Minocycline: Dosing, Efficacy, Compliance and Cost of Treatment

Dosing

Trade Names:

• Minocin* Stiefel Canada Inc.
• Dynacin* Medicis
• Vectrin* Medicis

Dosage Forms:

• Capsules: Minocycline 50 and 100mg (Minocin* Dynacin*)
• Suspension: Minocycline 50mg (Minocin* Dynacin*)
• Parenteral: Minocycline 100mg (Minocin IV*)

Acne vulgaris

• Minocycline 50-100 mg po bid, tapered to 50 mg/d as acne improves
• Most will show satisfactory improvement with 100mg a day
• Aim should be the prevention of new inflammatory lesions
• Use for 8-12 weeks only if good clinical response
• Avoid long term usage to minimize side effects and to reduce the risk of bacterial resistance (Dermatology 2003; 206(1):37-53)

Rosacea

• Minocycline 50-100mg daily until no further new lesions
• Try and maintain control after this by topical therapy alone
• Periodic use such as Minocycline 100mg daily for 1 week per month may be required if topicals alone not sufficient to prevent new lesions

Perioral dermatitis

• Minocycline 50-100mg for 1 month will clear most
• Some may need a further 1-2 months for cure

Efficacy

• Improvement in inflammatory lesion in acne is about a 20% reduction a month. It may take 1-2 months to see initial benefit. After 6 months there is an approximate 60-70% improvement in inflammatory acne counts. Studies over the last 20 years have shown that tetracycline, erythromycin, doxycycline and minocycline have about the same efficacy in acne. Bacterial resistance has lowered the efficacy in particular of both erythromycin and tetracycline where as this has been less of a problem to date with minocycline although it is on the rise.
• In clinical practice efficacy is in part related to compliance which may be less problematic in clinical trials.

Compliance

• All tetracyclines are broad-spectrum bacteriostatic agents. They are well absorbed, although oxytetracycline and tetracycline should not be taken with food. Minocycline as well as Doxycycline are absorbed almost as well on an empty as full stomach The topical formulations are delivered to the pilosebaceous apparatus and adjacent tissues. There is little absorption of the topical formulations. Minocycline is very lipid soluble and achieves good sebum penetration. Doxycycline and Minocycline are partially inactivated in the liver so liver disease is a relative contraindication. Most Tetracyclines are eliminated unchanged in the urine and the feces. The half life of the Tetracyclines are prolonged in renal failure except for Doxycycline
• Daily or bid dosing significantly helps the patient take the drug especially since it can be taken with or without food.

Cost of Treatment

Cost of treatment of 1 month of standard dose for acne: