Minocycline

Template:Short description Template:Use dmy dates Template:Cs1 config Template:Main other {{#invoke:Infobox|infobox}}Template:Template other{{#invoke:TemplatePar |check |template=Template:Infobox_drug |all= |opt= pronounce= pronounce_ref= pronounce_comment= ATC_prefix= ATC_suffix= ATC_supplemental= ATCvet= biosimilars= CAS_number_Ref= CAS_number= CAS_supplemental= ChEBI= ChEBI_Ref= ChEMBL_Ref= ChEMBL= ChemSpiderID= ChemSpiderID_Ref= chirality= class= container_only= DailyMedID= data_page= DrugBank_Ref= DrugBank= Drugs.com= duration_of_action= INN= INN_EMA= IUPAC_name= IUPHAR_ligand= KEGG_Ref= KEGG= MedlinePlus= NIAID_ChemDB= PDB_ligand= PubChemSubstance= PubChem= StdInChIKey_Ref= StdInChIKey= StdInChI_Ref= StdInChI_comment= StdInChI= UNII_Ref= UNII= DTXSID= Verifiedfields= Watchedfields= addiction_liability= alt2= altL= altR= alt= bioavailability= boiling_high= boiling_notes= boiling_point= captionLR= caption= caption2= charge= chemical_formula= chemical_formula_ref= chemical_formula_comment= class1= class2= class3= class4= class5= class6= component1= component2= component3= component4= component5= component6= density= density_notes= dependency_liability= drug_name= elimination_half-life= engvar= excretion= image2= imageL= imageR= image= image_class= image_class2= image_classL= image_classR= Jmol= legal_AU= legal_BR= legal_CA= legal_DE= legal_EU= legal_NZ= legal_UK= legal_UN= legal_US= legal_AU_comment= legal_BR_comment= legal_CA_comment= legal_DE_comment= legal_UK_comment= legal_NZ_comment= legal_US_comment= legal_UN_comment= legal_EU_comment= legal_status= licence_CA= licence_EU= licence_US= license_CA= license_EU= license_US= mab_type= melting_high= melting_notes= melting_point= metabolism= metabolites= molecular_weight= molecular_weight_round= molecular_weight_unit= molecular_weight_ref= molecular_weight_comment= onset= pregnancy_AU= pregnancy_AU_comment= pregnancy_category= protein_bound= routes_of_administration= SMILES= smiles= solubility= sol_units= source= specific_rotation= synonyms= target= tradename= type= vaccine_type= verifiedrevid= width2= widthL= widthR= width= AAN= BAN= JAN= USAN= source_tissues= target_tissues= receptors= agonists= antagonists= precursor= biosynthesis= gt_target_gene= gt_vector= gt_nucleic_acid_type= gt_editing_method= gt_delivery_method= sec_combustion= Ac=Ag=Al=Am=Ar=As=At=Au=B=Ba=Be=Bh=Bi=Bk=Br=C=Ca=Cd=Ce=Cf=Cl=Cm=Cn=Co=Cr=Cs=Cu= D=Db=Ds=Dy=Er=Es=Eu=F=Fe=Fl=Fm=Fr=Ga=Gd=Ge=H=He=Hf=Hg=Ho=Hs=I=In=Ir=K=Kr=La=Li=Lr=Lu=Lv= Mc=Md=Mg=Mn=Mo=Mt=N=Na=Nb=Nd=Ne=Nh=Ni=No=Np=O=Og=Os=P=Pa=Pb=Pd=Pm=Po=Pr=Pt=Pu=Ra=Rb=Re=Rf=Rg=Rh=Rn=Ru=S=Sb=Sc=Se=Sg=Si=Sm=Sn=Sr=Ta=Tb=Tc=Te=Th=Ti=Tl=Tm=Ts=U=V=W=Xe=Y=Yb=Zn=Zr= index_label= index2_label= index_comment= index2_comment= CAS_number2= CAS_supplemental2= ATC_prefix2= ATC_suffix2= ATC_supplemental2= PubChem2= PubChemSubstance2= IUPHAR_ligand2= DrugBank2= ChemSpiderID2= UNII2= KEGG2= ChEBI2= ChEMBL2= PDB_ligand2= NIAID_ChemDB2= SMILES2= smiles2= StdInChI2= StdInChIKey2= CAS_number2_Ref= ChEBI2_Ref= ChEMBL2_Ref= ChemSpiderID2_Ref= DrugBank2_Ref= KEGG2_Ref= StdInChI2_Ref= StdInChIKey2_Ref= UNII2_Ref= DTXSID2= QID= QID2=PLLR= pregnancy_US= pregnancy_US_comment= |cat=Pages using infobox drug with unknown parameters |format=0|errNS=0

