Drugs List

Therapeutic Indications

Uses

Acne vulgaris
Gonorrhoea
Infections sensitive to tetracycline
Meningococcal meningitis - prophylaxis of

Contraindications

Children under 12 years
Acute porphyria
Breastfeeding
End stage renal disease
Pregnancy
Systemic lupus erythematosus

Precautions and Warnings

Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Lactose intolerance
Myasthenia gravis
Severe renal impairment

Advise patient ability to drive or operate machinery may be impaired
Consult national/regional policy on the use of anti-infectives
Cross resistance to other tetracyclines may occur
Some formulations contain lactose
Some formulations contain propylene glycol
Swallow dose with plenty of fluid while sitting or standing
Long term use - monitor every 3 months for unusual pigmentation
Long term use: Monitor every 3 months for SLE or hepatitis
Advise patient to report any new or worsening respiratory symptoms
Advise patient to report any unusual pigmentation
Discontinue if hepatitis or new/worsening SLE occurs
Discontinue if any unusual pigmentation occurs
Discontinue if overgrowth of resistant organisms occurs
Discontinue if patient develops respiratory symptoms
Discontinue if photosensitivity occurs
Discontinue if signs of raised intracranial pressure
Advise to avoid antacids/mineral supplements 3 hours before or after dose
Advise patient that photosensitivity possible

Pregnancy and Lactation

Pregnancy

Minocycline is contraindicated during pregnancy.

Animal studies indicate that tetracyclines cross the placenta, are found in foetal tissues, and can have toxic effects on the developing foetus (often affecting skeletal development). Embryotoxicity has also been noted in animals treated early in pregnancy.

Tetracyclines can bind to calcium ions in developing teeth and bones and a permanent discolouration of the teeth can be observed when administering minocycline after the first trimester (Shaefer 2015). This reaction is more common with long term treatment but has been observed following repeated short term courses. Enamel hypoplasia has also been reported.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Minocycline is contraindicated during lactation.

Tetracyclines have been found in human breast milk in low levels. Absorption by the infant is probably inhibited by the calcium in breast milk. However, theoretically, dental staining and inhibition of bone growth could occur in breastfed infants (Briggs, 2015).

The infant should be monitored for rash and for possible effects on the gastrointestinal flora (such as diarrhoea or candidiasis).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acute hepatic failure
Acute renal failure
Agranulocytosis
Alopecia
Anaphylactoid purpura
Anaphylactoid reaction
Anaphylaxis
Angioneurotic oedema
Anogenital candidiasis
Anorexia
Antibiotic-associated colitis
Arthralgia
Arthritis
Ataxia
Autoimmune hepatitis
Balanitis
Benign intracranial hypertension
Bronchospasm
Brown-black microscopic discolouration of thyroid tissue
Bulging fontanelles in infants
Candidiasis (mouth or throat)
Conjunctival discolouration
Convulsions
Cough
Diarrhoea
Discolouration of body fluids
Dizziness
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dyspepsia
Dysphagia
Dyspnoea
Enamel hypoplasia
Enterocolitis
Eosinophilia
Erythema multiforme
Erythema nodosum
Exacerbation of pre-existing asthma
Exacerbation of systemic lupus erythematosus
Exfoliative dermatitis
Fever
Fixed drug eruption
Glossitis
Haemolytic anaemia
Headache
Hearing disturbances
Hepatitis
Hepatotoxicity
Hypaesthesia
Hyperaesthesia
Hyperbilirubinaemia
Hyperpigmentation
Hypersensitivity reactions
Increase in hepatic enzymes (transient)
Interstitial nephritis
Intrahepatic cholestasis
Jaundice
Joint disorder
Leucopenia
Light-headedness
Mouth discolouration
Myalgia
Myocarditis
Nausea
Neutropenia
Oesophageal ulceration
Oesophagitis
Overgrowth by non-susceptible organisms
Pancreatitis
Pancytopenia
Paraesthesia
Pericarditis
Photosensitivity
Pneumonitis
Polyarteritis nodosa
Pruritus
Pseudomembranous colitis
Pulmonary eosinophilia
Pulmonary infiltration
Rash
Sedation
Serum sickness-like reactions
Serum urea increased
Stevens-Johnson syndrome
Stomatitis
Systemic lupus erythematosus
Systemic lupus erythematosus-like syndrome
Thrombocytopenia
Thyroid abnormalities
Tinnitus
Tongue discolouration
Toxic epidermal necrolysis
Urticaria
Vasculitis
Vertigo
Visual disturbances
Vomiting
Vulvovaginal infections
Yellowish-brown discolouration of teeth

Presentation

Oral formulations of minocycline

Drugs List

Therapeutic Indications

Uses

Acne vulgaris
Gonorrhoea
Infections sensitive to tetracycline
Meningococcal meningitis - prophylaxis of

