minocycline (Rx)

Brand and Other Names:Dynacin, Minocin, more...Minocin Kit, Minolira, Solodyn, Ximino
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet/capsule

  • 50mg
  • 75mg
  • 100mg

tablet, extended-release

  • 45mg (Solodyn)
  • 55mg (Solodyn)
  • 65mg (Solodyn)
  • 80mg (Solodyn)
  • 90mg (Solodyn)
  • 105mg (Minolira, Solodyn)
  • 135mg (Minolira, Solodyn)

injection, intravenous

  • 100mg/vial
more...

Acne Vulgaris

50-100 mg PO twice daily

Solodyn, Minolira (extended-release tablets): 1 mg/kg PO qDay  

Administer therapy for 12 weeks

Extended-release tablets

  • Solodyn
    • 45-49 kg: 45 mg qDay (1-0.92 mg/kg)
    • 50-59 kg: 55 mg qDay (1.1-0.93 mg/kg)
    • 60-71 kg: 65 mg qDay (1.08-0.92 mg/kg)
    • 72-84 kg: 80 mg qDay (1.11-0.95 mg/kg)
    • 85-96 kg: 90 mg qDay (1.06-0.94 mg/kg)
    • 97-110 kg: 105 mg qDay (1.08-0.95 mg/kg)
    • 111-125 kg: 115 mg qDay (1.04-0.92 mg/kg)
    • 126-136 kg: 135 mg qDay (1.07-0.99 mg/kg)
  • Minolira
    • 45-59 kg: 52.5 mg qDay (half of the 105-mg tab)
    • 60-89 kg: 67.5 mg qDay (half of the 135-mg tab)
    • 90-125 kg: 105 mg qDay
    • 126-136 kg: 135 mg qDay

Purulent Cellulitis (Off-label)

Community acquired MRSA: 200 mg PO initially

Maintenance: 100 mg PO twice daily for 5-10 days

Chlamydial or Ureaplasma Urealyticum

Uncomplicated infection: 100 mg PO q12hr for at least 7 days

Gonococcal Infection

Uncomplicated infection in males (no anorectal infections or presence of urethritis: 200 mg PO initially)

Maintenance: 100 mg PO twice daily for at least 4 days

Uncomplicated gonococcal urethritis in men: 100 mg PO q12hr for 5 days

Meningococcal Carrier State

100 mg PO q12hr for 5 days

Urethral, Endocervical, or Rectal Infections

Caused by C. trachomatis or U. urealyticum (uncomplicated infection): 100 mg PO q12hr for 7 days

Mycobacterium marinum

100 mg PO q12hr for 6-8 weeks

Syphilis

200 mg PO initially, followed by 100 mg q12hr for 10-15 days

Rheumatoid Arthritis (Off-label)

100 mg PO twice daily

Infective Endocarditis

100 mg IV twice daily for at least 5 weeks

Infections, General Dosing

200 mg PO/IV initially, THEN 100 mg PO/IV q12hr; not to exceed 400 mg/day, OR

Alternatively, 200 mg PO initially, THEN 100 mg PO q12hr; OR 100-200 mg initially; THEN 50 mg PO q6hr

Dosage Modifications

Renal impairment: Reduce dose and/or frequency

Dosing Considerations

Susceptible organisms

  • Acinetobacter baumannii, Actinomyces spp, Afipia felis, Bacteroides spp, Bartonella bacilliformis, Borrelia recurrentis, Brucella spp, Burkholderia cepacia, Klebsiella granulomatis, Campylobacter jejuni, Chlamydia spp, Clostridium spp, Coxiella burnetii, Eikenella corrodens, Escherichia coli, Entamoeba spp, Francisella tularensis, Haemophilus ducreyi, Legionella pneumophila, Leptospira interrogans, Listeria monocytogenes, Mycoplasma hominis, Mycoplasma pneumoniae, Neisseria meningitidis, Neisseria gonorrhoeae, Nocardia asteroides, Prevotella melaninogenica, Propionibacterium acnes, Rickettsiae, Shigella spp, MRSA, Streptococcus pneumoniae, Streptococcus pyogenes, Treponema pallidum, Ureaplasma urealyticum, Vibrio cholerae, Yersinia pestis, Yersinia enterocolitica, Yersinia pseudotuberculosis, mycobacteria other than tuberculosis

Sarcoidosis (Orphan)

Orphan indication sponsor

  • Autoimmunity Research Foundation; Autoimmunity Research, Inc; Thousand Oaks, CA 91360

Dosage Forms & Strengths

tablet/capsule

  • 50mg
  • 75mg
  • 100mg

tablet, extended-release

  • 45mg (Solodyn)
  • 55mg (Solodyn)
  • 65mg (Solodyn)
  • 80mg (Solodyn)
  • 90mg (Solodyn)
  • 105mg (Minolira, Solodyn)
  • 135mg (Minolira, Solodyn)

injection, intravenous

  • 100mg/vial
more...

