Tetracyclines.

minocycline hydrochloride

Minocycline base 50 mg (as the hydrochloride Ph Eur) per capsule

Capsule

Minocycline is an antibiotic with a spectrum of activity similar to other tetracyclines but more active against Staphylococcus aureus and Nocardia spp.

It is indicated for the treatment of organisms sensitive to tetracyclines such as acne, respiratory infections, gonorrhoea, nocardiosis, staphylococcal infections; the chemoprophylaxis of meningococcal infections.

For oral administration.

Adults:

1) Routine antibiotic use: 200 mg daily in divided doses.

2) Acne: 50 mg twice daily or 100 mg once daily.

3) Gonorrhoea: In adult males, 200 mg initially followed by 100 mg every 12 hours for a minimum of 4 days with post-therapy cultures within 2-3 days. Adult females may require more prolonged therapy.

4) Prophylaxis of meningococcal infections: 100 mg twice daily for five days, usually followed by a course of rifampicin.

The treatment of acne should be continued for a minimum of 6 weeks. If after 6 months there is no satisfactory response, Aknemin 50 should be discontinued and other therapies considered. If Aknemin 50 is to be continued for more than 6 months, patients should be monitored at least 3 monthly thereafter for signs and symptoms of hepatitis or SLE

Aknemin 50 is not recommended for children under 12 years old. For children above 12 years old the recommended dose is 50 mg every 12 hours or 100 mg once daily.

Aknemin 50 may be used at the normal recommended dosage in elderly patients but caution is advised in patients with renal impairment.

Unlike earlier tetracyclines, absorption of Aknemin 50 is not impaired significantly by the intake of food or moderate amounts of milk.

Hypersensitivity to tetracyclines, systemic lupus erythematosus, renal impairment, children under 12 years old, pregnancy, lactation

Aknemin 50 should be used with caution in patients with hepatic dysfunction and in conjunction with alcohol and other hepatotoxic drugs.

Cross-resistance between tetracyclines may develop in micro-organisms and cross-sensitisation in patients. Aknemin 50 should be discontinued if there are signs or symptoms of overgrowth of resistant organisms, eg enteritis, glossitis, stomatitis, vaginitis, pruritus ani or staphylococcal enteritis.

Patients taking oral contraceptives should be warned that if diarrhoea or breakthrough bleeding occurs there is a possibility of contraceptive failure.

Rare cases of autoimmune hepatotoxicity and isolated cases of systemic lupus erythematosus (SLE) and also exacerbations of pre-existing SLE have been reported. If patients develop signs or symptoms of SLE or hepatotoxicity, or suffer exacerbation of existing SLE, minocycline should be discontinued.

Caution should be exercised in patients with Myasthenia Gravis as tetracyclines can cause weak neuromuscular blockade.

Tetracyclines decrease plasma prothrombin activity; reduced doses of concomitant anticoagulants may therefore be required. Aknemin should not be used with penicillins. The absorption of Aknemin is impaired by concomitant administration of antacids and preparations containing iron, calcium, aluminium, magnesium, bismuth or zinc salts. Diuretics may aggravate nephrotoxicity by volume depletion.

Blood and lymphatic system disorders: Haemolytic anaemia, thrombocytopenia, neutropenia and eosinophilia have been reported with tetracyclines.

Hypersensitivity reactions: Urticaria, fever, arthralgia, angioneurotic oedema, anaphylaxis and anaphylactoid purpura.

Nervous system disorders: Hyperaesthesia, paraesthesia have rarely been reported.

Headache, dizziness, vertigo and ataxia may occur. These disturbances are reversible within 3-48 hours of discontinuing therapy and occur less frequently when a low dose is given.

As with other tetracyclines, bulging fontanelles in infants and benign intracranial hypertension in adults have been reported. Treatment should be stopped if evidence of raised intracranial pressure develops.

Eye disorders: There are isolated cases of discolouration of the conjunctiva and lacrimal secretions.

Ear and labyrinth disorders: Impaired hearing has rarely been reported. Tinnitus may occur.

Cardiac disorders: Rarely pericarditis has been reported.

Respiratory, thoracic and mediastinal disorders: Rarely pulmonary infiltration has been reported.

Gastrointestinal disorders: Disturbances like anorexia, nausea, vomiting, diarrhoea, dyspepsia, dysphagia, antibiotic-associated colitis may occur. There have been isolated incidences of pancreatitis. A few cases of oesophagitis and oesophageal ulceration have been reported. To reduce the risk of oesophageal irritation and ulceration the capsules should be administered with adequate amount of fluids and probably not be given at bedtime or to patients with oesophageal obstruction or compression.

Hepato-biliary disorders: In common with other tetracyclines transient increases in liver function test values and, rarely, hepatitis have been reported. Some hepatic reactions have an autoimmune basis, and may occur after several months of minocycline treatment.

Skin and subcutaneous tissue disorders: Dermatological reactions are rare but erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, photosensitivity and alopecia have been reported.

Hyperpigmentation of skin have been reported occasionally.

Renal and urinary disorders: Rarely acute renal failure has been reported.

Other: When given over long periods, tetracyclines have been reported to produce brownish-black microscopic discolouration of thyroid tissue; no abnormalities of function are known to occur.

Discolouration of teeth and buccal mucosa have been reported occasionally. These are generally reversible on cessation of therapy. There are isolated cases of breast secretions and perspiration.

Almirall Limited

(POM)

20 March 2012