Treating Acne With Oral Minocycline

Minocycline is an oral antibiotic that is commonly prescribed for acne. It belongs to a group of antibiotics called tetracyclines. The acne treatments doxycycline and tetracycline also belong to this group. Minocycline is the most expensive of the three, but it can be effective against acne when other oral antibiotics have failed.

Minocycline is also sold as:

• Minocin
• Dynacin
• Vectrin
• Solodyn (extended-release)

Benefits

Minocycline has been used for decades and is especially effective against inflammatory acne. However, it's rarely used alone—it's nearly always prescribed along with a topical acne medication. The combination usually leads to better results than just minocycline.

Minocycline works to treat acne in two ways. First, it stops the growth of bacteria that cause acne breakouts. Second, it reduces inflammation. If you have red, inflamed pimples, this is good news.

On the other hand, minocycline won't do much for blackheads and other non-inflamed blemishes. Topical retinoids are a better choice for those.

What to Expect

Minocycline comes in a capsule, or, as the brand Solodyn, an extended-release tablet. If your doctor prescribes the capsule, you'll take it either two or four times a day, at regular intervals. Solodyn is a once-per-day treatment.

All brand-name versions of minocycline can be taken with or without food, but the generic form needs to be taken either one hour before or two hours after a meal. Regardless of the brand or formulation, you should drink a full glass of water with every dose. Be sure you follow the instructions from your doctor precisely and don't take more or less of the drug than is prescribed.

For the first few days you take minocycline capsules (not extended-release tablets), it's important that you begin with a single daily dose—usually recommended at bedtime—and work up to the full prescribed amount. You may experience some side effects, including:

• Dizziness
• Headaches

However, for most people, these symptoms are gone by morning. Your doctor and pharmacist should offer you guidance as to when to start taking additional daily doses.

How Quickly It May Work

It can take between six and eight weeks for the medication to have a noticeable effect on your acne, so be patient. If you're also using a topical acne treatment, you may start seeing results from that before the minocycline is in full effect.

Because it can take two months to have any impact, expect your doctor to keep you on the minocycline for at least three months to gauge its full effectiveness.

Contraindications

Minocycline shouldn't be used if you’re pregnant or breastfeeding, so let your doctor know if either of these applies to you.

Kids under 8 years old shouldn't use minocycline because of a risk of permanent tooth discoloration. Some sources recommend waiting until after age 10 or even age 12. Talk to your doctor to find out what's right in your case (or your child's).

Drug Interactions

Minocycline can interact negatively with several classes of drugs. This may impact whether you can take certain drugs, including minocycline, or require a dosage adjustment to be safe. Potentially problematic drug classes include:

• Low-dose oral contraceptives (birth control pills): Minocycline may lower the effectiveness of these medications, which could lead to breakthrough bleeding or unwanted pregnancy. An additional form of birth control is recommended while you take minocycline.
• Anticoagulants: The dosage of these blood thinners may need to be lowered while taking minocycline. Examples of anticoagulants are Coumadin (warfarin), Xarelto (rivaroxaban), and Eliquis (apixaban).
• Penicillin: Minocycline may interfere with these antibiotics' function, so combining them is not advised. Examples of penicillin drugs are amoxicillin, ampicillin, oxacillin.
• Methoxyflurane: Combining this inhaled anesthetic with minocycline can lead to fatal kidney toxicity. The brand name is Penthrane.
• Other tetracyclines: Taking minocyclines with other drugs in its class may also lead to severe kidney toxicity.

Absorption of minocycline can be impaired by certain metals or nutrients that are used medicinally. Let your doctor know if you regularly take:

• Antacids, which may contain aluminum, calcium, or magnesium
• Calcium supplements
• Magnesium supplements
• Iron supplements

Your doctor should always have a complete list of all drugs—including prescription and over-the-counter—and supplements that you take.

Dosage

A common starting dosage is 50 to 100 milligrams (mg), one or two times a day. You'll slowly taper off minocycline treatment once acne is under control. At this point, acne can often be kept in check by topical treatments alone. Sometimes, though, oral antibiotics have to be taken long-term to keep acne from returning.

Side Effects

Side effects can happen, although for most people they aren't too uncomfortable. Just make sure to check in with your doctor if you notice any. Some of the more common side effects are:

• Nausea and vomiting
• Diarrhea
• Dizziness

Bluish discoloration of the gums, mouth, skin, nails, tears, and urine can also happen with minocycline use. It generally occurs only with long-term use and it is reversible. Tooth discoloration (again, of bluish nature) is also possible. While it's extremely unusual, the discoloration can be permanent.

Less common side effects include:

• Itching of the vagina or rectum
• Tinnitus (ringing of the ears)
• Hair loss
• Dry mouth
• Swollen tongue
• Sore throat
• Inflammation in the tip of the penis
• Muscle pain
• Mood changes
• Numbness, tingling, or prickling sensations

If any of those side effects are persistent or become severe, let your doctor know. They may take you off the medication, depending on the nature and severity of the side effects.

When to See a Doctor

Minocycline can cause some serious side effects, but they're less common. Call your doctor or get medical attention immediately if you have:

• Blurry, double, or loss of vision
• Rash, hives, or blistering/peeling skin
• Swelling of the face, throat, tongue, lips, and eyes
• Problems breathing or swallowing
• Yellowing eyes or skin with nausea, vomiting, or confusion
• Bloody urine
• Watery or bloody stools with stomach cramps or fever (up to two months after stopping treatment)
• Joint pain or inflammation
• Swollen lymph nodes
• Unusual bleeding or bruising
• Seizures
• Chest pain or irregular heartbeat

If any of these occur, your doctor will likely take you off of minocycline.