Acne Vulgaris

<12 years: Safety and efficacy not established

Immediate-release products: 4 mg/kg PO initially (not to exceed 200 mg), THEN 2 mg/kg/day PO q12hr; not to exceed 400 mg/day  

Solodyn, Minolira (extended-release tablets): 1 mg/kg PO qDay

Administer therapy for 12 weeks

Extended-release tablets

  • Solodyn
    • 45-49 kg: 45 mg qDay (1-0.92 mg/kg)
    • 50-59 kg: 55 mg qDay (1.1-0.93 mg/kg)
    • 60-71 kg: 65 mg qDay (1.08-0.92 mg/kg)
    • 72-84 kg: 80 mg qDay (1.11-0.95 mg/kg)
    • 85-96 kg: 90 mg qDay (1.06-0.94 mg/kg)
    • 97-110 kg: 105 mg qDay (1.08-0.95 mg/kg)
    • 111-125 kg: 115 mg qDay (1.04-0.92 mg/kg)
    • 126-136 kg: 135 mg qDay (1.07-0.99 mg/kg)
  • Minolira
    • 45-59 kg: 52.5 mg qDay (half of the 105-mg tab)
    • 60-89 kg: 67.5 mg qDay (half of the 135-mg tab)
    • 90-125 kg: 105 mg qDay
    • 126-136 kg: 135 mg qDay

C. trachomatis or U. urealyticum

100 mg PO q12hr for 7 days

Infections, General Dosing

≤8 years: Not recommended, unless unable to take other, alternate antibiotics

>8 years: 4 mg/kg PO/IV initially; not to exceed 200 mg; THEN 2 mg/kg PO/IV q12hr; not to exceed adult dose; not to exceed 100 mg PO/IV q12hr for 5-10 days 

Dosing Considerations

Susceptible organisms

  • Acinetobacter baumannii, Actinomyces spp, Afipia felis, Bacteroides spp, Bartonella bacilliformis, Borrelia recurrentis, Brucella spp, Burkholderia cepacia, Klebsiella granulomatis, Campylobacter jejuni, Chlamydia spp, Clostridium spp, Coxiella burnetii, Eikenella corrodens, Escherichia coli, Entamoeba spp, Francisella tularensis, Haemophilus ducreyi, Legionella pneumophila, Leptospira interrogans, Listeria monocytogenes, Mycoplasma hominis, Mycoplasma pneumoniae, Neisseria meningitidis, Neisseria gonorrhoeae, Nocardia asteroides, Prevotella melaninogenica, Propionibacterium acnes, Rickettsiae, Shigella spp, MRSA, Streptococcus pneumoniae, Streptococcus pyogenes, Treponema pallidum, Ureaplasma urealyticum, Vibrio cholerae, Yersinia pestis, Yersinia enterocolitica, Yersinia pseudotuberculosis, mycobacteria other than tuberculosis
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Interactions

Interaction Checker

and minocycline

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            To report suspected adverse reactions, contact Valeant Pharmaceuticals North America LLC at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

            Discoloration of teeth (in children)

            Vestibular symptoms (>30%)

            Pericarditis

            Myocarditis

            Vasculitis

            Angioedema

            Alopecia

            Erythema nodosum

            Erythematous rash

            Exfoliative dermatitis

            Pruritus

            Toxic epidermal necrolysis

            Urticaria

            Dizziness

            Fever

            Fatigue

            Somnolence

            Angioedema

            Hyperpigmentation of nails

            Pigmentation of skin and mucous membranes

            Thyroid dysfunction

            Thyroid discoloration

            Thyroid cancer

            Vulvovaginitis

            Hemolytic anemia

            Neutropenia

            Thrombocytopenia

            Agrunolocytosis

            Pancytopenia

            Hepatic cholestasis

            Hepatitis

            Hyperbilirubinemia

            Jaundice

            CNS effects

            Clostridium difficile diarrhea

            Postmarketing Reports

            Anaphylaxis

            Angioneurotic edema

            Eosinophilia

            Pneumonitis

            Nephritis

            Myocarditis

            Swelling of the face

            Lymphadenopathy

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            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            Caution in significant renal impairment (may lead to azotemia, hyperphosphatemia, and acidosis; monitor BUN)

            Adjust dose if renal impairment occurs

            Anaphylaxis reported; discontinue use and institute supportive therapy

            Prolonged use may result in fungal or bacterial superinfection

            Lupus, hepatitis, and vasculitis autoimmune syndromes reported with use; discontinue if lupus symptoms occur and assess liver function tests; ANA and CBC

