Minocycline

(min oh SI kleen)

Introduced: 1970

Class: Antibiotic, tetracyclines

Prescription: USA: Yes

Controlled Drug: USA: No Canada: Yes

Available as Generic: Yes

Brand Name:Minocin

Principal Uses

As a Single Drug Product: This member of the tetracycline drug class is used primarily to treat (1) a broad range of infections caused by susceptible bacteria and protozoa, and (2) severe, resistant pustular acne.

How This Drug Works: This drug prevents the growth and multiplication of susceptible bacteria by interfering with their formation of essential proteins.

Available Dosage Forms and Strengths

Capsules — 50 mg, 100 mg Capsules,

prolonged-action (Minocin) — 50 mg, 100 mg

Oral suspension — 50 mg per 5-ml teaspoonful (5% alcohol)

Tablets, film-coated — 50 mg, 100 mg

Usual Adult Dosage Range: Initially, 200 mg; then 100 mg/12 hours or 50

mg/6 hours. The total daily dosage should not exceed 350 mg the first day or 200 mg thereafter. Note: Actual dosage and administration schedule must be determined by the physician for each patient individually.

Dosing Instructions: May be taken without regard to food. Take at same

time each day, with a full glass of water or milk. Take the full course prescribed. The tablet may be crushed and the capsule may be opened for administration. However, the pellets in Minocin capsules should not be chewed or crushed; mix with soft food and swallow unaltered.

Usual Duration of Use: The time required to control the infection and be free of fever and symptoms for 48 hours. This varies with the nature of the infection.

This Drug Should Not Be Taken If

• you are allergic to any tetracycline drug (see Drug Class, Section Four).

• you are pregnant or breast-feeding.

Inform Your Physician Before Taking This Drug If

• it is prescribed for a child under 8 years of age.

• you have a history of liver or kidney disease.

• you have systemic lupus erythematosus.

• you are taking any penicillin drug.

• you are taking any anticoagulant drug.

• you plan to have surgery under general anesthesia in the near future.

Possible Side-Effects (natural, expected and unavoidable drug actions) Superinfections, often due to yeast organisms. These can occur in the mouth, intestinal tract, rectum and/or vagina, resulting in rectal and vaginal itching.

Possible Adverse Effects (unusual, unexpected and infrequent reactions)

If any of the following develop, consult your physician promptly for guidance.

Mild Adverse Effects Allergic Reactions: Skin rash, hives, itching of hands and feet, swelling

of face or extremities. Marked dizziness, unsteadiness, incoordination (usually occurs during

the first 3 days). Pigmentation of skin.

Loss of appetite, stomach irritation, nausea, vomiting, diarrhea. Irritation of mouth or tongue, "black tongue," sore throat, abdominal

cramping or pain. Serious Adverse Effects Allergic Reactions: Anaphylactic reaction , asthma, fever,

swollen joints, abnormal bleeding or bruising. Permanent discoloration and/or malformation of teeth when taken

under 8 years of age, including unborn child and infant.

Possible Effects on Sexual Function: None reported.

Natural Diseases or Disorders That May Be Activated by This Drug

Systemic lupus erythematosus.

Possible Effects on Laboratory Tests

Complete blood cell counts: decreased red cells, hemoglobin, white cells ■ and platelets; increased eosinophils (allergic reaction). Blood lupus erythematosus (LE) cells: positive. Prothrombin time: increased.

Liver function tests: increased liver enzymes (AST/GOT and alkaline phosphatase).

CAUTION

1. Antacids, dairy products and preparations containing aluminum, bismuth, calcium, iron, magnesium or zinc can prevent adequate absorption of this drug and reduce its effectiveness significantly.

2. Troublesome and persistent diarrhea can develop in sensitive individuals. If diarrhea persists for more than 24 hours, discontinue this drug and consult your physician.

3. If surgery under general anesthesia is required while taking this drug, the choice of anesthetic agent must be considered carefully to prevent serious kidney damage.

Precautions for Use

By Infants and Children: If possible, tetracyclines should not be given to children under 8 years of age because of the risk of permanent discoloration and deformity of the teeth. Rarely, young infants may develop increased intracranial pressure within the first 4 days of receiving this drug. Tetracyclines may inhibit normal bone growth and development.

By Those over 60 Years of Age: Dosage must be carefully individualized and based upon determinations of kidney function. Natural skin changes may predispose to severe and prolonged itching reactions in the genital and anal regions.

Advisability of Use During Pregnancy

Pregnancy Category: D (tentative). See Pregnancy Code inside back cover. Animal studies: Tetracycline causes limb defects in rats, rabbits and

chickens. Human studies: Information from studies of pregnant women indicates that this drug can cause impaired development and discoloration of teeth and other developmental defects. It is advisable to avoid this drug completely during entire pregnancy.

Advisability of Use if Breast-Feeding

Presence of this drug in breast milk: Yes. Avoid drug or refrain from nursing.

Habit-Forming Potential: None.

Effects of Overdosage: Dizziness, nausea, vomiting, diarrhea.

Possible Effects of Long-Term Use: Superinfections; rarely, impairment of bone marrow, liver or kidney function.

Suggested Periodic Examinations While Taking This Drug (at physician's

discretion) Complete blood cell counts, liver and kidney function tests.

During extended use, sputum and stool examinations may detect early superinfection due to yeast organisms.

While Taking This Drug, Observe the Following

Foods: No restrictions.

Beverages: No restrictions.

Alcohol: No interactions expected. However, it is best avoided if you have

active liver disease.

Tobacco Smoking: No interactions expected. Other Drugs Tetracyclines may increase the effects of

• oral anticoagulants, and make it necessary to reduce their dosage.

• digoxin (Lanoxin), and cause digitalis toxicity.

• lithium (Eskalith, Lithane, etc.), and increase the risk of lithium toxicity.

Tetracyclines may decrease the effects of

• oral contraceptives, and impair their effectiveness in preventing pregnancy.

• penicillins, and impair their effectiveness in treating infections. Tetracyclines taken concurrently with

• methoxyflurane anesthesia may impair kidney function. The following drugs may decrease the effects of tetracyclines

• antacids (aluminum and magnesium preparations, sodium bicarbonate, etc.) may reduce drug absorption.

• iron and mineral preparations may reduce drug absorption. Driving, Hazardous Activities: This drug may cause marked dizziness or

incoordination. Restrict activities as necessary. Aviation Note: The use of this drug may be a disqualification for piloting.

Consult a designated Aviation Medical Examiner. Exposure to Sun: Use caution until sensitivity has been determined. Some tetracyclines can cause photosensitivity.

TEXT 11. Read the following text and put questions to it.