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| _other_data=(2E,4S,4aR,5aS,12aR)-2-(Amino-hydroxy-methylidene)-4,7-bis(dimethylamino)-10,11,12a-trihydroxy-4a,5,5a,6- tetrahydro-4H-tetracene-1,3,12-trione<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

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| _datapage = Minocycline (data page) | _vaccine_target={{#ifeq: | vaccine | | _type_not_vaccine }} | _legal_all=S4Rx-only | _ATC_prefix_supplemental=J01Template:ATC, Template:ATC | _has_EMA_link = | CAS_number=10118-90-8 | PubChem=54675783 | ChemSpiderID=16735907 | ChEBI=50694 | ChEMBL=1434 | DrugBank=DB01017 | KEGG=D05045 | _hasInChI_or_Key={{#if:1S/C23H27N3O7/c1-25(2)12-5-6-13(27)15-10(12)7-9-8-11-17(26(3)4)19(29)16(22(24)32)21(31)23(11,33)20(30)14(9)18(15)28/h5-6,9,11,17,27,29-30,33H,7-8H2,1-4H3,(H2,24,32)/t9-,11-,17-,23-/m0/s1DYKFCLLONBREIL-KVUCHLLUSA-N |yes}} | UNII=FYY3R43WGO | _hasJmol02 = |_hasMultipleCASnumbers = |_hasMultiplePubChemCIDs = |_hasMultipleChEBIs =

| _countSecondIDs={{#invoke:ParameterCount |main |CAS_number2 |ATC_prefix2 |PubChem2 |PubChemStructure2 |IUPHAR_ligand2 |DrugBank2 |ChemSpiderID2 |UNII2 |KEGG2 |ChEBI2 |ChEMBL2 |PDB_ligand2 |NIAID_ChemDB2 |SMILES2 |smiles2 |StdInChI2 |StdInChIKey2 |DTXCID2}} | _countIndexlabels={{#invoke:ParameterCount |main |index_label |index2_label}} | _trackListSortletter= |QID = |QID2 = |Verifiedfields=changed |Watchedfields=changed |verifiedrevid=413871574}} Minocycline, sold under the brand name Minocin among others, is a tetracycline antibiotic medication used to treat a number of bacterial infections such as some occurring in certain forms of pneumonia.<ref name="Minocin FDA label" /><ref name=AHFS2019/><ref name=BNF76/> It is generally (but not always) less preferred than the tetracycline doxycycline.<ref name=AHFS2019/><ref name=BNF76/> Minocycline is also used for the treatment of acne and rheumatoid arthritis.<ref name="BNF76">Template:Cite book</ref><ref name="Amzeeq FDA label" /> It is taken by mouth or applied to the skin.<ref name="AHFS2019">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Amzeeq FDA label">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Common side effects include nausea, diarrhea, dizziness, allergic reactions, and kidney problems.<ref name=AHFS2019/> Serious side effects may include anaphylaxis, a lupus-like syndrome, and easy sunburning.<ref name=AHFS2019/> Use in the later part of pregnancy may harm the baby and safety during breastfeeding is unclear.<ref name="Preg2019">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It works by decreasing a bacterium's ability to make protein thus stopping its growth.<ref name=AHFS2019/>

Minocycline was patented in 1961 and came into commercial use in 1971.<ref name="FischerGanellin2006">Template:Cite book</ref> It is available as a generic medication.<ref name=BNF76/><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In 2022, it was the 269th most commonly prescribed medication in the United States, with more than 900,000 prescriptions.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Medical uses

