Semisynthetic tetracycline antibiotic (oral)
Minocycline is a semisynthetic broad-spectrum tetracycline used mainly for moderate to severe acne and some infections (respiratory, urinary, skin). Like other tetracyclines, it must not be used in pregnancy nor in children up to 8 years, and may cause dizziness, pigmentation and photosensitivity reactions.
Also known as: Minociclina
Administration of Isotretinoin should be avoided during and shortly after Minocycline therapy: each drug alone has been associated with pseudotumor cerebri.
The minocycline label is explicit: isotretinoin administration should be avoided shortly before, during and shortly after minocycline therapy, because each drug alone is associated with pseudotumor cerebri. The risk is an additive effect on intracranial pressure, with the potential for permanent visual damage if unrecognized. In patients who need both therapies at different times in the course of acne, a non-overlapping interval should be ensured and headache, vomiting and visual disturbances monitored, with urgent referral for any suspicion of papilledema.
Isotretinoin + minocycline: avoid administration during and shortly after minocycline — risk of pseudotumor cerebri.
Both isotretinoin and minocycline may cause pseudotumor cerebri; concomitant or closely sequential use increases the risk.
Monitor for headache, nausea, vomiting and visual disturbances.
Persistent headache, visual disturbances or papilledema.
Avoid isotretinoin administration during and shortly after minocycline.
DailyMed/FDA (NIH/NLM) — approved Isotretinoin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d5a26c5e-9c3e-4781-8c08-62b91d21a68d ; approved Minocycline label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
Minocycline + Warfarin: tetracyclines may depress plasma prothrombin activity; a downward adjustment of the anticoagulant dosage may be required.
Like other tetracyclines, minocycline may depress plasma prothrombin activity and potentiate the effect of oral anticoagulants. In patients on warfarin starting minocycline, the INR should be monitored at the start and end of the antibiotic, with adjustment of the anticoagulant dose as needed. Alert the patient to signs of bleeding (gum bleeding, bruising, dark stools), especially in the elderly or those with unstable INR.
Minocycline + warfarin: tetracyclines depress prothrombin — adjust the anticoagulant dose and monitor INR.
Tetracyclines have been shown to depress plasma prothrombin activity, potentiating the effect of oral anticoagulants.
Monitor INR and signs of bleeding.
Bleeding, bruising or INR above target.
Monitor INR during the combination and adjust the warfarin dose as needed.
DailyMed/FDA (NIH/NLM) — approved Minocycline label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06 ; approved Warfarin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=541c9a70-adaf-4ef3-94ba-ad4e70dfa057
Minocycline + Ampicillin: bacteriostatic drugs may interfere with the bactericidal action of penicillins; the combination should be avoided.
As a bacteriostatic drug of the tetracycline class, minocycline may interfere with the bactericidal action of penicillins, such as ampicillin. The minocycline label advises avoiding the combination with penicillins. In mixed infections where the combination is considered, weigh the potential antagonism and monitor the clinical response. Whenever possible, choose an alternative antibiotic or separate the therapeutic regimens.
Minocycline + ampicillin: avoid — the bacteriostatic effect may interfere with the bactericidal action of penicillin.
Minocycline, being bacteriostatic, may interfere with the bactericidal action of ampicillin when used together.
Monitor therapeutic efficacy of the infection.
Therapeutic failure of the treated infection.
Avoid the combination; if needed, separate dosing and consider an alternative.
DailyMed/FDA (NIH/NLM) — approved Minocycline label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06 ; approved Ampicillin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3b683547-48ac-48ca-8fd4-6866fd17be34
Minocycline + Antacids (with aluminum, calcium or magnesium): minocycline absorption is impaired by chelation. Separate dosing times.
Antacids with aluminum, calcium or magnesium chelate minocycline in the gastrointestinal lumen, reducing absorption and antibiotic efficacy. The minocycline label documents reduced absorption with antacids. Separate dosing by at least 2–4 hours. Relevant in patients with dyspepsia treated with antacids or with calcium supplements. Monitor the clinical response to infection.
Minocycline + antacids: absorption is impaired by chelation — separate dosing by 2–4 hours.
Antacids with aluminum, calcium or magnesium chelate minocycline in the gastrointestinal lumen, reducing its absorption and efficacy.
Monitor antibiotic efficacy.
Therapeutic failure of the infection.
Separate minocycline dosing from antacids by at least 2–4 hours.
DailyMed/FDA (NIH/NLM) — approved Minocycline label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06 ; approved Antacids label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a13ac81-0c63-48c1-bbb0-f6e67f97b896
Minocycline + Zinc: minocycline absorption is impaired by chelation with preparations containing zinc. Separate dosing times.
Preparations containing zinc chelate minocycline in the gut, reducing its absorption and efficacy. The tetracycline class has this interaction documented in the label (absorption impaired by zinc-containing preparations). Separate dosing by at least 2–4 hours. Relevant in patients with zinc supplementation, common in dermatology. Monitor the response to antibiotic therapy.