            Discontinue therapy if pseudomembranous colitis occurs

            Risk of vestibular reactions

            Caution in hepatic impairment; discontinue if liver injury occurs

            Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; use skin protection and avoid prolonged exposure to sunlight

            Reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy

            Tetracycline use during tooth development (last half of pregnancy through age 8 years) can cause tooth enamel hypoplasia or permanent teeth discoloration; more common with long-term use and with repeated, short courses; during pregnancy, may retard skeletal development and reduce bone growth

            Fanconi-like syndrome may occur with outdated tetracyclines

            Lightheadedness and vertigo may occur; use caution when performing tasks that require mental alertness or operating heavy machinery

            May increase BUN secondary to antianabolic effects

            Cases of drug rash with eosinophilia and systemic symptoms (DRESS) reported, some fatal; discontinue immediately

            Intracranial hypertension (pseudotumor cerebri) has been associated with use of tetracyclines including minocycline; avoid concomitant use of isotretinoin and minocycline; isotretinoin is also known to cause pseudotumor cerebri; although intracranial hypertension typically resolves after discontinuation of treatment, risk of permanent visual loss exists; seek ophthalmologic evaluation if visual disturbance occurs during treatment; since intracranial pressure can remain elevated for weeks after drug cessation, monitor until patient stabilizes

            A decrease in fibula growth rate observed in premature human infants given oral tetracycline in doses of 25 mg/kg q6hr

            Hyperpigmentation may occur in nails, bone, skin (including scars), eyes, sclerae, thyroid, oral cavity, visceral tissue, and heart valves

            Increased risk of ergotism when coadministered with ergot alkaloids

            Sporadic cases of serum sickness-like reaction have presented shortly after oral minocycline use, manifested by fever, rash, arthralgia, lymphadenopathy and malaise

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Enters breast milk, some manufacturers say do not nurse; however AAP considers nursing compatible due to calcium chelation of drug and prevention of its absorption; long-term safety of prolonged exposure unknown

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Infection: Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria

            Rheumatoid arthritis: Mechanism not fully understood; may play immunomodulatory, anti-inflammatory, or chondroprotective effects; thought to be a potent inhibitor of metalloproteinases, which are active in rheumatoid arthritis joint destruction

            Absorption

            Absorption: 90-100%

            Peak plasma time: 1-4 hr (immediate release); 3.5-4 hr (extended release tablet)

            Peak plasma concentration (200 mg dose): 2-3.5 mcg/mL

            Distribution

            Majority deposits for extended periods in fat; crosses placenta; enters breast milk

            Protein bound: 70-75%

            Metabolism

            Liver (partially)

            Elimination

            Half-life, elimination: 15-23 hr (PO/IV)

            Excretion: Feces and urine

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            Administration

            Incompatibilities

            IV solutions: Calcium containing solutions (precipitant may form, particularly with alkaline solutions)

            Y-site: Adrenocorticotropic hormone (ACTH), aminophylline, amobarbital sodium, amphotericin B, bicarbonate infusion mixtures, calcium gluconate or chloride, carbenicillin, cephalothin sodium, cefazolin sodium, chloramphenicol succinate, colistin sulfate, heparin sodium, hydrocortisone sodium succinate, iodine sodium, methicillin sodium, novobiocin, penicillin, pentobarbital, phenytoin sodium, polymyxin, prochlorperazine, sodium ascorbate, sulfadiazine, sulfisoxazole, thiopental sodium, vitamin K (sodium bisulfate or sodium salt), whole blood

            Compatibilities

            IV solutions: 0.9% NaCl, dextrose solutions, dextrose and NaCl solutions, Ringer Injection, or Lactated Ringer

            IV Preparation

            Reconstitute cryodessicated powder with 5 mL sterile water for injection

            Immediately dilute further with 500-1000 mL of 0.9% NaCl, dextrose solutions, dextrose and NaCl solutions, Ringer Injection, or Lactated Ringer

            Reformulated Minocin IV

            • Allows for dilution with lower fluid volume
            • After vial reconstitution, dilute further with 100-1000 mL of 0.9% NaCl, dextrose solutions, dextrose and NaCl solutions, or 250-1000 mL of Ringer or Lactated Ringer injections

            IV Administration

            Avoid rapid IV infusion

            Infuse over one hour

            Not to exceed 400mg in 24 hours

            Oral Administration

            May take with or without food

            Ingestion of food along with may help reduce the risk of esophageal irritation and ulceration

            Extended-release tablets (ie, Solodyn) or capsules: Swallow whole without chewing, crushing, or splitting

            Extended-release tablet (Minolira): These tablets are scored and intended to split to give precise dose

            Storage

            Unreconstituted vial: Store at controlled room temperature 20-25 degrees C (68-77 degrees F)

            Final dilutions: Store at controlled room temperature or refrigerated for up to 24 hr

            May be stored at room temperature for up to 4 hours

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.