Names and pronunciation
(min-oh-sye′kleen) Arestin , Minocin, Solodyn, Ximino
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Drug reference
(min-oh-sye′kleen) Arestin , Minocin, Solodyn, Ximino
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Func. class.: Broad-spectrum antiinfective Func. class.: Antihypertensive
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Chem. class.: Tetracycline Chem. class.: Vasodilator, peripheral
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Do not confuse: Dynacin/Dynacire
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ACTION: Inhibits protein synthesis, phosphorylation in microorganisms by binding to ribosomal subunits, reversibly binding to ribosomal subunits; bacteriostatic ACTION: Directly relaxes arteriolar smooth muscle, causing vasodilation; reduces peripheral vascular resistance, decreases B/P
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USES: Acinetobacter sp., Actinomyces israelii, Actinomyces sp., Bacillus anthracis, Bartonella bacilliformis, Bor- detella pertussis, Borrelia burgdorferi, Borrelia recurrentis, Brucella sp., Burk- holderia mallei, Burkholderia pseudom- allei, Campylobacter fetus, Chlamydia trachomatis, Chlamydophila psittaci, Clostridium perfringens, Clostridium sp., Clostridium tetani, Coxiella burnetii, Eikenella corrodens, Entamoeba sp., Enterobacter aerogenes, Escherichia coli, Francisella tularensis, Fusobacterium fusiforme, Fusobacterium nucleatum, Haemophilus ducreyi, Haemophilus influenzae (beta-lactamase negative), Haemophilus influenzae (beta-lacta- mase positive), Klebsiella granulomatis, Klebsiella sp., Legionella pneumophila, Leptospira sp., Leptotrichia buccalis, Lis- teria monocytogenes, Mycobacterium marinum, Mycoplasma hominis, Myco- plasma pneumoniae, Neisseria gonor- rhoeae, Neisseria meningitidis, Nocardia sp., Pasteurella multocida, Porphyromo- nas gingivalis, Prevotella intermedia, Propionibacterium acnes, Propionibac- terium propionicum, Rickettsia akari, Rickettsia prowazekii, Rickettsia rickett- sii, Rickettsia tsutsugamushi, Shigella sp., Spirillum minus, Staphylococcus aureus (MRSA), Staphylococcus aureus (MSSA), Streptobacillus moniliformis, Streptococ- cus pneumoniae, Treponema pallidum, Treponema pertenue, Ureaplasma urea- lyticum, Vibrio cholerae, Vibrio parahae- molyticus, Yersinia enterocolitica, Yer- sinia pestis USES: Severe hypertension unre- sponsive to other therapy (use with diuretic and β-blocker); topically to treat alopecia
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CONTRAINDICATIONS: Preg- nancy, children <8 yr, hypersensitivity to tetracyclines Precautions: Hepatic disease, breast- feeding CONTRAINDICATIONS: Dissect- ing aortic aneurysm, hypersensitivity, M pheochromocytoma Precautions: Pregnancy, breastfeeding, children, geriatric patients, renal dis- ease, CVD, acute MI
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SIDE EFFECTS CNS: Dizziness, fever, light-headedness, vertigo, seizures, increased intracranial pressure, headache CV: Pericarditis, thrombophlebitis EENT: Permanent discoloration of teeth, oral candidiasis, tinnitus GI: Nausea, vomiting, diarrhea, anorexia, hepatotoxicity, CDAD GU: Renal failure HEMA: Eosinophilia, neutropenia, throm- bocytopenia, hemolytic anemia, pancytopenia RESP: Bronchospasm, cough, dyspnea INTEG: Rash, urticaria, photosensitiv- ity, increased pigmentation, exfoliative dermatitis, pruritus, blue-gray color of skin, mucous membranes MS: Myalgia, arthritis; bone growth retardation (<8 yr) SYST: Angioedema, Stevens-Johnson syndrome, DRESS SIDE EFFECTS Systemic CNS: Headache, fatigue CV: Severe rebound hypertension on withdrawal in children, tachycardia, angina, increased T wave, HF, pulmo- effusion, nary edema, pericardial edema, sodium, water retention, hypo- tension GI: Nausea, vomiting GU: Breast tenderness HEMA: Hct, HB; erythrocyte count may decrease initially, leukopenia INTEG: Pruritus, Stevens-Johnson syndrome, rash, hirsutism, contact der- matitis
