Adult: Initially, 200 mg, followed by 100 mg 12 hourly via IV infusion over 60 minutes. Max: 400 mg daily. Dosing and treatment recommendations and may vary among countries or individual products (refer to specific product guidelines). Child: >8 years Initially, 4 mg/kg, followed by 2 mg/kg 12 hourly via IV infusion over 60 minutes. Dose must not exceed the usual adult dose. Dosing and treatment recommendations and may vary among countries or individual products (refer to specific product guidelines).
Oral Acne vulgaris
Adult: As adjunct therapy for the treatment of severe cases: As conventional tab, conventional cap, or pellet-filled cap: 100 mg as a single dose or in 2 divided doses for at least 6 weeks. Discontinue treatment if there is no improvement after 6 months. For the treatment of inflammatory lesions of non-nodular moderate to severe cases: As extended-release tab: 100 mg once daily. Alternatively, 1 mg/kg once daily for 12 weeks. Discontinue treatment if there is no improvement after 6 months. Dosing and treatment recommendations and may vary among countries or individual products (refer to specific product guidelines). Child: ≥12 years As adjunct therapy for the treatment of severe cases: As conventional tab or conventional cap: Same as adult dose. For the treatment of inflammatory lesions of non-nodular moderate to severe cases: As extended-release tab: Same as adult dose. Dosing and treatment recommendations and may vary among countries or individual products (refer to specific product guidelines).
Oral Syphilis
Adult: As an alternative therapy in non-pregnant penicillin-allergic patients: As conventional tab, conventional cap, or pellet-filled cap: Initially, 200 mg, followed by 100 mg 12 hourly for 10-15 days. Dosing and treatment recommendations and may vary among countries or individual products (refer to specific product guidelines).
Oral Asymptomatic meningococcal carriers
Adult: For the prophylaxis of cases: As conventional tab, conventional cap, or pellet-filled cap: 100 mg bid for 5 days, followed by a course of rifampicin. Dosing and treatment recommendations may vary among countries or individual products (refer to specific product guidelines).
Adult: As conventional tab, conventional cap, or pellet-filled cap: Initially, 200 mg, followed by 100 mg 12 hourly. Dosing and treatment recommendations may vary among countries or individual products (refer to specific product guidelines).
Oral Mycobacterium marinum infections
Adult: As conventional tab, conventional cap, or pellet-filled cap: 100 mg 12 hourly for 6-8 weeks. Dosing and treatment recommendations and may vary among countries or individual products (refer to specific product guidelines).
Oral Uncomplicated gonorrhoea
Adult: As conventional tab, conventional cap, or pellet-filled cap: Initially, 200 mg, followed by 100 mg 12 hourly for at least 4 days. Dosing recommendations and indications may vary among countries or individual products (refer to specific product guidelines).
Oral Uncomplicated urethral gonorrhoea in men
Adult: As conventional tab, conventional cap, or pellet-filled cap: 100 mg 12 hourly for 5 days. Dosing and treatment recommendations and may vary among countries or individual products (refer to specific product guidelines).
Oral Nongonococcal urethritis
Adult: For the treatment of cases caused by Chlamydia trachomatis or Ureaplasma urealyticum: As conventional tab, conventional cap, or pellet-filled cap: 100 mg 12 hourly for at least 7 days. Dosing recommendations and indications may vary among countries or individual products (refer to specific product guidelines).
Topical/Cutaneous Acne vulgaris
Adult: For the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris: As 4% foam: Apply to the affected area(s) once daily at least 1 hour before bedtime. Dosage and treatment recommendations may vary among countries or individual products (refer to specific product guidelines). Child: ≥9 years For the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris: As 4% foam: Same as adult dose. Dosage and treatment recommendations may vary among countries or individual products (refer to specific product guidelines).
Topical/Cutaneous Periodontitis
Adult: As adjunct to scaling and root planing for the treatment of moderate to severe chronic cases: As 2% periodontal gel: Apply a sufficient amount to fill each periodontal pocket until the point of overflow. Initiate treatment every 14 days for a total of 3-4 applications (e.g. 0, 2, 4, and 6 weeks). Treatment must not be repeated within 6 months of initial therapy.
What are the brands available for Minocycline in Singapore?
Oral/Intravenous:
Dose and/or dosing frequency adjustment may be necessary based on clinical response and degree of renal impairment (refer to specific product or local guidelines).
Administration
May be taken with or without food. May be taken w/ meals to reduce GI discomfort. pellet-filled cap: Should be taken on an empty stomach.
