minocycline hydrochloride
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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.
☞ 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.
☞ 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.
☞ 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.