Table. Comparison of Doxycycline and Minocycline 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 Bioavailability 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% Metabolism Liver Liver Elimination Kidney: 20% to 30% Kidney: 10% to 13% Feces: 70% to 80% Feces: 19% Tissue Penetration Doxycycline is 5 times more lipophilic Minocycline is 5 times more lipophilic than than tetracycline doxycycline. Minocycline achieves highest penetration into saliva and cerebrospinal fluid 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 hypersensitivity 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 • Headache (23%) • Skin rashes • Dizziness (9%) • Photosensitivity • Vertigo (1%) • Vaginal candidiasis • Tinnitus (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. • Somnolence (2%) The following reactions occurred at > • Fatigue (9%) 2% and more than placebo with • Fever Oracea: Diarrhea 5%, nasopharyngitis • Skin rashes 5%, sinusitis 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 • Lupus-like syndrome • Lupus-like syndrome Table. Comparison of Doxycycline and Minocycline 18-20,37-44 Characteristics Doxycycline Minocycline • Blood dyscrasias • Blood dyscrasias • Hepatotoxicity • Hepatotoxicity • Esophageal ulceration • Esophageal ulceration • Pseudomembranous colitis • Pseudomembranous colitis • Hyperpigmentation Warnings • Tooth discoloration in forming teeth • Tooth discoloration in forming teeth • Do not use in pregnancy • 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 light-headedness can occur – use • Pseudomembranous colitis and caution with driving and operating Clostridium difficile associated hazardous equipment diarrhea • Potential overgrowth of nonsusceptible • Benign intracranial hypertension, organisms pseudotumor cerebri • Pseudomembranous colitis and C. • Autoimmune syndromes- tetracyclines difficile infection have been associated with • Hepatotoxicity autoimmune syndromes • Benign intracranial hypertension, • Tissue hyperpigmentation pseudotumor cerebri • Development of drug resistant • Autoimmune syndromes – minocycline is bacteria associated with drug induced lupus like syndrome, autoimmune hepatitis and vasculitis. • Hypersensitivity reactions including DRESS syndrome • Tissue hyperpigmentation • Development of drug resistant bacteria Labeled Indication • Acne • Acne Adult Patients, • In patients with penicillin allergy, • In patients with penicillin allergy, Based on Product treatment of uncomplicated gonorrhea treatment of Neisseria gonorrhoeae, Labeling for Oral from Neisseria gonorrhoeae, Syphilis Syphilis from Treponema pallidum, Yaws Doxycycline and from Treponema pallidum, Yaws from from Treponema pertenue, Listeriosis Minocycline Treponema pertenue, Listeriosis from from Listeria monocytogenes, Vincent’s Listeria monocytogenes, Vincent’s infection from Fusobacterium fusiforme, infection from Fusobacterium Actinomycosis from Actinomyces Israelii, fusiforme, Actinomycosis from and infections from Clostridium species Actinomyces Israelii, and infections • Adjunct treatment of amebic dysentery from Clostridium species • Anthrax treatment in patients with • Adjunct treatment of amebic penicillin contraindication dysentery • Bacterial infection caused by: Chlamydia • Anthrax due to Bacillus anthracis, trachomatis, Chlamydia psittaci, Borrelia including post-exposure treatment. recurrentis, Haemophilus ducreyi, • Bacterial infection caused by: Yersinia pestis, Francisella tularensis, Chlamydia trachomatis, C. psittaci, Vibrio cholerae, Campylobacter fetus, Borrelia recurrentis, Haemophilus Brucella species, Bartonella bacilliformis, ducreyi, Yersinia pestis, Francisella Calymmatobacterium granulomatis, tularensis, Vibrio cholerae, Escherichia coli, Enterobacter Campylobacter fetus, Brucella aerogenes, Shigella species, species, Bartonella bacilliformis, Acinetobacter 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 Neisseria meningitidis. Mycoplasma pneumoniae, • Adjunct treatment of periodontitis Streptococcus pneumoniae, (Arestin®) Haemophilus influenzae and • Respiratory tract infection caused by Klebsiella species Mycoplasma pneumoniae, Streptococcus • Treatment of rosacea 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 • Urinary tract infection from Klebsiella infection. species • Urethritis from Ureaplasma urealyticum infection (non- gonococcal) • Urinary tract infection from Klebsiella species • Prophylaxis of Plasmodium falciparum .