File:Minocycline-150.jpg

Minocycline 100-mg capsules manufactured by Ranbaxy Pharmaceuticals

Acne

Minocycline and doxycycline are frequently used for the treatment of acne vulgaris.<ref name="ReynoldsYeungCheng2024" /><ref>Template:Cite journal</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Minocycline is specifically indicated to treat inflammatory lesions of non-nodular moderate to severe acne vulgaris in people nine years of age and older.<ref name="ReynoldsYeungCheng2024">Template:Cite journal</ref><ref name="Amzeeq FDA label" /> Both minocycline and doxycycline have similar levels of effectiveness and common adverse effects for acne, although doxycycline may have a slightly lower risk of adverse side effects.<ref name="ReynoldsYeungCheng2024" /><ref name="pmid21061764">Template:Cite journal</ref> Both oral/systemic and more recently topical formulations of minocycline are available to treat acne.<ref name="ReynoldsYeungCheng2024" /><ref name="OngeMobley2021">Template:Cite journal</ref>

Historically, oral minocycline has been an effective treatment for acne vulgaris.<ref>Template:Cite journal</ref> However, acne that is caused by antibiotic-resistant bacteria is a growing problem in many countries.<ref>Template:Cite journal</ref> In Europe and North America, a number of people with acne no longer respond well to treatment with tetracycline family antibiotics because their acne symptoms are caused by bacteria (primarily Cutibacterium acnes) that are resistant to these antibiotics. In order to reduce resistance rates as well as increase the effectiveness of treatment, oral antibiotics should be generally combined with topical acne creams such as benzoyl peroxide or a retinoid (tretinoin, adapalene, etc.).<ref>Template:Cite journal</ref> There have also been concerns about systemic minocycline having a variety of rare adverse effects in terms of its use to treat acne.<ref name="ReynoldsYeungCheng2024" /><ref name="Dominic2021" />

Oral minocycline is used to treat acne for up to 3 to 4Template:Nbspmonths.<ref name="ReynoldsYeungCheng2024" /> Data beyond 3 to 4Template:Nbspmonths are limited.<ref name="ReynoldsYeungCheng2024" />

Other infections

Minocycline is also used for other skin infections such as methicillin-resistant Staphylococcus aureus.<ref name="pmid17088156">Template:Cite journal</ref>

Although minocycline's broader spectrum of activity, compared with other members of the group, includes activity against Neisseria meningitidis,<ref name="pmid15782277">Template:Cite journal</ref> 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.<ref name="pmid19665876">Template:Cite journal</ref>

A list of uses includes:

• Amoebic dysentery
• Anthrax
• Bubonic plague
• Cholera
• Ehrlichiosis
• Gonorrhea (when penicillin cannot be given)
• Gougerot-Carteaud syndrome (confluent and reticulated papillomatosis)
• Hidradenitis suppurativa
• For use as an adjuvant to HAART<ref>Template:Cite journal</ref>
• Leprosy<ref>Template:Cite journal</ref>
• Periodontal disease
• Perioral dermatitis<ref>U.S. National Library of Medicine (11 December 2009) 'Perioral dermatitis'. Retrieved 7 August 2010.</ref>
• Respiratory infections such as pneumonia
• Rocky Mountain spotted fever
• Rosacea
• Syphilis (when penicillin cannot be given)
• Urinary tract infections (UTIs), rectal infections, and infections of the cervix caused by certain microbes

Minocycline has been reported to be effective in the eradication of UTIs and prostatitis.<ref name="JonasCunha1982" /><ref name="PerlettiMarrasWagenlehner2013">Template:Cite journal</ref><ref name="HanusDanziger1984">Template:Cite journal</ref> A 2013 Cochrane review identified and included two comparative clinical trials of minocycline for chronic bacterial prostatitis.<ref name="PerlettiMarrasWagenlehner2013" /> For this condition, minocycline has been found to be equivalent or superior to doxycycline,<ref name="FreemanNightingaleQuintiliani1994">Template:Cite journal</ref><ref name="Brannan1975">Template:Cite journal</ref> equivalent to trimethoprim/sulfamethoxazole,<ref name="MadsenJensenIversen1983">Template:Cite journal</ref><ref name="PaulsonWhite1978">Template:Cite journal</ref> and superior to the first-generation cephalosporin cephalexin.<ref name="MagriBoltriCai2019">Template:Cite journal</ref><ref name="PerlettiMarrasWagenlehner2013" /><ref name="PaulsonZinnerResnick1986">Template:Cite journal</ref> It was also equivalent to the fluoroquinolone ofloxacin in the treatment of chronic bacterial prostatitis caused by Ureaplasma urealyticum.<ref name="PerlettiMarrasWagenlehner2013" /><ref name="OhkawaYamaguchiTokunaga1993">Template:Cite journal</ref> Treatment durations of minocycline for chronic bacterial prostatitis have ranged from 2 to 4Template:Nbspweeks.<ref name="PerlettiMarrasWagenlehner2013" /><ref name="Brannan1975" /><ref name="PaulsonWhite1978" /><ref name="PaulsonZinnerResnick1986" /><ref name="OhkawaYamaguchiTokunaga1993" />

