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Minocycline is a broad-spectrum tetracycline antibiotic, and has a broader spectrum than the other members of the group. It is a bacteriostatic antibiotic, classified as a long-acting type. As a result of its long half-life, it generally has serum levels two to four times that of the simple water-soluble tetracyclines.
Minocycline is the most lipid-soluble of the tetracycline-class antibiotics, giving it the greatest penetration into the prostate and brain, but also the greatest amount of central nervous system -related side effects, such as vertigo. A common side effect is diarrhea. Uncommon side effects (with prolonged therapy) include skin discolouration and autoimmune disorders that are not seen with other drugs in the class.
Minocycline is a relatively poor tetracycline-class antibiotic choice for urinary pathogens sensitive to this antibiotic class, as its solubility in water and levels in the urine are less than all other tetracyclines. Minocycline is metabolized by the liver and has poor urinary excretion.
Minocycline was patented in 1961 and came into commercial use in 1971.
1 Medical uses
3 Side effects
4 Neuropsychiatric effect
4.1 Antidepressant effect
4.2 Antipsychotic effect
6 Anti-inflammatory and neuroprotective
7 Trade names and availability
10 External links
Minocycline 100-mg capsules manufactured by Ranbaxy Pharmaceuticals
Minocycline and doxycycline are frequently used for the treatment of acne vulgaris.
Minocycline is also used for other skin infections such as methicillin-resistant Staphylococcus aureus as the one pill twice daily 100-mg dosage is far easier for patients than the four times a day required with tetracycline or oxytetracycline. Its activity against Lyme disease is enhanced by its superior ability to cross the blood-brain barrier.
Although minocycline’s broader spectrum of activity, compared with other members of the group, includes activity against Neisseria meningitidis, its use for prophylaxis is no longer recommended because of side effects (dizziness and vertigo).
It may be used to treat certain strains of methicillin-resistant S. aureus infection and a disease caused by drug-resistant Acinetobacter spp.
Both minocycline and doxycycline have shown effectiveness in asthma due to immune-suppressing effects.
A list of indications for which minocycline has been used include:
Gonorrhea (when penicillin cannot be given)
Gougerot-Carteaud syndrome ( confluent and reticulated papillomatosis )
HIV —for use as an adjuvant to HAART
Respiratory infections such as pneumonia
Rocky Mountain spotted fever
Syphilis (when penicillin cannot be given)
Urinary tract infections, rectal infections, and infections of the cervix caused by certain microbes
Acute encephalitis syndrome
Increase in sebaceous excretion can continue after the end of treatment. Increases in the number of excreting pilosebaceous follicles also may occur.
Contrary to most other tetracycline antibiotics ( doxycycline excluded), minocycline may be used in those with kidney disease, but may aggravate systemic lupus erythematosus.
Also, more so than other tetracyclines, minocycline can cause the rare condition of secondary intracranial hypertension, which has initial symptoms of headache, visual disturbances, dizziness, vomiting, and confusion.
Minocycline, like most tetracyclines, becomes dangerous past its expiration date.
Minocycline’s absorption is impaired if taken at the same time of day as calcium or iron supplements. Unlike some of the other tetracycline group antibiotics, it can be taken with calcium-rich foods such as milk, although this does reduce the absorption slightly.
Minocycline, like other tetracyclines, is associated with esophageal irritation and ulceration if insufficient fluids are taken with the drug before sleep.
A 2007 study suggested that minocycline harms amyotrophic lateral sclerosis patients. Patients on minocycline declined more rapidly than those on placebo. The mechanism of this side effect is unknown, although a hypothesis is that the drug exacerbated an autoimmune component of the primary disease. The effect does not seem to be dose-dependent because the patients on high doses did not do worse than those on the low doses.
Minocycline may cause upset stomach, diarrhea, dizziness, unsteadiness, drowsiness, mouth sores, headache, and vomiting. It increases sensitivity to sunlight, and may affect the quality of sleep and rarely causes sleep disorders.
Occasionally, minocycline therapy may result in autoimmune disorders such as drug-related lupus and autoimmune hepatitis, which usually occurs in men who also developed minocycline-induced lupus; however, women are more likely to develop minocycline-induced lupus. Significant or complete recovery occurs in most people who develop minocycline-induced autoimmune problems within a period of a few weeks to a year of cessation of minocycline therapy. Autoimmune problems emerge during chronic therapy, but can sometimes occur after only short courses of a couple of weeks of therapy.
Minocycline, but not other tetracyclines, can cause vestibular disturbances with dizziness, ataxia, vertigo, and tinnitus. These effects are thought to be related to minocycline’s greater penetration into the central nervous system. Vestibular side effects are much more common in women than in men, occurring in 50 to 70% of women receiving minocycline. As a result of the frequency of this bothersome side effect, minocycline is rarely used in female patients.
Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and trouble breathing. a side effect also more common in female patients, potentially leading to permanent vision damage.
Thyroid cancer has been reported in the postmarketing setting in association with minocycline products. When minocycline therapy is given over prolonged periods, monitoring for signs of thyroid cancer should be considered.
