Minocycline Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Acne

Immediate-release formulations:
Initial dose: 50 to 100 mg orally twice a day for 3 to 6 weeks or until improvement occurs
Maintenance dose: 50 to 100 mg orally once a day

Extended-release tablets:
45 to 49 kg: 45 mg orally once a day
50 to 59 kg: 55 mg orally once a day
60 to 71 kg: 65 mg orally once a day
72 to 84 kg: 80 mg orally once a day
85 to 96 kg: 90 mg orally once a day
97 to 110 kg: 105 mg orally once a day
111 to 125 kg: 115 mg orally once a day
126 to 136 kg: 135 mg orally once a day

Duration: 12 weeks

Usual Adult Dose for Actinomycosis

100 mg orally or IV every 12 hours

Duration: Initial parenteral therapy for 2 to 6 weeks, followed by oral therapy for a total duration of 6 to 12 months

Clinical response should be monitored by CT or MRI.

Usual Adult Dose for Bacterial Infection

Oral: 200 mg initially followed by 100 mg orally every 12 hours; alternatively, 100 to 200 mg initially followed by 50 mg orally 4 times a day has been used

IV: 200 mg initially followed by 100 mg IV every 12 hours (maximum dose: 400 mg/24 hours)

Usual Adult Dose for Meningitis - Meningococcal

Elimination of Neisseria meningitidis carrier state: 100 mg orally every 12 hours for 5 days

Rifampin, ciprofloxacin, or ceftriaxone are considered first-line agents.

Usual Adult Dose for Skin or Soft Tissue Infection

Mycobacterium marinum: 100 mg orally or IV every 12 hours for at least 3 months

Vibrio vulnificus: 100 mg IV or orally every 12 hours plus cefotaxime 2 g IV every 8 hours or ceftazidime 1 to 2 g IV every 8 hours

Usual Adult Dose for Skin and Structure Infection

Mycobacterium marinum: 100 mg orally or IV every 12 hours for at least 3 months

Vibrio vulnificus: 100 mg IV or orally every 12 hours plus cefotaxime 2 g IV every 8 hours or ceftazidime 1 to 2 g IV every 8 hours

Usual Pediatric Dose for Acne

12 years or older:
Extended-release tablets:
45 to 49 kg: 45 mg orally once a day
50 to 59 kg: 55 mg orally once a day
60 to 71 kg: 65 mg orally once a day
72 to 84 kg: 80 mg orally once a day
85 to 96 kg: 90 mg orally once a day
97 to 110 kg: 105 mg orally once a day
111 to 125 kg: 115 mg orally once a day
126 to 136 kg: 135 mg orally once a day

Duration: 12 weeks

Usual Pediatric Dose for Bacterial Infection

Above 8 years of age: 4 mg/kg orally or IV initially followed by 2 mg/kg every 12 hours

The usual adult dosage should not be exceeded.

Renal Dose Adjustments

Dosage adjustments may be required in patients with renal impairment (CrCl less than 80 mL/min) to prevent accumulation, azotemia, hyperphosphatemia, and acidosis.

Immediate-release and IV formulations: The total daily dose should not exceed 200 mg/day in patients with renal impairment.

Extended-release tablets: Dose reductions and/or extended dosing intervals are recommended; however, specific recommendations are not available.

Liver Dose Adjustments

Caution is recommended if used in patients with hepatic dysfunction or concomitantly with other potentially hepatotoxic drugs.

Precautions

Minocycline has been associated with central nervous system side effects, included lightheadedness, dizziness, or vertigo. Patients should be cautioned against driving or performing hazardous tasks requiring coordination and mental alertness until they know how the drug affects them.

Tetracyclines have been associated with bulging fontanels in infants and pseudotumor cerebri (benign intracranial hypertension) in adults. Minocycline has been reported to cause or precipitate pseudotumor cerebri, the hallmark of which is papilledema. Usual symptoms include headache and blurred vision in adults. Signs and symptoms of pseudotumor cerebri usually resolve upon tetracycline discontinuation; however, permanent sequelae (such as permanent or severe visual loss) are possible. Prior to initiation of tetracycline therapy, patients should be asked about visual disturbances. If visual disturbance occurs during treatment, patients should be checked for papilledema.

Drug rash with eosinophilia and systemic symptoms (including fatal cases) syndrome has been reported during postmarketing experience with minocycline use in patients with acne. Minocycline should be discontinued at once if this syndrome is recognized.

Because of their anti-anabolic action, tetracyclines may cause BUN elevations. Increased serum levels of tetracycline-class drugs may result in azotemia, hyperphosphatemia, and acidosis in patients with significant renal impairment. Under such conditions, monitoring of creatinine and BUN is recommended. If renal impairment is present, even usual oral or parenteral doses may lead to systemic accumulation of minocycline and possible liver toxicity. Close observation for evidence of toxicity (and dosage adjustments if necessary) may be appropriate. Determination of serum levels of the drug may be advisable if therapy is prolonged.

Periodic monitoring of organ system functions (including renal, hepatic, and hematopoietic function) is recommended. Appropriate tests for autoimmune syndromes should be done as indicated.

Tetracyclines have been associated with the development of autoimmune syndromes (such as drug-induced lupus-like syndrome, autoimmune hepatitis, vasculitis, and serum sickness). Liver function tests, antinuclear antibody, complete blood count, and other appropriate tests are recommended in symptomatic patients. Treatment with tetracyclines should be discontinued immediately.

Hypersensitivity syndrome, lupus-like syndrome, and serum sickness-like syndrome have been reported. Death has been reported in some cases involving these syndromes. Minocycline should be stopped at once if any of these syndromes are recognized.

Minocycline may induce photosensitivity in some individuals. Patients on tetracycline therapy should minimize or avoid exposure to direct sunlight and other sources of ultraviolet radiation, and to use sunscreens and other protection whenever prolonged exposure is unavoidable. Therapy should be discontinued at the first sign of skin erythema.

Thyroid cancer has been reported during postmarketing experience. Monitoring for signs of thyroid cancer should be considered when minocycline therapy is given over extended periods.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following tetracycline therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Superinfection with nonsusceptible organisms (i.e., yeasts) may occur with minocycline therapy. Minocycline should be discontinued and appropriate treatment should be started if superinfection occurs.

Safety of extended-release minocycline tablet use beyond 12 weeks for the treatment of only inflammatory lesions of non-nodular moderate to severe acne vulgaris has not been established.

When used during tooth development (second half of pregnancy and infancy to 8 years) tetracyclines may cause permanent yellow-gray-brown discoloration of the teeth and enamel hypoplasia. Tetracyclines should not be used during tooth development unless other drugs are contraindicated or not likely to be effective.

Minocycline is not recommended for pediatric patients less than 8 years of age unless the expected benefits outweigh the risks. Safety and efficacy of the extended release tablet formulation have not been established in pediatric patients less than 12 years of age.

Dialysis

Dose reductions or extended administration intervals may be advisable for patients with renal impairment. Minocycline is not significantly removed by hemodialysis or peritoneal dialysis.

Other Comments

Ingestion of adequate amounts of fluids with oral forms is recommended to reduce the risk of esophageal irritation and ulceration.

Decomposed tetracyclines may cause potentially fatal nephrotoxicity (Fanconi's syndrome); therefore, outdated or decomposed medications should be discarded.

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