Other uses

Both minocycline and doxycycline have shown effectiveness in asthma due to immune-suppressing effects.<ref name="pmid21501686">Template:Cite journal</ref> Minocycline and doxycycline have modest effectiveness in treating rheumatoid arthritis.<ref name="pmid21723947">Template:Cite journal</ref> However, the 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis does not include minocycline.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Available forms

Minocycline is available in the form of 50 and 100Template:Nbspmg oral capsules, among a variety of other formulations.<ref name="Minocin FDA label" /><ref name="Drugs@FDA">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The oral form of minocycline is usually taken twice daily, once every 12Template:Nbsphours, although divided doses four times daily can also be employed.<ref name="Minocin FDA label" /> Extended-release oral forms are also available.<ref name="Drugs@FDA" /> A topical formulation is available as well.<ref name="ReynoldsYeungCheng2024" /><ref name="OngeMobley2021" /><ref name="Drugs@FDA" />

Contraindications

The drug is contraindicated in people with known hypersensitivity to tetracycline antibiotics, as there is complete cross sensitivity in this group. It is also contraindicated in people with severe liver impairment and after the 16th week of pregnancy.<ref name="Arzneistoff-Profile" />

Side effects

Minocycline may cause upset stomach, diarrhea, dizziness, unsteadiness, drowsiness, mouth sores, migraines, and vomiting. It increases sensitivity to sunlight, and may affect the quality of sleep and rarely causes sleep disorders.<ref name="pmid6661620">Template:Cite journal</ref> It has also been linked to cases of lupus.<ref>Template:Cite news</ref> Prolonged use of minocycline can lead to blue-gray staining of skin, fingernails, and scar tissue. This staining is not permanent, but can take a very long time for the skin color to return to normal; however, a muddy brown skin color in sun-exposed areas is usually permanent.<ref name="pmid19595269">Template:Cite journal</ref> Permanent blue discoloration of gums or teeth discoloration may also occur. Rare but serious side effects include fever, yellowing of the eyes or skin, stomach pain, sore throat, vision changes, and mental changes, including depersonalization.<ref name="MedNet">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="pmid14746427">Template:Cite journal</ref>

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.<ref name="pmid18200008">Template:Cite journal</ref><ref name="pmid20642295">Template:Cite journal</ref> Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can occur during the first few weeks of therapy with minocycline.<ref name="pmid20642295" />

Minocycline, but not other tetracyclines, can cause vestibular disturbances, including symptoms of dizziness, ataxia, vertigo, and tinnitus.<ref name="SweetGibbs2001" /><ref name="MartinsMartoJohnson2021" /> These effects are thought to be related to minocycline's greater penetration into the central nervous system.Template:Citation needed The vestibular side effects are much more common in women than in men, reportedly occurring in 50 to 70% of women receiving minocycline.<ref name="SweetGibbs2001" />Template:Additional citation needed However, other sources state that vestibular side effects occur in only 1 to 10% of patients.<ref name="MartinsMartoJohnson2021" /> In any case, other studies have found that side effects occur more frequently in women than in men (~58% vs. 34%, respectively).<ref name="MartinsMartoJohnson2021" /> Due to its vestibular side effects, minocycline has been said to be rarely used in female patients.<ref name="SweetGibbs2001">Template:Cite book</ref>Template:Additional citation needed Minocycline's vestibular side effects typically resolve after discontinuation of the drug.<ref name="Bauman 2010 pp.435–436">Template:Cite book</ref><ref name="Drugs.com 2023">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="pmid4143012">Template:Cite journal</ref><ref name="pmid1081373">Template:Cite journal</ref>

