minocycline hydrochloride: clinical use

Prescribing considerations

• The selected products are licensed for acne, but NHS England advises against routine initiation for acne in primary care because of safety concerns.
• Assess hepatic and renal function where impairment is suspected or extended treatment is anticipated.
• Review concurrent retinoids, anticoagulants, beta-lactams, diuretics, hepatotoxic agents and mineral-containing products.
• Counsel about vestibular effects, photosensitivity, pigmentation, oesophageal injury, lupus-like reactions, hepatitis and symptoms of intracranial hypertension.

Contraindications and cautions

• Hypersensitivity to minocycline, another tetracycline or a product excipient
• Pregnancy
• Breastfeeding under the selected product licences
• Children younger than 12 years
• Complete renal failure

Monitoring

• Consider baseline liver and renal assessment when clinically indicated or extended treatment is anticipated.
• During extended treatment, assess liver function, pigmentation and symptoms of systemic lupus erythematosus; consider blood count and renal monitoring.
• Discontinue and investigate suspected hepatotoxicity, unusual pigmentation, lupus or serum-sickness-like reactions, raised intracranial pressure or severe hypersensitivity.

Clinical pharmacology

Minocycline is a semisynthetic tetracycline that inhibits bacterial protein synthesis and is primarily bacteriostatic. Food and moderate amounts of milk do not significantly impair absorption of these modified-release products.

Formulation and product differences

• Acnamino MR is a hard gelatin capsule containing one film-coated tablet and one enteric-coated tablet.
• Minocin MR is a hard-shell modified-release capsule using a double-pulse delivery system, releasing portions in the stomach and upper gastrointestinal tract.

Capsule

Route: Oral

Strengths: 100 mg

Modified-release capsule

Route: Oral

Strengths: 100 mg