Reconstitution
IV: Reconstitute with 5 mL of sterile water for inj, then further dilute with 100-1,000 mL of NaCl 0.9%, dextrose 5% in water, or dextrose 5% in water with NaCl 0.9% or in 250-1,000 mL of Lactated Ringer's inj.
Contraindications
Hypersensitivity to minocycline or other tetracycline antibiotics. Complete renal failure. Children <12 years. Pregnancy and lactation. Concomitant use with retinol or retinoids (e.g. isotretinoin).
Special Precautions
Patient with myasthenia gravis, SLE. Not recommended for the treatment of acne in men or women attempting to conceive a child. Avoid use during tooth development (infants and children ≤8 years). Renal and hepatic impairment. Children.
Adverse Reactions
Significant: Fungal or bacterial superinfection including pseudomembranous colitis, bacterial resistance; permanent discolouration (yellow-grey-brown) of the teeth (particularly when given during tooth development [last half of pregnancy; infancy and childhood to the age of 8 years]), tissue hyperpigmentation, tooth enamel hypoplasia, bone growth suppression; weak neuromuscular blockade; CNS effects (e.g. dizziness, tinnitus, vertigo), idiopathic intracranial hypertension (e.g. pseudotumour cerebri), breathing difficulties (e.g. dyspnoea, bronchospasm, asthma exacerbation, pulmonary eosinophilia, pneumonitis), skin photosensitivity (e.g. mild sunburn-like reactions, photodermatitis), increased BUN. Rarely, SLE and exacerbation of pre-existing SLE. Gel: Dental abscess, local irritation. Blood and lymphatic system disorders: Agranulocytosis, haemolytic anaemia, thrombocytopenia, neutropenia, eosinophilia, leucopenia, pancytopenia. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, glossitis, dysphagia, dyspepsia, stomatitis, pancreatitis. General disorders and administration site conditions: Fever, fatigue, malaise. Metabolism and nutrition disorders: Anorexia. Musculoskeletal and connective tissue disorders: Arthralgia, joint stiffness or swelling, arthritis. Nervous system disorders: Headache, convulsions, flushing sensation, paraesthesia, hypoaesthesia, sedation. Respiratory, thoracic and mediastinal disorders: Wheezing (modified-release cap). Skin and subcutaneous tissue disorders: Pruritus, urticaria, nail discolouration; dryness, burning sensation, exfoliation, erythema, or stinging of skin, skin peeling and itching, telangiectasia (foam); maculopapular and erythematous rashes, skin and mucous membranes pigmentation (cap, pellet-filled and modified-release cap). Potentially Fatal: Serious liver injury including hepatitis and fulminant hepatic failure, hypersensitivity reactions (e.g. serum sickness-like reaction, lupus-like syndrome, sweet syndrome, fixed drug eruption, drug reaction with eosinophilia and systemic symptoms), Stevens-Johnson syndrome, toxic epidermal necrolysis), Clostridiodes difficile-associated diarrhoea.
This drug may cause dizziness, vertigo, headache, light-headedness, visual disturbances, and tinnitus; if affected, do not drive or operate machinery. Avoid excessive exposure to sunlight or artificial UV light, consider applying sunscreen or wearing protective clothing when going outdoors. Periodontal gel: Avoid tooth brushing, flossing, mouthwashing, drinking or eating for at least 2 hours after administration.
Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor LFTs, renal function, and BUN with prolonged therapy; serum Mg (in patients with renal impairment). Monitor antinuclear antibody (ANA) and CBC if symptomatic for autoimmune disorder. Perform ophthalmologic evaluation if visual disturbances occur. In patients with idiopathic intracranial hypertension: Monitor intracranial pressure until stabilisation. Obtain follow-up serologic tests 3 months following therapy (if used for syphilis).
Overdosage
Symptoms: Dizziness, nausea, vomiting, abdominal pain, hypotension, intestinal haemorrhage, acidosis, lethargy, azotaemia (without concomitant creatinine elevation), coma. Management: Symptomatic and supportive treatment. Perform gastric lavage, if needed. May administer antacids and Ca salts to reduce absorption.