Symptoms of an allergic reaction include rash, itching, swelling, severe dizziness, and trouble breathing.<ref name="MedNet" /> Minocycline has also been reported to very rarely cause idiopathic intracranial hypertension (pseudotumor cerebri),<ref name="pmid15675888">Template:Cite journal</ref> a side effect also more common in female patients, potentially leading to permanent vision damage if not recognized early and treated.<ref>Template:Cite journal</ref>

Contrary to most other tetracycline antibiotics (doxycycline excluded), minocycline may be used in those with kidney disease, but may aggravate systemic lupus erythematosus.<ref name="Note1">Template:Cite journal</ref> It may also trigger or unmask autoimmune hepatitis.<ref name="pmid16394302">Template:Cite journal</ref>

Minocycline can cause the rare condition of secondary intracranial hypertension, which has initial symptoms of headache, visual disturbances, dizziness, vomiting, and confusion.<ref name="Friedman 2005 pp. 29–37">Template:Cite journal</ref> Brain swelling and rheumatoid arthritis are rare side effects of minocycline in some people.<ref>Template:Cite journal</ref>

Minocycline, like most tetracyclines, becomes dangerous past its expiration date.<ref name="ReferenceA">"Principles and methods for the assessment of nephrotoxicity associated with exposure to chemicals". Environmental health criteria: 119. World Health Organization (WHO). Template:ISBN. ISSN 0250-863X. 1991</ref> While most prescription drugs lose potency after their expiration dates, tetracyclines are known to become toxic over time. Expired tetracyclines can cause serious damage to the kidney due to the formation of a degradation product, anhydro-4-epitetracycline.<ref name="ReferenceA" /> 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.<ref>Template:Cite book</ref>

Minocycline, like other tetracyclines, is associated with esophageal irritation and ulceration if insufficient fluids are taken with the drug before sleep.<ref>Drugs.com 'Minocycline Disease Interactions'. Retrieved 12 February 2017.</ref>

A 2007 study suggested that minocycline harms amyotrophic lateral sclerosis (ALS) 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.<ref>Template:Cite journal</ref>

Other possible rare side effects of minocycline include hyperpigmentation and hypersensitivity reactions, among others.<ref name="ReynoldsYeungCheng2024" /><ref name="Dominic2021">Template:Cite journal</ref> It has been associated with more rare and serious adverse effects than other tetracyclines.<ref name="MartinsMartoJohnson2021">Template:Cite journal</ref> Some of the rare adverse effects of minocycline may result in death.<ref name="MartinsMartoJohnson2021" /><ref name="Dominic2021" /> This has spurred interest in topical instead of systemic minocycline for treatment of acne.<ref name="MartinsMartoJohnson2021" /><ref name="ReynoldsYeungCheng2024" />

Minocycline is another drug known to cause leukopenia.

Minocycine has shown thyroid toxicity in animals, including in rodents, mini pigs, dogs, and monkeys.<ref name="Minocin FDA label" />

The use of minocycline to treat acne has been associated with skin and gut dysbiosis (see antibiotic misuse).<ref>Template:Cite journal</ref>

Overdose

Symptoms of minocycline overdose may include dizziness, nausea, and vomiting.<ref name="Minocin FDA label" /> There is no specific antidote for overdose of minocycline and treatment should be symptom-based and supportive.<ref name="Minocin FDA label" /> The drug is not removed by hemodialysis or peritoneal dialysis.<ref name="Minocin FDA label" />

Interactions

The combination of minocycline with dairy, antacids, calcium and magnesium supplements, iron products, laxatives containing magnesium, or bile acid sequestrants may decrease minocycline's effectiveness by forming chelates. Combining it with isotretinoin, acitretin or other retinoids can increase the risk for intracranial hypertension. Minocycline significantly reduces concentrations of the anti-HIV drug atazanavir in the body.<ref name="Arzneistoff-Profile" /><ref name="mediQ">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Pharmacology