Minocycline + zinc: absorption is impaired by chelation — separate dosing by 2–4 hours.
Preparations containing zinc chelate minocycline in the gut, reducing its absorption and efficacy.
Monitor antibiotic efficacy.
Therapeutic failure of the infection.
Separate minocycline dosing from zinc supplements by at least 2–4 hours.
DailyMed/FDA (NIH/NLM) — approved Minocycline label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06 ; approved Zinc label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=49698d00-f44b-4b1f-ae34-6b9067911757
Minocycline + Iron: minocycline absorption is impaired by chelation with preparations containing iron. Separate dosing times.
Preparations containing iron chelate minocycline in the gastrointestinal lumen, reducing its absorption and efficacy — an interaction documented in the tetracycline class. Relevant in patients with iron-deficiency anaemia treated with ferrous sulfate. Separate dosing by at least 2–4 hours and, ideally, take minocycline on an empty stomach. Monitor the clinical response to infection.
Minocycline + iron: absorption is impaired by chelation — separate dosing by 2–4 hours.
Preparations containing iron chelate minocycline in the gastrointestinal lumen, reducing its absorption and efficacy.
Monitor antibiotic efficacy.
Therapeutic failure of the infection.
Separate minocycline dosing from iron supplements by at least 2–4 hours.
DailyMed/FDA (NIH/NLM) — approved Minocycline label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06 ; approved Iron label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=73d1f079-d8eb-44f4-b33d-05fb25b80c8f
Calcium in dairy products may chelate minocycline and reduce its absorption; the effect is smaller than with other tetracyclines, but separation is still recommended.
Prefer taking minocycline with water, 1 hour before or 2 hours after dairy.
DailyMed/FDA (NIH/NLM) — approved Minocycline label (HCl): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
Alcohol may worsen the dizziness and gastrointestinal intolerance associated with minocycline.
Limit alcohol intake during treatment, especially if dizziness occurs.
DailyMed/FDA (NIH/NLM) — approved Minocycline label (HCl): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
Risk of hepatotoxicity (including autoimmune hepatitis and liver failure) associated with minocycline; pre-existing hepatic disease increases the risk.
Monitor symptoms and liver function; discontinue if signs of liver injury.
DailyMed/FDA (NIH/NLM) — approved Minocycline label (HCl): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
Minocycline causes cutaneous photosensitivity (exaggerated reaction to sun and ultraviolet light).
Avoid prolonged sun exposure and ultraviolet light; use sunscreen.
DailyMed/FDA (NIH/NLM) — approved Minocycline label (HCl): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
Minocycline accumulates in renal impairment — prolonged half-life of 18 to 69 hours in renal patients ("half-life ranged from 11 to 16 hours in 7 patients with hepatic dysfunction, and from 18 to 69 hours in 5 patients with renal dysfunction").
Use with caution and reduce dose or interval in renal impairment; monitor.
DailyMed/FDA (NIH/NLM) — approved Minocycline label (HCl): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
"Minocycline, like other tetracycline-class antibiotics, can cause fetal harm when administered to a pregnant woman" (label); the class causes permanent tooth discoloration during tooth development.
Contraindicated in pregnancy and in children up to 8 years; inform the patient of the fetal risk if she becomes pregnant during treatment.
DailyMed/FDA (NIH/NLM) — approved Minocycline label (HCl): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
"Minocycline, like other tetracycline-class antibiotics, can cause fetal harm when administered to a pregnant woman"; the class causes permanent tooth discoloration during tooth development.
Contraindicated in pregnancy (fetal risk and tooth discoloration).
Tetracyclines are excreted in breast milk; risk of tooth discoloration in the infant — avoid during breastfeeding.
No specific contraception required; inform the patient of the fetal risk if she becomes pregnant during treatment.
DailyMed/FDA (NIH/NLM) — approved Minocycline label (HCl): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a5fc4d50-50b2-46e0-b722-4c6b2ec47d06
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Broad-spectrum antibiotic of the tetracycline class (semisynthetic, lipophilic); active against Gram-positive and Gram-negative organisms, including resistant Staphylococcus aureus (MRSA) and Bacillus anthracis.
Inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit (bacteriostatic); high lipophilicity favours tissue penetration and activity in acne.
Oral absorption is rapid and almost complete, without meaningful reduction with food ("absorption of minocycline hydrochloride capsules was unchanged compared to dosing under fasting conditions"); reduced by antacids and iron, zinc or calcium preparations (chelation).
Partially metabolised in the liver; eliminated in urine and faeces, with active metabolites. Half-life is prolonged in renal dysfunction (18–69 h in renal patients) and, to a lesser extent, in hepatic impairment.
Half-life of 11–16 hours in normal volunteers ("half-life in the normal volunteers ranged from 11... to 16 hours"), of 18–69 hours in renal dysfunction and of 11–16 hours (or more) in hepatic dysfunction.
