Clinical beta

FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.

Drug Monograph

Minocycline

Minocycline

Tetracycline (PO)

AcneMRSAAtypical

Indication

Acne β€’ MRSA SSTI alternative β€’ atypical coverage

At a glance

INDICATIONS (CORE USE)

Similar to doxycycline for many indications; **vertigo** more common; **pigmentation** long-term (skin/teeth/bone).

ADULT DOSE (STANDARD)

100 mg PO q12h then 50–100 mg daily maintenance (acne lower)

MAX DOSE

~200 mg/day adult acute

Route

PO, IV (rare)

PEDIATRIC DOSE

>8 years weight-based β€” short courses RMSF etc.

Do not miss

Must-not-miss safety points

Major warning

- Vestibular toxicity β€” dizziness common - Drug-induced lupus / autoimmune hepatitis rare - Pigmentation with prolonged use - Same tetracycline pregnancy/teeth rules as doxy

Indications

USE IF: Acne, some MRSA/atypical scenarios when doxycycline not tolerated or formulary preference. AVOID IF: Vestibular symptoms occupation (pilots), pregnancy, young children prolonged.

Primary

  • Moderate–severe acne vulgaris
  • CA-MRSA SSTI oral alternative

Secondary

  • Nocardia / atypical mycobacterial regimens (specialist)

Other

  • Rheumatology off-label uses β€” not ED bread-and-butter

Dosing

STANDARD (ADULT PO)

100 mg PO q12h acute infection; lower daily doses acne (dermatology)

ADULT DOSE

Acne: lower daily doses per dermatology; infection: 100 mg BID early

PEDIATRIC DOSE

As doxycycline caution <8 years.

MAX DOSE

200 mg/day typical acute max

Practical Note

Take with full glass water.

Warnings

Clinical warnings

  • Intracranial hypertension
  • Hyperpigmentation

Adverse effects

  • vertigo
  • nausea
  • blue-gray skin/nail pigmentation

Contraindications

  • Tetracycline allergy

Drug interactions

  • Same as doxycycline β€” chelation
  • warfarin

Special populations

Pediatrics

>8 years weight-based β€” short courses RMSF etc.

Pregnancy

Avoid pregnancy

Lactation

caution.

Renal impairment

Better than older tetracyclines in renal impairment for oral β€” still caution. **CrCl scaffold (FMBM β€” titrate to FDA/SFDA label + institutional pharmacy nomogram):** - **CrCl β‰₯50** β†’ standard dosing per agent (doxycycline often minimal renal adjustment) - **CrCl 10–50** β†’ **caution** some tetracyclines; verify label vs severe CKD - **CrCl <10** β†’ avoid or extreme caution (agent-dependent); minocycline β†’ severe **hepatic** impairment caution

Hepatic impairment

Monitor LFTs long course.

Elderly

Dizziness β†’ fall risk.

Administration

PO with water; avoid lying down after.

Monitoring

  • Monitor: - IV or prolonged oral course β†’ **LFTs** per indication - Doxycycline / minocycline β†’ **photosensitivity** counseling + sun protection - LFTs prolonged therapy - Dizziness functional assessment
  • Recheck: - No clinical improvement at 48–72h β†’ reassess diagnosis, resistance, source control, and drug interactions - If targets not met after reassessment of dose, organ function, and interactions β†’ escalate per protocol (DO NOT continue blindly)

Overdose / toxicity

Clinical Picture

**Life-threatening (first):** **acute liver failure** (rare massive); **esophageal perforation** (pill injury) β€” uncommon. **Secondary:** GI upset, IV phlebitis, chronic pigmentation.

Immediate Actions

Stop β†’ antiemetics; hydration; LFTs if hepatitis suspected

Antidote

No specific antidote; treat complications (e.g. anaphylaxis β†’ epinephrine per ACLS)

Decontamination

Recent large PO β†’ charcoal if window

Escalation

Intractable vomiting, esophageal perforation suspicion, acute liver failure β†’ **ICU** / surgery; **severe renal failure with toxicity β†’ consider HD** (agent-dependent clearance) β€” pharmacy consult

Clinical pearls

Common mistakes, resistance logic, and bedside traps

High-Yield Summary

Doxycycline’s dizzy cousin. **Pigmentation** with months/years. Good for acne; think twice if patient drives for work.

Clinical pearls

Stewardship: infection courses should end β€” don’t inherit acne dose for serious infection without reassessment. *Stewardship (all antimicrobials):* Empiric choice β†’ syndrome severity + **local antibiogram**; shortest effective course.

Stewardship & safety

  • Vertigo
  • Pigmentation
  • Water with pill

Pharmacokinetics

CNS penetration higher β€” explains vestibular SE; hepatic metabolism.

Mechanism of action

Lipophilic tetracycline β€” 30S inhibition.

Common brand names

Global data (no country-specific data available)

Saudi Arabia

(placeholder β€” verify local formulary)

Common trade names are curated examples only β€” formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.

Country practice notes

  • Empiric choice β†’ tie to syndrome, severity, and local antibiogram β€” not habit.
  • IV β†’ PO step-down when oral bioavailability and susceptibility allow.
  • Do not use antibiotics for uncomplicated viral illness β€” stewardship.

References

Saudi Arabia

  • SFDA (Saudi Food & Drug Authority)
  • Saudi National Formulary / MOH (where available)

International

  • WHO Model List of Essential Medicines (verify current edition)
  • US FDA or EU EMA product information (when national SmPC is unavailable)
  • Sanford Guide
  • IDSA / ESCMID (indication-specific)
  • Local antimicrobial stewardship / hospital formulary
  • FDA / SFDA / regional product labeling
  • Sanford Guide
  • IDSA / ESCMID (indication-specific)
  • Local antimicrobial stewardship / hospital formulary
  • FDA / SFDA / regional product labeling

Do not miss

  • Uncomplicated viral URI/bronchitis β†’ antibiotics rarely indicated
  • Narrow or stop when susceptibilities + clinical stability allow
  • Autoimmune hepatitis / DRESS rare β€” LFTs if unwell weeks into therapy.
  • Vertigo
  • Pigmentation
  • Water with pill