Minocycline


Thông tin thuốc gốc
Chỉ định và Liều dùng
Intravenous
Susceptible infections
Adult: Initially, 200 mg followed by 100 mg 12 hrly. Max: 400 mg/day.
Child: >8 yr Initially, 4 mg/kg, then 2 mg/kg 12 hrly not to exceed the usual adult dose.

Oral
Susceptible infections
Adult: 200 mg daily in divided doses.

Oral
Mycobacterium marinum infections
Adult: 100 mg 12 hrly for 6-8 wk.

Oral
Asymptomatic meningococcal carriers
Adult: 100 mg 12 bid for 5 days, followed by a course of rifampicin.

Oral
Acne
Adult: 50 mg bid or 100 mg once daily. ≥45 kg: 1 mg/kg once daily as modified-release preparation.

Oral
Syphilis
Adult: 200 mg initially, followed by 100 mg 12 hrly for 10-15 days.

Oral
Nongonococcal urethritis
Adult: 100 mg 12 hrly for at least 7 days.

Oral
Uncomplicated gonorrhoea
Adult: Initially, 200 mg, followed by 100 mg 12 hrly for a min of 4 days, follow-up cultures should be done w/in 2-3 days after completion of therapy.

Oral
Uncomplicated urethral gonorrhoea in men
Adult: 100 mg 12 hrly for 5 days.

Topical/Cutaneous
Periodontitis
Adult: As extended-release powder: Insert the unit-dose cartridge subgingivally into the base of periodontal pocket as an adjunct to scaling and root planing. Each cartridge contains 1 mg of minocycline. This should be done by a dental healthcare provider and is not meant for self administration.
Renal Impairment
Oral, Intravenous:
Reduce dose or increase dosing interval. Max: 200 mg/day.
Cách dùng
May be taken with or without food. May be taken w/ meals to reduce GI discomfort.
Pellet-Filled Cap: Should be taken on an empty stomach. Take w/ a full glass of water on an empty stomach at least 1 hr before or 2 hr after meals.
Hướng dẫn pha thuốc
Intravenous:
Add 5 mL of sterile water for inj and immediately further dilute to a vol of 500-1,000 mL w/ NaCl inj, dextrose inj, dextrose and NaCl inj, Ringer's inj, or lactated Ringer's inj.
Tương kỵ
Ca-containing soln except lactated Ringer’s, allopurinol, amifostine, soln containing ACTH, aminophylline, amobarbital Na, amphotericin B, bicarbonate infusion mixtures, carbenicillin, cephalothin Na, cefazolin Na, chloramphenicol succinate, colistin sulfate, hydromorphone, iodine Na, methicillin Na, meperidine, morphine, novobiocin, pemetrexed, propofol, penicillin, pentobarbital, phenytoin Na, polymyxin, prochlorperazine, Na ascorbate, sulfadiazine, sulfisoxazole, thiotepa, thiopental Na, vitamin K (Na bisulfate or Na salt), whole blood.
Chống chỉ định
Hypersensitivity to minocycline and other tetracyclines. Concurrent use w/ methoxyflurane. Lactation.
Thận trọng
Patient w/ history of predisposition to oral candidiasis, pre-existing SLE and myasthenia gravis. Hepatic and renal impairment. Pregnancy.
Phản ứng phụ
Haemolytic anaemia, thrombocytopenia, neutropenia, brownish-black microscopic discolouration of thyroid tissue, thyroid cancer, hyperaesthesia, paraesthesia, headache, dizziness, vertigo, ataxia, bulging fontanelles in infants and benign intracranial HTN in adults, discolouration of the conjunctiva and lacrimal secretions, impaired hearing, tinnitus, pericarditis, pulmonary infiltration, pulmonary eosinophilia, anorexia, nausea, vomiting, diarrhoea, dyspepsia, dysphagia, oesophagitis, oesophageal ulceration, increases in LFT values, hepatitis, acute hepatic failure, jaundice, hyperbilirubinaemia, erythema multiforme, exfoliative dermatitis, photosensitivity, alopecia, hyperpigmentation, rash, acute renal failure, discolouration of teeth, buccal mucosa and tongue.
Potentially Fatal: Drug Rash w/ Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson syndrome, Clostridium difficile-associated disease, hypersensitivity syndrome (comprising eosinophilia, fever, rash), lupus-like and serum sickness-like syndrome (both comprising arthralgia, fever, joint stiffness or swelling).
Thông tin tư vấn bệnh nhân
May impair ability to drive or operate machinery. Avoid prolonged exposure to sunlight.
MonitoringParameters
Monitor LFT, BUN, renal function, CBC. If treatment continues for longer than 6 mth, monitor every 3 mth for hepatotoxicity, pigmentation and SLE.
Quá liều
Symptoms: Dizziness, nausea and vomiting. Management: Symptomatic and supportive treatment.
Tương tác
Impaired absorption by concomitant admin w/ Ca-containing antacids and other divalent or trivalent cations (e.g. Al, bismuth, Fe, Mg, Zn). May decrease effectiveness of oral contraceptives. May interfere w/ the bactericidal action of penicillins. May potentiate the effect of anticoagulants. Increased risk of nephrotoxicity w/ diuretics. Increased risk of pseudotumour cerebri w/ retinoids (e.g. isotretinoin). Increased risk of ergotism w/ ergot alkaloids.
Potentially Fatal: Concurrent use w/ methoxyflurane may result to fatal renal toxicity.
Lab Interference
May cause false elevations in urinary catecholamine levels due to interference w/ fluorescence test.
Tác dụng
Description: Minocycline inhibits protein synthesis by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. It is active against Streptococcus aureus, Neisseria meningitidis, various enterobacteria, Acinetobacter, Bacteroides, Haemophilus and Nocardia spp., and some mycobacteria.
Pharmacokinetics:
Absorption: Readily and almost completely absorbed from the GI tract. Time to peak plasma concentration: W/in 1-4 hr.
Distribution: Widely distributed in body tissues and fluids w/ high concentrations in the hepatobiliary tract, lungs, sinuses and tonsils, as well as in tears, saliva and sputum. Relatively poor CSF penetration, crosses the placenta and enters breast milk. Plasma protein binding: Approx 75%.
Metabolism: Undergoes minimal hepatic metabolism, converted mainly to 9-hydroxyminocycline.
Excretion: Via urine (approx 8-13%) and faeces (approx 20-30%) as unchanged drug. Elimination half-life: 15-23 hr (IV), 11-22 hr (oral).
Bảo quản
Store between 20-25°C. Protect from light, moisture and excessive heat.
References
Anon. Minocycline. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 19/06/2014.

Arestin Powder (OraPharma, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 19/06/2014.

Buckingham R (ed). Minocycline. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/06/2014.

Joint Formulary Committee. Minocycline Hydrochloride (EENT). British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/06/2014.

Joint Formulary Committee. Minocycline. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/06/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Minocycline Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 19/06/2014.

Minocin Injection (Rempex Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 19/06/2014.

Minocin Pellet-Filled Capsules, Intravenous and Oral Suspension. U.S. FDA. https://www.fda.gov/. Accessed 19/06/2014.

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