Dosage

Adults

Children

Additional Dosage Information

Contraindications

Children under 12 years
Acute porphyria
Breastfeeding
End stage renal disease
Pregnancy
Systemic lupus erythematosus

Precautions and Warnings

Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Lactose intolerance
Myasthenia gravis
Severe renal impairment

Advise patient ability to drive or operate machinery may be impaired
Consult national/regional policy on the use of anti-infectives
Cross resistance to other tetracyclines may occur
Some formulations contain lactose
Some formulations contain propylene glycol
Swallow dose with plenty of fluid while sitting or standing
Long term use - monitor every 3 months for unusual pigmentation
Long term use: Monitor every 3 months for SLE or hepatitis
Advise patient to report any new or worsening respiratory symptoms
Advise patient to report any unusual pigmentation
Discontinue if hepatitis or new/worsening SLE occurs
Discontinue if any unusual pigmentation occurs
Discontinue if overgrowth of resistant organisms occurs
Discontinue if patient develops respiratory symptoms
Discontinue if photosensitivity occurs
Discontinue if signs of raised intracranial pressure
Advise to avoid antacids/mineral supplements 3 hours before or after dose
Advise patient that photosensitivity possible

Pregnancy and Lactation

Pregnancy

Minocycline is contraindicated during pregnancy.

Animal studies indicate that tetracyclines cross the placenta, are found in foetal tissues, and can have toxic effects on the developing foetus (often affecting skeletal development). Embryotoxicity has also been noted in animals treated early in pregnancy.

Tetracyclines can bind to calcium ions in developing teeth and bones and a permanent discolouration of the teeth can be observed when administering minocycline after the first trimester (Shaefer 2015). This reaction is more common with long term treatment but has been observed following repeated short term courses. Enamel hypoplasia has also been reported.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Minocycline is contraindicated during lactation.

Tetracyclines have been found in human breast milk in low levels. Absorption by the infant is probably inhibited by the calcium in breast milk. However, theoretically, dental staining and inhibition of bone growth could occur in breastfed infants (Briggs, 2015).

The infant should be monitored for rash and for possible effects on the gastrointestinal flora (such as diarrhoea or candidiasis).

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Acute hepatic failure
Acute renal failure
Agranulocytosis
Alopecia
Anaphylactoid purpura
Anaphylactoid reaction
Anaphylaxis
Angioneurotic oedema
Anogenital candidiasis
Anorexia
Antibiotic-associated colitis
Arthralgia
Arthritis
Ataxia
Autoimmune hepatitis
Balanitis
Benign intracranial hypertension
Bronchospasm
Brown-black microscopic discolouration of thyroid tissue
Bulging fontanelles in infants
Candidiasis (mouth or throat)
Conjunctival discolouration
Convulsions
Cough
Diarrhoea
Discolouration of body fluids
Dizziness
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dyspepsia
Dysphagia
Dyspnoea
Enamel hypoplasia
Enterocolitis
Eosinophilia
Erythema multiforme
Erythema nodosum
Exacerbation of pre-existing asthma
Exacerbation of systemic lupus erythematosus
Exfoliative dermatitis
Fever
Fixed drug eruption
Glossitis
Haemolytic anaemia
Headache
Hearing disturbances
Hepatitis
Hepatotoxicity
Hypaesthesia
Hyperaesthesia
Hyperbilirubinaemia
Hyperpigmentation
Hypersensitivity reactions
Increase in hepatic enzymes (transient)
Interstitial nephritis
Intrahepatic cholestasis
Jaundice
Joint disorder
Leucopenia
Light-headedness
Mouth discolouration
Myalgia
Myocarditis
Nausea
Neutropenia
Oesophageal ulceration
Oesophagitis
Overgrowth by non-susceptible organisms
Pancreatitis
Pancytopenia
Paraesthesia
Pericarditis
Photosensitivity
Pneumonitis
Polyarteritis nodosa
Pruritus
Pseudomembranous colitis
Pulmonary eosinophilia
Pulmonary infiltration
Rash
Sedation
Serum sickness-like reactions
Serum urea increased
Stevens-Johnson syndrome
Stomatitis
Systemic lupus erythematosus
Systemic lupus erythematosus-like syndrome
Thrombocytopenia
Thyroid abnormalities
Tinnitus
Tongue discolouration
Toxic epidermal necrolysis
Urticaria
Vasculitis
Vertigo
Visual disturbances
Vomiting
Vulvovaginal infections
Yellowish-brown discolouration of teeth

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: February 2017

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Aknemin 100mg capsules. Almirall Ltd. Revised June 2015.

Summary of Product Characteristics: Aknemin 50mg capsules. Almirall Ltd. Revised June 2015.

Summary of Product Characteristics: Minocycline 100mg tablets. Actavis UK Ltd. Revised September 2016.

Summary of Product Characteristics: Minocycline 50mg tablets. Actavis UK Ltd. Revised September 2016.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 15 September 2017

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Minocycline. Last revised: 10 March 2015
Last accessed: 22 February 2017