Pharmacodynamics

Antibiotic activity

{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}}

Minocycline mediates its antibiotic activity by binding to the 30S ribosomal subunit of bacteria and thereby inhibiting protein synthesis.<ref name="AsadiAbdiKouhsari2020">Template:Cite journal</ref><ref name="Garrido-MesaZarzueloGálvez2013">Template:Cite journal</ref> It is primarily bacteriostatic.<ref name="Minocin FDA label" /> The drug is a broad-spectrum antibiotic and shows activity against a wide range of both Gram-positive and Gram-negative bacteria.<ref name="AsadiAbdiKouhsari2020" /><ref name="Garrido-MesaZarzueloGálvez2013" /><ref name="JonasCunha1982" />

Other activities

Minocycline shows a number of off-target activities in addition to its antibiotic activity.<ref name="SinghKhannaKalra2021">Template:Cite journal</ref><ref name="BahramiMorrisPourgholami2012" /><ref name="Garrido-MesaZarzueloGálvez2013" /> These include inhibition of matrix metalloproteinases (MMPs), anti-inflammatory effects, antiapoptotic effects, antioxidant effects, and neuroprotective effects.<ref name="SinghKhannaKalra2021" /><ref name="BahramiMorrisPourgholami2012" /><ref name="Garrido-MesaZarzueloGálvez2013" />

Some other reported activities of minocycline include:

• PARP1 inhibition K_i = 13.8Template:NbspnM<ref name="pmid16769901">Template:Cite journal</ref>
• Neuroprotection IC₅₀ = 10Template:NbspnM<ref name="pmid11306611">Template:Cite journal</ref>
• Microglia full inhibition = 20Template:NbspnM<ref name="pmid11306611" />
• Suppression of the mouse's locomotor activity = 0.5Template:Nbspmg/kg<ref name="minomycin-if">{{#invoke:citation/CS1|citation

|CitationClass=web }}</ref>

• Indirect inhibition of inducible nitric oxide synthase<ref>Template:Cite journal</ref>

Pharmacokinetics

Absorption

Minocycline is quickly and nearly completely absorbed from the upper part of the small intestine. Taking it together with food, including milk, has no relevant influence on resorption. It reaches highest blood plasma concentrations after 1 to 2Template:Nbsphours.Template:Citation needed

Distribution

The drug has a plasma protein binding of 70 to 75%. It penetrates into almost all tissues; very high concentrations are found in the gallbladder and liver. It crosses the blood–brain barrier better than doxycycline and other tetracyclines, reaching therapeutically relevant concentrations in the cerebrospinal fluid and also in inflamed meninges.<ref name="Arzneistoff-Profile" /><ref name="AC">Template:Cite book</ref> Minocycline achieves good concentrations in the urinary bladder, and many other tissues.<ref name="JonasCunha1982" /> It shows excellent penetration into the prostate gland.<ref name="JonasCunha1982" /><ref name="CunhaGarabedian-Ruffalo1990">Template:Cite journal</ref> However, while permeation of prostate tissue and semen is good, levels are lower in prosatic fluid.<ref name="JonasCunha1982" />

Metabolism

Minocycline is inactivated by metabolism in the liver to about 50%. It is primarily metabolized into 9-hydroxyminocycline.<ref name="DrugBank">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Two N-demethylated metabolites are also formed.<ref name="DrugBank" />

Elimination

The rest is predominantly excreted into the gut (in part via the gallbladder, in part directly from blood vessels) and eliminated via the feces. About 10–15% are eliminated via the kidneys. It is excreted about 5 to 10% unchanged in urine.<ref name="CunhaGarabedian-Ruffalo1990" /> For comparison, other tetracyclines, like doxycycline and tetracycline, are excreted 30 to 70% unchanged in urine.<ref name="CunhaGarabedian-Ruffalo1990" /> The biological half-life of minocycline is 11 to 26Template:Nbsphours in healthy people,<ref name="AHFS2019" /> up to 30Template:Nbsphours in those with kidney failure,<ref name="AHFS2019" /> and significantly longer in those with liver disease.<ref name="Arzneistoff-Profile" /><ref name="AC" />

Chemistry

Minocycline is a tetracycline derivative.<ref name="JonasCunha1982" /><ref name="BahramiMorrisPourgholami2012">Template:Cite journal</ref> It is closely structurally related to other tetracyclic antibiotics such as tetracycline, doxycycline, and tigecycline.<ref name="BahramiMorrisPourgholami2012" /><ref name="JonasCunha1982" />

