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Oral tetracycline antibiotic (anti-acne) Pregnancy: Avoid in second and third trimester. Use topical alternatives in pregnancy.

Lymecycline 408mg (Acne)

Brand names: Tetralysal 300

Adult dose

Dose: 408 mg once daily
Route: Oral (may be taken with or without food — better GI tolerability than older tetracyclines)
Frequency: Once daily
Max: 408 mg/day
Licensed in the UK specifically for acne vulgaris. Lymecycline 408 mg = equivalent to approximately 300 mg tetracycline base. Minimum course 8 weeks; continue for at least 3–6 months for acne. Combine with topical benzoyl peroxide to limit antibiotic resistance.

Paediatric dose

Route: Oral
Frequency: Once daily
Max: Not recommended in children <12 years
Contraindicated under 12 years (dental staining, bone development). Adolescents ≥12 years: adult dose 408 mg OD.

Dose adjustments

Renal

Use with caution in renal impairment; lymecycline is renally excreted — avoid if eGFR significantly reduced.

Hepatic

Use with caution in hepatic impairment.

Clinical pearls

  • UK-licensed tetracycline specifically for acne — alternative to doxycycline with once-daily dosing and improved GI tolerability
  • Combine with topical benzoyl peroxide to reduce risk of antibiotic-resistant C. acnes — BAD and NICE guidance
  • Generally better tolerated than oxytetracycline (twice-daily, food restrictions) — preferred oral tetracycline in many BAD guidelines
  • Allow minimum 3 months before assessing response; up to 6 months for full effect
  • No food restrictions unlike oxytetracycline — improves adherence

Contraindications

  • Children under 12 years
  • Pregnancy (second and third trimester)
  • Breastfeeding
  • Concurrent isotretinoin or acitretin (pseudotumour cerebri)
  • Hypersensitivity to tetracyclines

Side effects

  • GI upset (generally better tolerated than older tetracyclines)
  • Photosensitivity
  • Oesophageal irritation (less common than doxycycline)
  • Vaginal candidiasis (prolonged use)
  • Pseudotumour cerebri (with concurrent retinoids)

Interactions

  • Antacids (iron, calcium, magnesium, aluminium) — separate by 2 hours
  • Isotretinoin / acitretin — contraindicated
  • Warfarin — monitor INR (possible enhanced anticoagulation)

Monitoring

  • Acne response at 3 months
  • Photosensitivity reactions
  • Symptoms of raised ICP

Reference: BNFc; BNF; BAD Acne Guidelines 2021; NICE CG184. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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