with rare but serious adverse effects, including autoimmune disorders, such as drug reaction with eosinophilia and systemic symptoms (DRESS), drug-induced lupus, and other hypersensitivity reactions, as reported in 1 and 1.
• The use of minocycline should be limited to the shortest possible duration, ideally 3-4 months, to minimize the development of bacterial resistance, as recommended in 1 and 1.
• Concomitant topical therapy with benzoyl peroxide or a retinoid should be used with systemic antibiotics and for maintenance after completion of systemic antibiotic therapy, as suggested in 1 and 1.

From the FDA Drug Label

MINOCIN (minocycline) for Injection, is a sterile formulation of a semisynthetic derivative of tetracycline. The chemical name of minocycline is 4,7-Bis(dimethylamino)- 1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12a- tetrahydroxy-1,11-dioxo-2- naphthacenecarboxamide monohydrochloride. Minocycline is a semisynthetic derivative of tetracycline and a sterile formulation for intravenous infusion, used to treat various bacterial infections 2.

• It is indicated for the treatment of infections caused by Gram-negative and Gram-positive bacteria.
• The chemical name of minocycline is 4,7-Bis(dimethylamino)- 1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12a- tetrahydroxy-1,11-dioxo-2- naphthacenecarboxamide monohydrochloride 2.

From the Research

Definition and Properties of Minocycline

• Minocycline is a semi-synthetic, second-generation tetracycline, introduced in 1972, with both antibacterial and anti-inflammatory properties 3.
• It is used for various infectious diseases and in the treatment of acne 3.
• Minocycline has a better pharmacokinetic profile compared to first-generation tetracyclines and is not phototoxic like doxycycline 3.

Uses and Efficacy

• Minocycline is used to treat acne vulgaris, especially inflammatory acne, although its efficacy is not superior to other tetracyclines 3.
• It is also investigated for use in neurologic diseases due to its anti-inflammatory and neuroprotective effects 3, 4.
• Minocycline has been found to have multiple non-antibiotic biological effects, including anti-inflammatory, anti-apoptotic, and inhibition of proteolysis, angiogenesis, and tumor metastasis 4.

Adverse Effects and Safety

• Minocycline has an increased risk of severe adverse effects, including hypersensitivity reactions, autoimmune reactions, and CNS symptoms like dizziness 3.
• Long-term treatment may induce hyperpigmentation of the skin or other organs, and resistance of P. acnes to minocycline can occur 3.
• Serious adverse effects, such as hypersensitivity syndrome reaction, drug-induced lupus, and idiopathic intracranial hypertension, have been reported with systemic administration of minocycline 5, 6.
• Topical minocycline formulations are being developed as a safer alternative for treating acne and rosacea, with fewer adverse effects and less drug interaction 5.