TETRACYCLINES ============= (1) Minocycline vs. Doxycycline (2) Cost (3) Tetracyclines and Birth Contrl Pills (4) Tetracycline allergy (5) Side Effects -------------------------- MINOCYCLINE VS DOXYCYCLINE -------------------------- I have Rx's 1000's of patients with Minocin 100 mg hs [and some bid] over the past 7 years with good results and very few problems. I'ver reviewed the world's literature on the subject and Minocin is the LEAST likey of the tetracyclines to cause photosensitivity, while Doxycycline is a high risk for photosensitivity. Minocin works at least as well as Doxycycline - so why bother with Doxycycline? KC Smith, MD, FRCPC =================== minocin vs. doxy--in the past 3 years, i have had 6 patients with minocin skin hyperpigmentation, and two adults with greying of the teeth. be cautious with long term minocin. William.Liss MD =============== I too use minocin unless there is a strong reason not to, but I can think of at least two reasons: 1. Cost! Doxy is dirt cheap for those without prescription coverage. 2. Managed Care! We are beginning to see MCO's track individual physician prescribing patterns, with the implicit, and I suspect eventually explicit, threat of excluding "expensive prescribers" from the network. Minocin and Accutane are the two drugs which will eventually get me thrown out, I suspect! Mark Ling, M.D., Ph.D. ====================== I use minocycline and doxycycline both extensively for acne, and have been impressed with the number of hypersensitivity problems with minocycline, particularly dermatographism and the flu-like fever and myalgia minocycline syndrome. I've never seen either of these with TCN or with doxycycline.... Do others have similar experiences? Mark Valentine MD ================= I have never seen those symptoms having treated thousands of patients with Minocin. Are you using generics???????? Reviva@aol.com ============== Yes, I am using generics now. However, I am fairly certain several of these patients ocurred in the pre-generic era. I just don't have the chutzpah to prescribe branded Minocin anymore, given the preposterous expense. Mark1105@aol.com ================= I've seen 2 cases of Minocin pneumonitis [resolved with d/c] in 7 years, and I've prescribed it thousands of times. No photosensitivity, 1 possible pigmentation of tooth tips [resolved with d/c] and 1 pigmentation of lips [resolved with d/c]. I usually order 100 mg, #50 - 100, 6 refills, 1 po qhs, so the total volume must be several million caps. Kevin C. Smith, MD, FRCPC ========================= ---- COST ---- The reason for using doxycycline rather than Minocin is that the wholesale cost for generic doxycycline is about 10 cents for a 100 mg tab or cap, and Minocin is about $2. Over the course of a year, at 100 mg once a day, that works out to about $75 patient cost for doxycycline vs $900 for Minocin. If it were your money, which would you take? Even generic minocycline will cost the patient about $500 a year. The two work equally well (and both are much more effective than tetracycline), and have the advantage of not requiring an empty stomach, a rare event in teenagers. For those with GI problems from generic doxycycline, Monodox works as well, and is still less expensive than Minocin or generic minocycline. I treat the majority of my acne patients with doxycycline, and there are only 4 or 5 a summer that require a change in antibiotic due to photosensitivity. InSkin@aol.com ============== A brief not on cost of therapy from my local OSCO drug: minocyline generic 100 mg #60 $81.00 (they also told me they would sell the generic for $50.00 to "compete with Walmart") Dynacin 100 mg #60 $148.00 Minocin pellets 100 mg #60 $170.00 Although I feel that both Dynacin and Minocin are superior, it is hard to convince the patients to spend the extra money. I find that with Dynacin patients clear better but also get more dizziness (? better absorbtion) Previousely I did not think there was not much difference in cost between Dynacin and the generic, but at some pharmacies apparently it is significant. Mike Crowe, M.D. ================ ------------------------------------- TETRACYCLINES AND BIRTH CONTROL PILLS ------------------------------------- Two comments on the subjects of tetracyclines and bc pills and onantibiotics and scleroderma: The only antibiotic clearly associated with decreased effectiveness of bc pills is Rifampin but the issue here is more what the PDR says ("...may reduce the efficacy...") than what the science says (consider the silicone implant case) so the wise doctor