Minocycline

How it works

It binds reversibly to the bacterial 30S ribosomal subunit, blocking attachment of aminoacyl-tRNA to the ribosome and inhibiting protein synthesis.

Prescribing in practice

• Unlike other tetracyclines it can rarely cause hypersensitivity syndromes, lupus-like reactions, hepatitis and irreversible skin, mucosal or scleral pigmentation, so treatment should be reviewed and stopped if these occur.
• It is contraindicated in pregnancy, breastfeeding and in children because tetracyclines deposit in growing bone and teeth, causing discolouration.
• Absorption is reduced by antacids and iron, zinc, calcium or magnesium-containing products, which should be separated from the dose.

Monitoring

Review periodically for hepatic, autoimmune and pigmentation effects, and reassess the need for continued treatment in long-term acne use.

Counselling the patient

• Report joint pain, rash, fever or any new skin or gum discolouration.
• Avoid taking with milk, indigestion remedies or iron and mineral supplements at the same time.
• Take with plenty of water and do not lie down immediately afterwards to avoid throat irritation.

Evidence & guidelines

Prescribing reflects the SPC and MHRA advice on the risks of pigmentation and hypersensitivity reactions with minocycline.