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INTERACTIONS Increase: effect of warfarin, digoxin, insulin, oral anticoagulants, theophylline, neuromuscular blockers Increase: chance of pseudomotor cere- bri—retinoids; do not use concurrently Decrease: effect of hormonal contracep- tives, use another form of contraception Decrease: effect of live virus vaccines, bring up to date before use Decrease: minocycline absorption, give 2 hr before or 3 hr after iron products; laxatives (calcium, aluminum, magne- sium) antidiarrhea Decrease: effect of penicillins, avoid using together Drug/Lab Test False negative: urine glucose with Clinis- tix or Tes-Tape Increase: BUN, FTs, eosinophils Decrease: HB, platlets, neutrophils INTERACTIONS Increase: hypotension—antihyperten- sives, MAOIs Decrease: antihypertensive effect— NSAIDs, salicylates, estrogens Drug/Herb Increase: antihypertensive effect—haw- thorn Drug/Lab Test Increase: renal studies Decrease: HB/Hct/RBC
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Black Box Warning: CAD, HF, cardiac disease, cardiac tamponade, edema, hy- potension, orthostatic hypotension, peri- cardial effusion Black Box Warning: Cardiac disease: may cause reflex increase in heart rate and decrease in B/P • Beers: avoid use in older adults; may exacerbate syncope; monitor frequently for syncope • Pregnancy/breastfeeding: use only if benefits outweigh risk to fetus; do not use in breastfeeding
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TREATMENT OF OVERDOSE: (PO) Administer normal saline IV, vaso- pressors
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DOSAGE AND ROUTES Most infections • Adult: PO/IV 200 mg, then 100 mg q12hr, max 400 mg/24 hr IV; SUBGIN- GIVAL inserted into periodontal pocket • Child/adolescents 9-17 yr: PO/IV 4 mg/kg, then 4 mg/kg/day PO in divided doses q12hr Rickettsial infections • Adult: PO/IV 200 mg, then 100 mg q12hr • Child ≥9 yr/adolescent: PO/IV 4 mg/ kg, then 2 mg/kg q12hr, max adult dose Gonorrhea (allergic to penicillin) • Adult: PO 200 mg, then 100 mg q12hr × ≥4 days Syphilis (allergic to penicillin) • Adult: PO 200 mg, then 100 mg q12hr × 10-15 days Meningococcal carrier state • Adult: PO 100 mg q12hr × 5 days • Child ≥9 yr: PO 4 mg/kg/dose initially (max 200 mg), then 2 mg/kg dose q12hr × 5 days, max 100 mg/dose Uncomplicated gonococcal urethritis in men • Adult: PO 100 mg q12hr × 5 days Acne vulgaris (Solodyn only) • Adult/adolescent/child ≥12 yr: PO ext rel 1 mg/kg/day × 12 wk or those weigh- M ing 126-136 kg—135 mg/day; 111-125 kg—115 mg/day; 97-110 kg—105 mg/ day; 85-96 kg—90 mg/day; 72-84 kg— 80 mg/day; 60-71 kg—65 mg/day; 50-59 kg—55 mg/day; 45-49 kg—45 mg/day Acne vulgaris (all except Solodyn) • Adult/adolescent/child ≥12 yr: PO ext rel 1 mg/kg/day × 12 wk or those weigh- ing 91-136 kg—135 mg/day; 60-90 kg—90 mg/day; 45-59 kg—45 mg/day DOSAGE AND ROUTES Severe hypertension • Adult: PO 5 mg/day in 1-2 divided doses; max 100 mg/day; usual range 10- 40 mg/day divided in 1-2 doses • Geriatric: PO 2.5 mg/day, may be in- creased gradually Child 12-17 yr: PO 5 mg daily, may in- crease to 10, 20, then 40 mg/day single or divided doses q3day • Child 1-11 yr: PO (initial) 0.1-0.2 mg/ kg/day; (effective range) 0.25-1 mg/kg/ day; (max) 50 mg/day Alopecia • Adult: TOP 1 mL bid, rub into scalp daily, max 2 mL/day Renal dose • Adult: PO CCr 10-15 mL/min extend interval to q24hr; CCr <10 mL/min not recommended