will warn his patient in the words of the PDR and suggest alternative forms of birth control since a finite number of failures dooccur on bc pills and a few may be taking tetracycline. If you are lucky, it will notbe your patient. Until someone does double blind controlled studies on the effect of antibioticson Scleroderma demonstrating actual effect on the disease process, the use of antibiotics in scleroderma is experimental and if your patient gets pseudomembranous colitis while taking antibiotics for scleroderma, the lawyer for that patient will remind the court of that fact. Did you ever notice that all of the positive studies linking with Borrelia infection are European and all of the negative are American? Unrelated comment:All doctors should always follow what they can defend as optimal care at all times and not be bullied by HMO's or other financial arrangements. Try to remember that we are the ones who have this aching responsibility not insurance companies or Industrial Management Councils! Pat Condry MD ============= I might as well add my anecdotal 2 cents worth here since there seems to be as much agreement as disagreement of this topic. My clinical experience has been that minocycline (Minocin and Dynacin) are the best acne drugs with doxy a second runner. My patients complain of much more GI problems with doxy. I think that Dynacin is an equal drug to brand name minocin at about 30% less cost. In fact I have more people get dizzy with Dynacin and therefore assume that the absorption is quite good. The other generic minocyclines are in my experience second class at best. I can recite several cases where the patient opted for the cheaper drug and switched back after one month because their acne had flared. This is probably because they were used to taking their meds with food and the generic is simply not well absorbed. The cost locally of generics is about one half of brand name minocin so the temptation is there and the pharmacists push the generic, I think their margins are greater on the generic drug. As far as side effects I have certainly seen a lot of minocycline hives over the years, some hyperpigmentation of old injury sites and one case of blue ears and and nails. The hyperpigmentation problems are much more of a problem for those on 200mg a day. The BCP - antibiotic debate rages on. The studies from the UK showing almost the same pregnancy rate in large populations on TCN's and pill and pill alone are my best evidence but I always warn the patient as many of you have suggested. Remember the package insert and our vulnerability to those who make their living off our efforts to give good patient care and not cookbook patient care that follows all of the guidelines. L.J. Gregg, M.D. ================ From: Marilynne Mckay[SMTP:mmckay@emory.edu] New excitement from the Media we know and love! I started a teenaged patient on Minocin 6 weeks ago -- today he returned with a note from his mother saying she'd heard a TV story on Minocin that said it was highly dangerous...she'd halved his dose and wanted to know the story from me. Of course I knew nothing, so I called Lederle and here's what I was told: An article in the Jan 20 1996 British Medical Journal by Gough et al discussed toxicities of the tetracycline class of drugs and Minocin was mentioned. Nothing new was written that doesn't appear in the list of warnings in the drug insert for Minocin. The drug insert has not changed from previous years either. The Lederle representative on the 800 toll-free line said that she had not actually seen a copy of the article yet, but they were sure getting lots of calls. Their official story is that the drug insert tells all and always has. So what's the story? Has anyone read the article or seen the TV news? Is this a real problem or is it yet another example of "slow news day" journalism poking around to stimulate a non-issue brouhaha about a non-recreational drug used by thousands, if not millions, of young people? This has the potential of dominating the press releases from the Academy Meeting...maybe there's good press to be gotten for the AAD (or maybe not). (By the way, my patient had been on Doxycycline for months to no avail and virtually cleared within a month of starting Minocin 100 b.i.d.....) Marilynne McKay,MD ================== -------------------- TETRACYCLINE ALLERGY -------------------- Does anyone have any experience on cross reactivity of minocyline with doxycycline, tetracycline. I have a 16 y.o. female patient with quite inflammatory acne who developed urticaria while