Table. Comparison of and 18-20,37-44 Characteristics Doxycycline Minocycline How supplied Doxycycline monohydrate Minocycline hydrochloride Tablets: 50 mg, 75 mg, 100 mg, 150 mg Tablets: 50 mg, 75 mg, 100 mg Capsules: 50 mg, 100 mg, 150 mg Capsules: 50 mg, 75 mg, 100 mg Capsule extended- release: 40 mg Extended release tablets: 45 mg, 90 mg, Suspension: 25 mg/5 mL 135 mg Doxycycline hyclate Solodyn extended release tablets: 55 mg, Tablets: 20 mg, 100 mg 65 mg, 80 mg, 105 mg, 115 mg Delayed release tablets: 75 mg, 100 Subgingival: 1 mg mg, 150 mg Injection: 100 mg Capsules: 50 mg, 100 mg Injection: 100 mg Doxycycline Calcium Syrup: 50 mg/5 mL 90% to 100% 90% to 100% Time to peak 1.5 to 4 hours 1.5 to 4 hours Half-life 15 to 24 hours 11 to 22 hours Protein binding 82% - 93% 76% Liver Elimination : 20% to 30% Kidney: 10% to 13% : 70% to 80% Feces: 19% Tissue Penetration Doxycycline is 5 times more lipophilic Minocycline is 5 times more lipophilic than than doxycycline.

Minocycline achieves highest penetration into saliva and compared to doxycycline and tetracycline. Dosage Dosage depends on indication for use. Dosage depends on indication for use. Adverse reactions Doxycycline may be associated with Minocycline may be associated with more more GI upset than minocycline. GI vestibular, autoimmune, hepatic and upset may vary with doxycycline reactions than doxycycline. formulation. Common Adverse Frequency not given in labeling or • Gastrointestinal distress (dyspepsia, Drug Reactions tertiary references. anorexia, nausea, dysphagia) • Gastrointestinal distress (dyspepsia, • Arthralgia (1%) anorexia, nausea, dysphagia) • Myalgia (1%) • Glossitis • (23%) • • Dizziness (9%) • • Vertigo (1%) • Vaginal candidiasis • (2%) • Urticaria (2%) Note: only the Oracea product labeling • Pruritus (5%) reports incidence of adverse reactions • Malaise (4%) and that is for doxycycline 40 mg daily. • (2%) The following reactions occurred at > • Fatigue (9%) 2% and more than with • Oracea: 5%, nasopharyngitis • Skin rashes 5%, 3%, and hypertension 3%. • Photosensitivity • Vaginal candidiasis Serious Adverse • Benign intracranial hypertension • Benign intracranial hypertension Drug Reactions • Exfoliative dermatitis, • Exfoliative dermatitis • Hypersensitivity reactions • Hypersensitivity reactions • -like syndrome • Lupus-like syndrome Table. Comparison of Doxycycline and Minocycline 18-20,37-44 Characteristics Doxycycline Minocycline • Blood dyscrasias • Blood dyscrasias • • Hepatotoxicity • Esophageal ulceration • Esophageal ulceration • Pseudomembranous colitis • Pseudomembranous colitis • Hyperpigmentation Warnings • discoloration in forming teeth • in forming teeth • Do not use in • Do not use in pregnancy • Photosensitivity – dependent on dose, • Decrease dose in renal impairment UVA intensity, and skin type • Photosensitivity – dependent on dose, • Potential overgrowth of UVA intensity, and skin type nonsusceptible organisms including • CNS effects like vertigo, dizziness or fungi -headedness can occur – use • Pseudomembranous colitis and caution with driving and operating difficile associated hazardous equipment diarrhea • Potential overgrowth of nonsusceptible • Benign intracranial hypertension, organisms pseudotumor cerebri • Pseudomembranous colitis and C. • Autoimmune syndromes- difficile have been associated with • Hepatotoxicity autoimmune syndromes • Benign intracranial hypertension, • Tissue hyperpigmentation pseudotumor cerebri • Development of drug resistant • Autoimmune syndromes – minocycline is associated with drug induced lupus like syndrome, autoimmune and vasculitis. • Hypersensitivity reactions including DRESS syndrome • Tissue hyperpigmentation • Development of drug resistant bacteria Labeled Indication • • Acne Adult Patients, • In patients with allergy, • In patients with penicillin allergy, Based on Product treatment of uncomplicated treatment of , Labeling for Oral from Neisseria gonorrhoeae, Syphilis from Treponema pallidum, Doxycycline and from Treponema pallidum, Yaws from from Treponema pertenue, Minocycline Treponema pertenue, Listeriosis from from Listeria monocytogenes, Vincent’s Listeria monocytogenes, Vincent’s infection from Fusobacterium fusiforme, infection from Fusobacterium from Actinomyces Israelii, fusiforme, Actinomycosis from and from Clostridium species Actinomyces Israelii, and infections • Adjunct treatment of amebic dysentery from Clostridium species • treatment in patients with • Adjunct treatment of amebic penicillin contraindication dysentery • Bacterial infection caused by: • Anthrax due to , trachomatis, , Borrelia including post-exposure treatment. recurrentis, ducreyi, • Bacterial infection caused by: , Francisella tularensis, , C. psittaci, , Campylobacter , Borrelia recurrentis, Haemophilus species, , ducreyi, Yersinia pestis, Francisella Calymmatobacterium granulomatis, tularensis, Vibrio cholerae, , Enterobacter Campylobacter fetus, Brucella aerogenes, species, species, Bartonella bacilliformis, species. Calymmatobacterium granulomatis, • Rickettsial disease Escherichia coli, Enterobacter • Skin and skin structure infections from S. Table. Comparison of Doxycycline and Minocycline 18-20,37-44 Characteristics Doxycycline Minocycline aerogenes, Shigella species, aureus. However, not drug of choice for Acinetobacter species. any type of staphylococcal infection. • Rickettsial disease • Treatment of asymptomatic carriers of • Respiratory tract infection caused by . pneumoniae, • Adjunct treatment of periodontitis , (Arestin®) and • Respiratory tract infection caused by species , Streptococcus • Treatment of in adult patients pneumoniae, Haemophilus influenzae (Oracea®) and Klebsiella species • Skin and skin structure infections from • Uncomplicated Ureaplasma urealyticum S. aureus. However, not drug of infection choice for any type of staphylococcal • from Klebsiella infection. species • from Ureaplasma urealyticum infection (non- gonococcal) • Urinary tract infection from Klebsiella species • Prophylaxis of falciparum