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Available forms: Caps 50, 75, 100 mg; powder for inj 100 mg; caps, pellet filled 50, 100 mg; tabs 50, 75, 100 mg; ext rel tabs 45, 55, 65, 80, 90, 105, 115, 135 mg Available forms: Tabs 2.5, 10 mg; topi- cal 2%, 5% sol; topical foam 5%
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Administer: • After C&S obtained before first dose; begin treatment as soon as drawn • Store in airtight, light-resistant container at room temperature; do not expose to light • Fanconi’s syndrome: do not use out- dated products; may cause nephrotoxicity PO route • With full glass of water; with food for GI symptoms • Use pellet-filled caps/tabs 1 hr before or 2 hr after a meal • Use extended-release tabs at same time each day, without regard to food • Swallow caps, extended-release tabs whole; do not crush, chew • 2 hr before or after laxative or ferrous products; 3 hr after antacid IV route • After reconstituting 100 mg/5 mL ster- ile water for inj; further dilute in 100- 1000 mL of NaCl, dextrose sol; give over 1-6 hr, do not give rapidly or 250-1000 mL with Ringer’s or LR, do not admix • Change to PO dose as soon as possible to reduce thrombophlebitis risk Y-site compatibilities: Alfentanil, amikacin, atracurium, benztropine, buprenorphine, butorphanol, calcium chloride, CARBOpla- tin, caspofungin, cefonicid, chlorproMA- ZINE, cimetidine, cisatracurium, codeine, cyclophosphamide, cycloSPORINE, cytara- bine, DACTINomycin, dexmedetomidine, diltiaZEM, diphenhydrAMINE, DOBUTa- mine, DOCEtaxel, doxacurium, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, eptifibatide, etoposide, fenoldopam, fen- taNYL, filgrastim, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, IDArubi- cin, ifosfamide, inamrinone, isoproterenol, labetalol, levoFLOXacin, lidocaine, line- zolid, LORazepam, magnesium sulfate, mannitol, melphalan, metaraminol, metho- trexate, methyldopa, metoclopramide, metoprolol, midazolam, mitoXANTRONE, nalbuphine, naloxone, perphenazine, potassium chloride, remifentanil, sar- gramostim, teniposide, vinorelbine, vit B/C Administer: • Store protected from light and heat PO route • Without regard to meals • With β-blocker and/or diuretic for hy- pertension Topical route • 1 mL no matter how much balding has occurred; increasing dosage does not speed growth
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Assess: • CDAD: diarrhea, abdominal cramps, fe- ver; may start up to 2 mo after treatment ends; if diarrhea occurs, evaluate • I&O ratio • Age and tooth development • Blood tests: PT, CBC, AST, ALT, BUN, creatinine • Signs of anemia: Hct, HB, fatigue • Serious allergic reactions (anaphylax- is, Stevens-Johnson syndrome, DRESS): assess for rash, fever, fatigue, fluid-filled blisters, abnormal LFTs; product should be discontinued immediately • Nausea, vomiting, diarrhea; administer antiemetic, antacids as ordered • Overgrowth of infection: fever, ma- laise, redness, pain, swelling, drainage, perineal itching, diarrhea; changes in cough or sputum; black, furry tongue in long-term therapy • Beers: Avoid in older adults, may exacerbate syncope, monitor fre- quently • Pregnancy/breastfeeding: do not use in pregnancy, can cause fetal harm; if pregnancy occurs, stop immediately; do not breastfeed, excreted in breast milk Assess: • Monitor closely; usually given with β-blocker to prevent tachycardia and increased myocardial workload; usually given with diuretic to prevent serious fluid accumulation; patient should be hospitalized during beginning treatment • Nausea, edema in feet, legs daily • Skin turgor, dryness of mucous mem- branes for hydration status • Crackles, dyspnea, orthopnea • Electrolytes: potassium, sodium, chlo- ride, CO2 • Renal studies: catecholamines, BUN, creatinine • Hepatic studies: AST, ALT, alk phos • B/P, pulse • Weight daily, I&O