The drug is used in form of minocycline hydrochloride dihydrate,<ref name="AC" /> which is sparingly soluble in water and slightly soluble in ethanol. Minocycline reacts acidic in aqueous solution.<ref name="Arzneistoff-Profile" />

The partition coefficient (P) of minocycline has been reported to be 39.4 (i.e., log P of 1.60).<ref name="SaivinHouin1988">Template:Cite journal</ref> However, other sources have stated the experimental log P of minocycline to be 0.05,<ref name="DrugBank" /> 0.5,<ref name="Fuoco2012">Template:Cite journal</ref> and 1.1.<ref name="FlorenceAttwood1988">Template:Cite book</ref> In any case, minocycline is consistently described as a highly lipophilic compound with excellent tissue penetration and distribution.<ref name="LeydenDelRosso2011">Template:Cite journal</ref><ref name="SaivinHouin1988" /><ref name="JonasCunha1982">Template:Cite journal</ref> It has been said to be unique among the tetracyclines in that it is the most lipophilic of all of the members of this group.<ref name="JonasCunha1982" /> Minocycline has 10 to 30Template:Nbsptimes greater lipophilicity than tetracycline and 5Template:Nbsptimes greater lipophilicity than doxycycline.<ref name="JonasCunha1982" /><ref name="LeydenDelRosso2011" /> The improved lipophilicity of minocycline is thought to be advantageous in terms of its clinical antibiotic effectiveness.<ref name="JonasCunha1982" />

History

Minocycline was patented in 1961, was first described in the scientific literature in 1967,<ref name="JonasCunha1982" /> and came into commercial use in 1971.<ref name="FischerGanellin2006" /> A topical foam for treatment of acne was approved in 2019.<ref name="Amzeeq FDA label" />

Society and culture

Brand names

• Minomycin
• Minostad (in Europe, for the treatment of acne)
• Akamin
• Minocin
• Minoderm
• Cyclimycin
• Arestin (1-mg doses administered locally into periodontal pockets, after scaling and root planing, for treatment of periodontal disease.)<ref>{{#invoke:citation/CS1|citation

|CitationClass=web }}</ref>

• Nomika (in Indonesia)
• Aknemin
• Solodyn (extended-release, for the treatment of acne)
• Dynacin
• Sebomin
• Mino-Tabs
• Acnamino
• 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)
• Vinocyclin 100 (100-mg dose approved for treatment of acne in Vietnam)
• Dentomycin (2% minocylcine gel for use in periodontal pockets)
• Amzeeq (4% foam, approved for treatment of acne United States)
• Zilxi (1.5% foam, approved for treatment of rosacea in the United States)
• Cleeravue-M

Generic availability

It is available as a generic medication.<ref name=BNF76/>

Research

Neuropsychiatric disorders

Depression

Minocycline has been studied in the treatment of depression.<ref name="ShamimMannaDwivedi2023" /><ref name="HuangZhouChen2025" /><ref name="AlJumailiVora2023" /><ref name="QiuDuanYin2023" /> According to a 2023 systematic review of minocycline for treatment-resistant depression based on four clinical trials, "There is no significant difference with minocycline compared to placebo for depression not responding to first-line antidepressant therapy."<ref name="ShamimMannaDwivedi2023">Template:Cite journal</ref> Likewise, a 2025 systematic review and meta-analysis of four randomized controlled trials found that minocycline was not significantly more effective than placebo in treating depression.<ref name="HuangZhouChen2025">Template:Cite journal</ref> Minocycline might have some benefit in treatment-resistant depression with inflammation however.<ref name="AlJumailiVora2023">Template:Cite journal</ref> Yet another meta-analysis, also published in 2023, found that minocycline was effective in the treatment of depression, including treatment-resistant depression, with a small to moderate effect size.<ref name="QiuDuanYin2023">Template:Cite journal</ref>

