MinocyclineRx

Trade Names: Minocin

Synonyms: Minocycline hydrochloride

Drug Class: Tetracycline antibiotic

Preparations
Capsules: 50- and 100 mg

Dose: Effective dose in RA is 200 mg/day (100 mg twice daily)

Indications: RA (see PDR for infectious indications and doses)

Mechanism of Action: Unknown; RA effects are probably related to downregulation of intraarticular metalloproteinases rather than antibacterial effects.

Contraindications: Hypersensitivity to minocycline, children younger than 9 years old, pregnancy

Precautions: Renal impairment

Pregnancy Risk: D

Adverse Effects
Common: Diarrhea, nausea, photosensitivity, hyperpigmentation particularly affecting the face with long-term use, discoloration of teeth in children
Less common: Allergy, rash, increased intracranial pressure, pericarditis, dysphagia, enterocolitis, drug-induced lupus, vasculitis (including polyarteritis nodosa and ANCA+ vasculitis), pseudotumor cerebri, vertigo, agranulocytosis, hepatitis, esophagitis

Drug Interactions
Antacids: Decreased absorption of minocycline
Oral contraceptive: Decreased contraceptive efficacy
Warfarin: Increased effect

Patient Instructions: Avoid sunlight. Do not take with antacids or milk.

Comments: Clinical effect in RA is small; may be most suitable for patients with mild or early disease.

Clinical Pharmacology: Well absorbed after oral administration, renal elimination. Half-life is 15 hours.

Cost: $$$

BIBLIOGRAPHY

O'Dell JR, Blakely KW, Mallek JA, et al. Treatment of early seropositive rheumatoid arthritis: a two-year, double-blind comparison of minocycline and hydroxychloroquine. Arthritis Rheum 2001;44:2235-41. PMID: 11665963