taking generic minocycline and would like to consider doxycycline or tetracyline in the future. Mike Crowe, M.D. ================ 2) I personally discovered that I have a fixed drug eruption to TCN while I was an intern. When Doxcycline came out, I took some with me on a trip to Mexico and when I took it with the onset of the 'touristas', I again developed a fixed drug eruption. I would never come near a TCN derived drug. 3) I have had a fair number of patients whose acne was controlled on a fixed dosage of Minocin (Lederle) or Dynacin who were substituted another generic by their pharmacist. They subsequently began to break out and I had to increase there dosage of the generic to control them.. I then convinced them that by taking 1 1/2-2 pills of the generic vs. 1 pill of Dynacin or Minocin (Lederle), the cost was the same. I just don't think the generics are absorbed as well so the full dosage doesn't reach the target organ. Jeff Marmelzat, M.D. ==================== ------------------------- TETRACYCLINE SIDE EFFECTS ------------------------- Does anyone have any information on any contraindications to the long-term (let's say over 2 months) use of oral doxycycline for acne ? The Monodox drug rep insists that this should be no different from using ordinary Tetracycline in terms of indications and side effects.He says there is nothing to the contrary in the literature.Anybody with personal experience on this matter ? Chris Dabski, M.D. ================== I have as Dr Ngai treated acne with doxycycline for 10 years without any serious side effects. The phototoxicity is only rarely seen in the lower maintenance dosage of 50 mg. My usual length of treatment is 3-6 months. One of the main advantages of doxycycline is that milk products do not have any effect on its absorption so they can be taken with the drug to diminish the risk of oesophagal complications. Jon H. Olafsson M.D. Ph D. ========================== I have used doxycycline instead of tetracycline for the last 15 years for acne and find it very satisfactory. The most frequent side effect is gastic upset, nausea and vomiting if taken on empty stomach. It may produce severe oesophagitis if the capsule is stuck by not swallowing it with plenty of water. Rarely it can cause fixed drug eruption, as tetracycline does. The convenience of taking it once daily and after meals is better than tetracycline in terms of efficacy and compliance. Stephen Ngai M.R.C.P. ===================== I use doxy for months at 100mg with the evening meal. I have had no problems with it and it is my tetracycline of first choice in non sunny months. The evening dose helps prevent sun sensitivity too. When questioned, teens will tell you how difficult it is to take tetracycline on an empty stomach even once a day. Doxy avoids that problem. Jerry Eisner MD =============== Firstly, I have used Minocin (not generic) in the treatment of thousands of patients and find it to be the most beneficial AB for this problem. I have only had 2 cases of pigment disorders which cleared when the drug was d/c'd and have never seen a photosensitivity rxn. Secondly, there seems to be a significant difference, probably in absorption between Minocin and other generic minocyclines. I have over 30 cases of acne controlled with a specific dose of Minocin which flared when switched to an equivelent dose of a generic with all other factors being essentially the same. These were patients well controlled on an overall regimen that included Minocin. Thirdly, what is the consensus opinion of this group on the efficacy of BCP's when patients are given Minocin or other AB's for the treatment of acne. Is there a REAL problem? Do you warn patients? Do you not use AB systemically? Jeff Marmelzat, M.D. ========================= It is my understanding that the concept of antibiotics decreasing the efficacy of birth control pills comes from British statistics and is due to anti-tuberculous drugs commonly used in England. I have read that tetracyclines probably do not have this effect. I have not had any problem with this in my practice. Philip.Hughe MD ================ I'm interested in hearing if any of you have had this complaint (paresthesias while taking tetracycline), and if anyone knows of any references on the subject. Mark Kaufmann, M.D. ------------------- I have fleshed out one reference to Tetracycline and Paresthesias: (1994): Blanchard L, The Schoch Letter, Vol 44, #6 (anecdotal). This is on page 408 of my Drug Eruption Reference Manual (Fifth Edition - 1996). Jerry Litt ----------- ^ ^ ^ ^ ^ ^ ^ 7.6.96