Schizophrenia

Early research has found a tentative benefit from minocycline in schizophrenia,<ref>Template:Cite journal</ref> with several trials underway as of 2012.<ref>Template:Cite journal</ref> A 2014 meta-analysis found minocycline may reduce negative and total symptom scores and was well tolerated.<ref>Template:Cite journal</ref> A 2019 meta-analysis, which included 13 randomized controlled trials, found that minocycline was effective in the treatment of the positive, negative, and general symptoms of schizophrenia, with small to moderate effect sizes.<ref name="ZhengZhuZhang2019">Template:Cite journal</ref> Similarly, a 2023 systematic review and meta-analysis of 10 randomized controlled trials found that minocycline was effective in treating the total, negative, and general symptoms of schizophrenia but not the positive or cognitive symptoms, again with small to moderate effect sizes.<ref name="pmid36982324" />

Other conditions

Some early studies suggest that minocycline may be beneficial as an add-on treatment for moderate-to-severe obsessive-compulsive disorder (OCD) when used with a selective serotonin reuptake inhibitor (SSRI).<ref name="pmid36368186">Template:Cite journal</ref><ref name="pmid36982324">Template:Cite journal</ref>

Stroke and neurodegenerative diseases

In ongoing research and trial, minocycline demonstrated efficacy and seems a promising neuroprotective agent in acute stroke patients, especially in AIS subgroup. Further RCTs are needed to evaluate the efficacy and safety of minocycline among ICH patients.<ref>Template:Cite journal</ref>

Research is examining the possible neuroprotective and anti-inflammatory effects of minocycline against the progression of a group of neurodegenerative disorders including multiple sclerosis, rheumatoid arthritis, Huntington's disease, and Parkinson's disease.<ref>Template:Cite press release</ref><ref name="Note2">Template:Cite journal</ref><ref name="Note3">Template:Cite journal</ref><ref>Template:Cite journal</ref> As mentioned above, minocycline harms ALS patients.Template:Citation needed

A trial found no difference between minocycline and placebo in people with Alzheimer's disease.<ref name="Howard">Template:Cite journal</ref> Minocycline is somewhat neuroprotective in mouse models of Huntington's disease.<ref name="Beal">Template:Cite journal</ref>

Multiple sclerosis

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.<ref>Template:Cite journal</ref><ref name="Maier">Template:Cite journal</ref><ref>Template:Cite journal</ref>

Delirium

A 2024 randomized controlled trial found that prophylactic minocycline provided a small but significant decrease in delirium incidence in critically ill patients.<ref name="XuRenHuang2024">Template:Cite journal</ref><ref name="Dal-PizzolCoelhoSimon2024">Template:Cite journal</ref> Unexpectedly, there was also a significant decrease in hospital mortality with minocycline prophylaxis.<ref name="XuRenHuang2024" /><ref name="Dal-PizzolCoelhoSimon2024" /> The mortality benefits of minocycline might have simply been due to its bactericidal effects.<ref name="WangWei2024">Template:Cite journal</ref>

Hearing protection

Several preclinical studies (in vitro cell cultures and animal models) suggest that minocycline may have otoprotective benefits. Animal models indicate it could potentially reduce noise-induced and blast-induced hearing loss, possibly by protecting hair cells and mitigating inflammation.<ref name="pmid28007648">Template:Cite journal</ref><ref name="pmid36820161">Template:Cite journal</ref> In vitro and animal studies also show minocycline may help decrease ototoxicity from certain drugs like gentamicin,<ref name="pmid15708492">Template:Cite journal</ref> neomycin,<ref name="pmid25950003">Template:Cite journal</ref> and cisplatin.<ref name="pmid21716954">Template:Cite journal</ref><ref name="pmid21493367">Template:Cite journal</ref>

Other uses

Minocycline also has been used as a "last-ditch" treatment for toxoplasmosis in AIDS patients.<ref>Template:Cite journal</ref>

Minocycline has been suggested as a possible treatment for post-COVID-19 syndrome ("long COVID"), but no quality clinical trials exist.<ref name="BenzakourBondolfi2022">Template:Cite journal</ref><ref name="Numata2021">Template:Cite journal</ref><ref name="Miwa2025">Template:Cite journal</ref> The same is true of minocycline as a potential treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).<ref name="Numata2021" /><ref name="Miwa2025" /><ref name="Miwa2021">Template:Cite journal</ref>

References

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