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(min-oh-SIGH-kleen)
Arestin, Dynacin, Minocin, Minocin IV,  Alti-Minocycline, Apo-Minocycline, Novo-Minocycline, Vectrin
Class: Antibiotic/tetracycline

 Action Inhibits bacterial protein synthesis.

 Indications Treatment of periodontitis as an adjunct to scaling and root planing. Treatment of infections caused by susceptible strains of gram-positive and gram-negative bacteria, Rickettsia and Mycoplasma pneumonia, and trachoma; treatment for susceptible infections when penicillins are contraindicated; adjunctive treatment of acute intestinal amebiasis; treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from nasopharynx, chlamydia, inflammatory acne, syphilis, gonorrhea, and lymphogranuloma nervosum. Unlabeled use(s): Alternative to sulfonamides in treatment of nocardiosis; sclerosing agent to control malignant pleural effusion.

 Contraindications Hypersensitivity to tetracyclines.

 Route/Dosage

Periodontitis

ADULTS: Subgingival 1 mg minocycline microspheres are to be inserted by an oral health care professional.

Susceptible Infections

ADULTS: PO/IV 200 mg initially, then PO/IV 100 mg q 12 hr or PO 50 mg qid. CHILDREN > 8 YR: PO/IV 4 mg/kg initially, then 2 mg/kg q 12 hr.

Gonococcal Infection

ADULTS: PO 200 mg initially, then 100 mg bid for minimum of 4 days; 100 mg bid for 5 days.

Inflammatory Acne

ADULTS: PO 50 mg 1to 3 times daily.

Primary/Secondary Syphilis

ADULTS: PO 200 mg initially then 100 mg q 12 hr for 10 to 15 days.

Chlamydia

ADULTS: PO 100 mg bid for ³ 7 days.

Meningococcal Carrier State

ADULTS: PO 100 mg q 12 hr for 5 days.

 Interactions

Antacids (containing aluminum, calcium, magnesium, zinc), bismuth salts, divalent or trivalent cations: May decrease oral absorption of minocycline. Anticoagulants, oral: Increased anticoagulant activity. Contraceptives, oral: May reduce effect of oral contraceptives. Digoxin: May increase digoxin serum levels. Insulin: Increases hypoglycemic potential. Iron salts: May decrease absorption of minocycline. Methoxyflurane: Increased potential for nephrotoxicity exists; do coadminister. Penicillins: May interfere with bactericidal action of penicillins. Urinary alkalinizers, zinc salts: May decrease serum minocycline levels. INCOMPATIBILITIES: Calcium-containing solutions other than Ringer’s Injection and Ringer’s Injection Lactate.

 Lab Test Interferences May increase liver function test values and BUN. False-negative results in urine glucose testing with glucose oxidase (eg, Clinistix, Tes-tape). False increase in urinary catecholamines with fluorometric method.

 Adverse Reactions

CNS: Lightheadedness; dizziness; vertigo. DERM: Urticaria; rash; photosensitivity; blue-gray pigmentation of skin and mucous membranes. EENT: Glossitis, black hairy tongue, dysphagia, sore throat; hoarseness. GI: Diarrhea; nausea; vomiting; abdominal pain or discomfort; esophageal ulcers; norexia; bulky, loose stools. GU: Increased BUN. HEMA: Hemolytic anemia; thrombocytopenia; neutropenia. HEPA: Hepatitis; increased liver enzymes. OTHER: Hypersensitivity, including anaphylaxis; pseudotumor cerebri.

 Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Advise against nursing. Children: Avoid in children < 8 yr unless other appropriate drugs are ineffective or contraindicated because abnormal bone formation and discoloration of teeth may occur. Esophageal irritation/ulceration: May result from tablet or capsule lodging in esophagus. Greater risk in patients with esophageal obstructive disease or hiatal hernia. Expiration: Do not use outdated product; degraded product is highly nephrotoxic. Hepatic effects: Large IV doses can be dangerous, leading to liver failure. Parenteral therapy: Prolonged periods of parenteral use may result in thrombophlebitis. Pseudotumor cerebri (benign intracranial hypertension): Has been reported in adults. Usual manifestations are headache and blurred vision. Superinfection: Prolonged use may result in bacterial or fungal overgrowth.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Do not use outdated drug; degraded product is highly nephrotoxic.
  • Administer tablets or capsules with full glass of water. If possible, have patient in standing position for 90 sec after ingestion.
  • Administer evening dose ³ 1 hr before bedtime.
  • Administer oral form ³ 2 hr before or after ingesting antacids containing aluminum, calcium, zinc or magnesium; bismuth salts; ferrous salts or other divalent or trivalent cations.
  • Reserve parenteral therapy for situations when oral therapy is not indicated; switch to oral therapy as soon as possible.
  • Initially dissolve powder for injection with Sodium Chloride Injection, Dextrose Injection, Dextrose and Sodium Chloride Injection, Ringer’s Injection, or Lactated Ringer’s Injection. Do not use any solution containing calcium (a precipitate may form).
  • Store prepared solution for up to 24 hr at room temperature; discard if stored longer.
  • Immediately before use further dilute prepared solution to 500 to1000 ml with one of solutions listed for initial preparation.
  • Store suspension at room temperature. Do not freeze.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note renal insufficiency or liver impairment.
  • In long-term therapy perform hematopoietic, renal, and hepatic studies.
  • Observe for common side effects of nausea, diarrhea, vomiting, rash, blue-gray pigmentation of skin and mucous membranes, lightheadedness, dizziness or vertigo and report to healthcare provider.
  • Report headache and blurred vision, symptoms of pseudotumor cerebri (benign intracranial hypertension), to healthcare provider.
  • Be alert for possible thrombophlebitis with prolonged parenteral therapy.
  • Be alert for superinfection; prolonged use of drug may result in bacterial or fungal overgrowth. Superinfection of bowel with staphylococci may be life threatening.

 Patient/Family Education

  • Instruct patient to avoid simultaneous ingestion of drug and antacids, oral iron supplements and vitamins with iron.
  • Advise patient to take q 12 hr.
  • Instruct patient that if antacid is needed or if iron supplement or vitamin with iron is being taken, to take it ³ 2 hr before or 2 hr after drug.
  • Advise patients using suspension to store it in refrigerator and to shake well before use.
  • Warn patient that using expired drug is dangerous.
  • Encourage patients with gonococcal or chlamydia infections to keep follow-up visits.
  • Inform patient that drug may interfere with effectiveness of birth control pills and advise use of alternative or additional nonhormonal birth control methods while taking the drug.
  • Instruct patient to report these symptoms to their healthcare provider: nausea, diarrhea, vomiting, headache, lightheadedness, dizziness, vertigo, rash, blue-gray pigmentation of the skin and mucous membranes, visual disturbances, or other bothersome physical complaints.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Advise patient that drug may cause dizziness and lightheadedness and to use caution while driving or performing other tasks requiring mental alertness.

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