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Alti-Minocycline (CAN), Arestin, Dynacin, Gen-Minocycline (CAN), Minocin IV, Novo-Minocycline (CAN)
Pregnancy Category D
Bacteriostatic: Inhibits protein synthesis of susceptible bacteria, causing cell death.
· 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.
Capsules—50, 75, 100 mg; pellet-filled capsules—50, 100 mg; oral suspension—50 mg/5 mL; powder for injection—100 mg
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.
End of infusion
Metabolism: Hepatic; T1/2: 11–26 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces
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.
· 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
· 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
· 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
· Administer oral medication without regard to food or meals; if GI upset occurs, give with meals.
· 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.