In 2009, the FDA added minocycline to its Adverse Event Reporting System; a list of medications under investigation by the FDA for potential safety issues. It cites a potential link between the use of minocycline products and autoimmune disease in pediatric patients.
See also: List of dental abnormalities associated with cutaneous conditions
The overall antidepressant effect size of minocycline compared to placebo was -0.78 ( 95% CI : -0.4 to -1.33, P =0.005), indicative of a large and statistically significant antidepressant effect.
Improving negative symptoms of schizophrenia by using minocycline in combination with antipsychotic drugs has been shown in a meta-review based on four meta-analysis systematic reviews.
PARP1 inhibition K i = 13.8 nM
Neuroprotection IC 50 = 10 nM
Microglia full inhibition = 20 nM
Suppression of the mouse ‘s locomotor activity = 0.5 mg/kg
Anti-inflammatory and neuroprotective
NMDA receptor antagonists induce cortical apoptosis in perinatal rodents and sustain schizophrenia-like alterations that are ameliorated by treatment with antipsychotics. Minocycline with antipsychotic and neuroprotective effects exacerbated dizocilpine (MK-801)-induced brain-cell apoptosis without protection.
In various models of neurodegenerative disease, minocycline has demonstrated both neurorestorative and neuroprotective properties. Neurodegenerative diseases such as Huntington’s disease and Parkinson’s disease have shown a particularly beneficial response to minocycline in research studies, and an antipsychotic benefit has been found in people with schizophrenia, and minocycline is proposed as a possible add-on therapy for some schizophrenics. As mentioned above, minocycline harms ALS patients.
Minocycline is also known to indirectly inhibit inducible nitric oxide synthase.
Minocycline may exhibit neuroprotective action against AIDS dementia complex by inhibiting macrophage inflammation and HIV replication in the brain and cerebrospinal fluid.
an inflammatory enzyme associated with brain aging, and the antibiotic is being studied for use in Alzheimer’s disease patients.
As an anti-inflammatory, minocycline inhibits apoptosis (cell death) via attenuation of TNF-alpha, downregulating proinflammatory cytokine output. This effect is mediated by a direct action of minocycline on the activated T cells and on microglia, which results in the decreased ability of T cells to contact microglia, which impairs cytokine production in T cell-microglia signal transduction.
A 2007 study reported the impact of the antibiotic minocycline on clinical and magnetic resonance imaging (MRI) outcomes and serum immune molecules in 40 MS patients over 24 months of open-label minocycline treatment. Despite a moderately high pretreatment relapse rate in the patient group prior to treatment (1.3/year pre-enrollment; 1.2/year during a three-month baseline period), no relapses occurred between months 6 and 24 on minocycline. Also, despite significant MRI disease-activity pretreatment (19/40 scans had gadolinium-enhancing activity during a three-month run-in), the only patient with gadolinium-enhancing lesions on MRI at 12 and 24 months was on half-dose minocycline. Levels of interleukin-12 (IL-12), which at high levels might antagonize the proinflammatory IL-12 receptor, were elevated over 18 months of treatment, as were levels of soluble vascular cell adhesion molecule-1 ( VCAM-1 ). The activity of matrix metalloproteinase-9 was decreased by treatment. Clinical and MRI outcomes in this study were supported by systemic immunological changes and call for further investigation of minocycline in MS.
Patients taking 200 mg of minocycline for five days within 24 hours of an ischemic stroke showed an improvement in functional state and stroke severity over a period of 3 months compared with patients receiving placebo.
A double-blind, placebo-controlled study of minocycline for depression especially considering its relatively good safety profile.
Minocycline was shown to be highly effective in conferring neuroprotection during murine cerebral malaria.
Trade names and availability
Minocycline is no longer covered by patent,so is marketed under a variety of trade names:
Minostad (in Europe, for the treatment of acne )
Arestin (1-mg doses administered locally into periodontal pockets, after scaling and root planing, for treatment of periodontal disease.)
Solodyn (extended-release, for the treatment of acne)
Minopen (in Japan)
Maracyn 2 (for treatment of bacterial infections in aquarium fish and amphibians)
Quatrocin (in Syria)
Minox (in Ireland)
Minoz (in India and Romania)
Divaine (in India)
Dentomycin (2% minocylcine gel for use in periodontal pockets)
StoneBridge Pharma also markets Minocycline as Cleeravue-M in combination with SteriLid eyelid cleanser in the treatment of rosacea blepharitis.
Early research has found a tentative benefit from minocycline in schizophrenia,
Minocycline has been shown to reduce the risk of the honey trap effect in healthy human subjects. A 2013 study reported that male subjects in a control group rated attractive young females as more trustworthy compared to the subjects who had been treated with minocycline.
In November 2018 a report “Translation attenuation by minocycline enhances longevity and proteostasis in old post-stress-responsive organisms” by Scrips researchers indicates other possible uses for minocycline in protean aggregation disorders.
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