Drug Interactions
May potentiate the effects of anticoagulants. Absorption may be impaired when used concomitantly with colestyramine, colestipol, quinapril; antacids or other drugs containing Al, Ca, or Mg, ulcer-healing agents (e.g. sucralfate, bismuth salts); oral Fe preparations. May aggravate nephrotoxicity with diuretics. May interfere with the bactericidal action of penicillin. May decrease the efficacy of oral contraceptives and increase the risk of breakthrough bleeding. Increased risk of ergotism with ergotamine and ergometrine. May reduce the therapeutic effect of typhoid vaccine. Potentially Fatal: Concurrent use with methoxyflurane may lead to renal toxicity. May increase the risk of benign intracranial hypertension with isotretinoin or other systemic retinoids.
Food Interaction
Rate and extent absorption may be decreased by food and/or milk products.
Lab Interference
May cause false elevations of urine glucose or urinary catecholamine levels.
Action
Description: Mechanism of Action: Minocycline, a semi-synthetic tetracycline derivative, has bacteriostatic activity against a broad range of gram-positive and gram-negative bacteria. It inhibits protein synthesis by binding to the 30S and possibly the 50S ribosomal subunits of susceptible bacteria. Pharmacokinetics: Absorption: Readily and almost completely absorbed from the gastrointestinal tract. Food and/or milk may decrease the rate and extent of oral absorption. Bioavailability: 90-100%. Time to peak plasma concentration: 1-3 hours (conventional tab); 3.5-4 hours (extended-release tab); 1-4 hours (cap, pellet-filled cap). Distribution: Widely distributed in the body tissues and fluids with high concentrations in the hepatobiliary tract, lungs, sinuses and tonsils, as well as in tears, saliva, and sputum; penetrates the CSF (relatively poor). Crosses the placenta and enters breast milk. Volume of distribution: 0.14-0.7 L/kg. Plasma protein binding: 55-96%. Metabolism: Minimally metabolised in the liver, mainly to 9-hydroxyminocycline. Excretion: Via urine (5-12% as unchanged drug); faeces (20-34%). Elimination half-life: Oral: 16 hours (range: 11-17 hours); IV: 15-23 hours.
Chemical Structure
Minocycline Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 54675783, Minocycline. https://pubchem.ncbi.nlm.nih.gov/compound/Minocycline. Accessed Nov. 26, 2024.
Storage
Conventional tab/conventional cap/pellet-filled cap/intact vial: Store between 20-25°C. Extended-release tab: Store between 15-30°C. Protect the conventional or extended-release forms, pellet-filled cap, and intact vial from heat, light, and moisture. Diluted solution for inj: Store at room temperature for up to 4 hours or at 2-8°C for up to 24 hours. Periodontal gel: Store between 2-8°C. Do not freeze. Foam: Store between 2-8°C. May be stored <25°C for up to 90 days; do not refrigerate. Protect from heat or temperature >49°C. Storage recommendations may vary among countries and individual products (refer to specific product guidelines).
A01AB23 - minocycline ; Belongs to the class of local antiinfective and antiseptic preparations. Used in the treatment of diseases of the mouth. D10AF07 - minocycline ; Belongs to the class of topical antiinfective preparations used in the treatment of acne. J01AA08 - minocycline ; Belongs to the class of tetracyclines. Used in the systemic treatment of infections.
References
AA-Minocycline 50 mg and 100 mg (Pharmaforte [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 10/09/2024.Amzeeq Aerosol, Foam (Journey Medical Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/09/2024.Anon. Minocycline Hydrochloride (Systemic). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 10/09/2024.Anon. Minocycline Hydrochloride (Topical). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 10/09/2024.Brayfield A, Cadart C (eds). Minocycline. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/09/2024.Dentomycin 2% w/w Periodontal Gel (Henry Schein UK Holdings Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/09/2024.Joint Formulary Committee. Minocycline. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/09/2024.Minocin Capsule, Coated Pellets (Aphena Pharma Solutions - Tennessee, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/09/2024.Minocin Injection (Melinta Therapeutics, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/09/2024.Minocycline (Systemic). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 10/09/2024.Minocycline (Topical). UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 10/09/2024.Minocycline 100 mg Film-coated Tablets (Generics [UK] Limited t/a Mylan). MHRA. https://products.mhra.gov.uk. Accessed 10/09/2024.Minocycline Hydrochloride Capsule (Zydus Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/09/2024.Minocycline Hydrochloride Tablet, Film Coated (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/09/2024.Minocycline Tablet, Extended Release (Lupin Pharmaceuticals, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 10/09/2024.Pharmacy Retailing (NZ) Limited Trading as Healthcare Logistics. Minomycin Capsule data sheet 6 December 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 10/09/2024.Sebonin 100 mg MR Capsules (Accord-UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 10/09/2024.
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