minocycline hydrochloride

(mi noe sye' kleen)

Alti-Minocycline (CAN), Arestin, Dynacin, Gen-Minocycline (CAN), Minocin IV, Novo-Minocycline (CAN)

 

Pregnancy Category D

 

Drug classes

Antibiotic

Tetracycline

 

Therapeutic actions

Bacteriostatic: Inhibits protein synthesis of susceptible bacteria, causing cell death.

 

Indications

·        Infections caused by rickettsiae; Mycoplasma pneumoniae; agents of psittacosis, ornithosis, lymphogranuloma venereum and granuloma inguinale; Borrelia recurrentis; Hemophilus ducreyi; Pasteurella pestis; Pasteurella tularensis; Bartonella bacilliformis; Bacteroides; Vibrio comma; Vibrio fetus; Brucella; E. coli; Enterobacter aerogenes; Shigella; Acinetobacter calcoaceticus; H. influenzae; Klebsiella; Diplococcus pneumoniae; S. aureus

·        When penicillin is contraindicated, infections caused by N. gonorrhoeae, Treponema pallidum, Treponema pertenue, Listeria monocytogenes, Clostridium, Bacillus anthracis. As an adjunct to amebicides in acute intestinal amebiasis

·        Oral tetracyclines are indicated for treatment of acne, uncomplicated urethral, endocervical, or rectal infections in adults caused by Chlamydia trachomatis

·        Oral minocycline is indicated in treatment of asymptomatic carriers of Neisseria meningitidis (not useful for treating the infection); infections caused by Mycobacterium marinum; uncomplicated urethral, endocervical, or rectal infections caused by Ureaplasma urealyticum; uncomplicated gonococcal urethritis in men due to N. gonorrhoeae

·        Arestin: Adjunct to scaling and root planing to reduce pocket depth in patients with adult periodontitis

·        Unlabeled use: Alternative to sulfonamides in the treatment of nocardiosis

 

Contraindications and cautions

·        Contraindicated with allergy to tetracylines.

·        Use cautiously with renal or hepatic dysfunction, pregnancy, lactation.

 

Available forms

Capsules—50, 75, 100 mg; pellet-filled capsules—50, 100 mg; oral suspension—50 mg/5 mL; powder for injection—100 mg

 

Dosages

ADULTS

200 mg followed by 100 mg q 12 hr IV. Do not exceed 400 mg/day. Or 200 mg initially, followed by 100 mg q 12 hr PO. May be given as 100–200 mg initially and then 50 mg qid PO.

·        Syphilis: Usual PO dose for 10–15 days.

·        Urethral, endocervical, rectal infections: 100 mg bid PO for 7 days.

·        Gonococcal urethritis in men: 100 mg bid PO for 5 days.

·        Gonorrhea: 200 mg PO followed by 100 mg q 12 hr for 4 days; get post-therapy cultures within 2–3 days.

·        Meningococcal carrier state: 100 mg q 12 hr PO for 5 days.

·        Adult peridontitis: Unit dose cartridge discharged in subgingival area.

PEDIATRIC PATIENTS > 8 YR

4 mg/kg IV followed by 2 mg/kg q 12 hr IV or PO.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE

IV doses of minocycline are not as toxic as other tetracyclines in these patients. Decrease recommended dosage; increase dosing interval with renal impairment. Do not exceed 200 mg Minocin in 24 hr in patients with renal impairment.

 

Pharmacokinetics

Route

Onset

Peak

Oral

Rapid

2–3 hr

IV

Immediate

End of infusion

 

Metabolism: Hepatic; T1/2: 11–26 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine and feces

 

IV facts

Preparation: Dissolve powder and then further dilute to 500–1,000 mL with sodium chloride injection, dextrose injection, dextrose and sodium chloride injection, Ringer's injection, or lactated Ringer's injection; administer immediately.

Infusion: Infuse slowly over 6 hr; discard any diluted solution not used within 24 hr.

Incompatibilities: Avoid solutions with calcium; a precipitate may form.

Y-site incompatibilities: Do not inject with hydromorphone, meperidine, morphine.

 

Adverse effects

·        Dental: Discoloring and inadequate calcification of primary teeth of fetus if used by pregnant women; discoloring and inadequate calcification of permanent teeth if used during period of dental development

·        Dermatologic: Phototoxic reactions, rash, exfoliative dermatitis (more frequent, more severe with this tetracycline than with any others)

·        GI: Fatty liver, liver failure, anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, esophageal ulcer

·        Hematologic: Hemolytic anemia, thrombocytopenia, neutropenia, eosinophilia, leukocytosis, leukopenia

·        Local: Local irritation at injection site

·        Other: Superinfections, nephrogenic diabetes insipidus syndrome

 

Interactions

·        Decreased absorption of minocycline with antacids, iron, alkali

·        Increased digoxin toxicity

·        Increased nephrotoxicity with methoxyflurane

·        Decreased activity of penicillin

·        Decreased absorption of minocycline if taken with food, dairy products

 

Nursing considerations

Assessment

·        History: Allergy to tetracyclines, renal or hepatic dysfunction, pregnancy, lactation

·        Physical: Skin status, orientation and reflexes, R and sounds, GI function and liver evaluation, urinalysis and BUN, liver and renal function tests; culture infected area

 

Interventions

·        Administer oral medication without regard to food or meals; if GI upset occurs, give with meals.

 

Teaching points

·        Take drug throughout the day for best results.

·        Take with meals if GI upset occurs.

·        Arestin: After treatment, avoid eating hard, crunchy, or sticky foods for 1 wk and postpone brushing for a 12-hr period.

·        You may experience these side effects: Sensitivity to sunlight (wear protective clothing, use sunscreen); diarrhea, nausea (take with meals; eat frequent small meals).

·        Report rash, itching; difficulty breathing; dark urine or light-colored stools; severe cramps, watery diarrhea.

 

Adverse effects in Italic are most common; those in Bold are life-threatening.