Minocycline Milk

Tetracyclines. It is important to give the tetracyclines on an empty stomach tetracyclines are not to be taken with dairy products (milk or cheese). The exceptions are doxycycline (Vibramycin) and minocycline (Minocin), which may be taken with dairy products or food. The nurse should give clindamycin with food or a full glass of water. The nurse can give troleandomycin and clarithromycin without regard to meals. All tetracyclines should be given with a full glass of water (240 mL). 

These antibiotics are partially absorbed from the stomach and upper gastrointestinal tract. Food impairs absorption of all tetracyclines except doxycycline and minocycline. Absorption of doxycycline and minocy-cbne is improved with food. Since the tetracyclines form insoluble chelates with calcium (such as are found in many antacids), magnesium, and other metal ions, their simultaneous administration with milk (calcium), magnesium hydroxide, aluminum hydroxide, or iron will interfere with absorption. Because some of the tetracyclines are not completely absorbed, any drug remaining in the intestine may inhibit sensitive intestinal microorganisms and alter the normal intestinal flora. 

The oral dosage for rapidly excreted tetracyclines, equivalent to tetracycline hydrochloride, is 0.25-0.5 g four times daily for adults and 20-40 mg/kg/d for children (8 years of age and older). For severe systemic infections, the higher dosage is indicated, at least for the first few days. The daily dose is 600 mg for demeclocycline or methacycline, 100 mg once or twice daily for doxycycline, and 100 mg twice daily for minocycline. Doxycycline is the oral tetracycline of choice because it can be given as a once-daily dose and its absorption is not significantly affected by food. All tetracyclines chelate with metals, and none should be orally administered with milk, antacids, or ferrous sulfate. To avoid deposition in growing bones or teeth, tetracyclines should be avoided in pregnant women and children less than 8 years of age. 

Milk and dairy foods decrease the absorption of some tetracyclines (doxycycline and minocycline are not affected), some quinolone antibiotics (absorption of ciprofloxacin and norfloxacin is decreased but ofloxacin is not affected), penicillamine and alendronate. Large volumes of milk can reduce the ulcer-healing properties of bismuth tripotassium dicitratobismuthate (bismuth chelate),... 

Figure 14.8 LC-ESI-MS chromatogram in time-scheduled SIM mode for the analysis of milk spiked with 25 pg/kg of tetracyclines. Peaks MC=minocycline, TC=tetracycline, OTC=oxytetracycline, CTC=chlortetracycline, and DC=doxy-cycline. Reprinted from [15] with permission. 2002, John Wiley and Sons Ltd.

Leyden JJ. Absorption of minocycline hydrochloride and tetracycline hydrochloride. Effect of food, milk, and iron. J Am Acad Dermatol (1985) 12,308-12. 

Because of their chelating action, tetracycline drugs are inactivated in the patient s bowel by any dietary calcium or magnesium ions, whether from milk or from antacid medication. Through such mishaps, many patients have lost the potential benefit of these antibiotics. Tetracyclines are usually given orally. Tetracycline, itself, is still much prescribed, but there are also lower-dose forms available demeclocycline and methacycline, and a sub-class of these which require less frequent dosing doxycycline and minocycline. 

---