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Evaluate: • Therapeutic response: decreased tem- perature, absence of lesions, negative C&S Evaluate: • Therapeutic response: decreased B/P, increased hair growth
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CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid sunlight, wear protective clothing; that sunscreen does not seem to decrease photosensitivity • That all prescribed medication must be taken to prevent superinfection; not to use outdated product because Fan- coni’s syndrome may occur • To report diarrhea that can occur several months after discontinuing product • To avoid taking antacids, iron, ci- metidine; to use 2 hr before, 6 hr after this product, absorption may be de- creased; to take with a full glass of water; to take with food; not to take at bedtime, esophageal irritation may occur • That teeth discoloration, joint or mus- cle pain may occur • To use backup contraception; effec- tiveness may be decreased • Not to use during pregnancy, breast- feeding; not to use for acne if trying to conceive • To avoid driving, other hazardous ac- tivities until reaction is known • To swallow extended-release product whole, do not crush, chew, split; not to increase, double doses, take at same time of day (mi-nox′i-dill) Hair Regrowth Treatment Men, Minoxidil for Men, Rogaine Mens Extra Strength, Rogaine Mens, Rogaine Womens (topical) Patient and caregiver information: • That body hair will increase but is reversible after discontinuing treat- ment • Not to discontinue product abruptly • To report pitting edema, dizziness, weight gain >5 lb, SOB, bruising or bleeding, heart rate >20 beats/min over normal, severe indigestion, dizziness, light-headedness, panting, new or aggra- vated symptoms of angina • To take product exactly as prescribed because serious side effects may occur Topical: • That for topical use, treatment must continue for the long term, or new hair will be lost • Not to use except on scalp; use on clean, dry scalp before styling aids; wash hands after each use
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PHARMACOKINETICS PO: Peak 1-4 hr, half-life 11-22 hr; excreted in urine, feces, breast milk; crosses placenta PHARMACOKINETICS PO: Onset 30 min, peak 2-3 hr, duration 48-120 hr; half-life 4.2 hr; metabolized in liver; metabolites excreted in urine, feces; protein binding minimal
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• Child/adolescents 9-17 yr: PO/IV 4 mg/kg, then 4 mg/kg/day PO in divided doses q12hr Rickettsial infections
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• Child ≥9 yr/adolescent: PO/IV 4 mg/ kg, then 2 mg/kg q12hr, max adult dose Gonorrhea (allergic to penicillin)
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• Child ≥9 yr: PO 4 mg/kg/dose initially (max 200 mg), then 2 mg/kg dose q12hr × 5 days, max 100 mg/dose Uncomplicated gonococcal urethritis in men
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• Adult/adolescent/child ≥12 yr: PO ext rel 1 mg/kg/day × 12 wk or those weigh- M ing 126-136 kg—135 mg/day; 111-125 kg—115 mg/day; 97-110 kg—105 mg/ day; 85-96 kg—90 mg/day; 72-84 kg— 80 mg/day; 60-71 kg—65 mg/day; 50-59 kg—55 mg/day; 45-49 kg—45 mg/day Acne vulgaris (all except Solodyn)
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• Adult/adolescent/child ≥12 yr: PO ext rel 1 mg/kg/day × 12 wk or those weigh- ing 91-136 kg—135 mg/day; 60-90 kg—90 mg/day; 45-59 kg—45 mg/day DOSAGE AND ROUTES Severe hypertension
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• Child 1-11 yr: PO (initial) 0.1-0.2 mg/ kg/day; (effective range) 0.25-1 mg/kg/ day; (max) 50 mg/day Alopecia
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