Lymecycline

How it works

It inhibits bacterial protein synthesis by binding the 30S ribosomal subunit and also has anti-inflammatory effects relevant to acne, including activity against Cutibacterium acnes.

Prescribing in practice

• Contraindicated in pregnancy, breastfeeding and in children under twelve because tetracyclines cause permanent dental discolouration and affect bone development; avoid in this group.
• It should not be taken at the same time as antacids, or iron, calcium, magnesium or zinc salts, which impair absorption through chelation.
• An adequate trial of several weeks is needed before judging response in acne, and benefit-risk should be reviewed for prolonged courses.

Monitoring

Monitor for clinical response and for adverse effects such as photosensitivity, gastrointestinal upset and, rarely, intracranial hypertension.

Counselling the patient

• Do not take if you are or could be pregnant, or if breastfeeding.
• Separate the capsule from indigestion remedies and iron, calcium or zinc supplements.
• Use sun protection, and seek urgent advice for severe headache with visual disturbance.

Evidence & guidelines

Oral tetracyclines including lymecycline are recommended in NICE guidance as an option for moderate-to-severe acne vulgaris, generally combined with a topical agent.