Minocycline (EENT)

Brand names: Arestin
Drug class: Antineoplastic Agents

Usage of Minocycline (EENT)

Periodontitis

Used subgingivally for treatment of adult periodontitis as an adjunct to scaling and root planing procedures to reduce pocket depth.

Relate drugs

How to use Minocycline (EENT)

Administration

Subgingival Administration

Administered subgingivally as extended-release powder into periodontal pockets by a dental health-care professional.

Administration does not require local anesthesia.

Extended-release preparation is bioresorbable and does not need to be manually removed.

Subgingival Administration Technique

A unit-dose cartridge containing minocycline extended-release dry powder must be inserted into a spring-loaded cartridge handle prior to administration. The handle mechanism should be sterilized prior to reuse on another patient.

Administer by inserting the unit-dose cartridge into the base of the periodontal pocket and then pressing the thumb ring in the handle mechanism to expel the powder while gradually withdrawing the tip from the base of the pocket.

No dental adhesive or periodontal dressing is required following subgingival administration.

Consult manufacturer's information for additional information regarding subgingival administration of minocycline extended-release powder.

Dosage

Available as minocycline hydrochloride; dosage expressed in terms of minocycline.

Each commercially available unit-dose cartridge delivers 1 mg of minocycline.

Adults

Periodontitis Subgingival

Dosage varies depending on the size, shape, and number of periodontal pockets treated.

In clinical trials, up to 122 unit-dose cartridges were used during a single visit to treat all pocket sites with probing depth ≥5 mm and up to 3 treatments were administered at intervals of 3 months.

Warnings

Contraindications

  • Known hypersensitivity to minocycline or other tetracyclines.

    • Warnings/Precautions

    Warnings

    Dental and Bone Effects

    Do not use tetracyclines during tooth development (e.g., pregnancy, infancy, childhood to the age of 8 years); potential for permanent tooth discoloration (yellow-gray-brown) or enamel hypoplasia. More common during long-term tetracycline use, but also reported following repeated short-term use of the drugs.

    Tetracyclines form a stable calcium complex in any bone-forming tissue. Reversible decrease in fibula growth rate has occurred in premature infants receiving oral tetracycline.

    Sensitivity Reactions

    Hypersensitivity Reactions

    Hypersensitivity reactions and hypersensitivity syndrome reported in patients receiving oral tetracyclines. These reactions have included, but are not limited to, anaphylaxis, anaphylactoid reactions, angioedema, urticaria, rash, and eosinophilia; hepatitis, pneumonitis, nephritis, myocarditis, and/or pericarditis may also be present. Serious skin reactions, including Stevens-Johnson syndrome and erythema multiforme, reported with oral minocycline.

    Swelling of the face, pruritus, fever, and lymphadenopathy reported in patients receiving minocycline extended-release powder for subgingival administration. Some of these reactions were serious.

    Photosensitivity Reactions

    Photosensitivity, manifested as exaggerated sunburn reaction on areas of body exposed to direct sunlight or ultraviolet (UV) light, reported in some patients receiving tetracyclines.

    Discontinue subgingival minocycline at first sign of skin erythema.

    Other Warnings/Precautions

    Autoimmune Syndrome

    Tetracyclines, including oral minocycline, have been associated with the development of autoimmune syndromes, including a lupus-like syndrome manifested as arthralgia, myalgia, rash, and swelling.

    Sporadic cases of serum sickness-like reactions have presented shortly after oral minocycline use; manifested as fever, rash, arthralgia, lymphadenopathy, and malaise.

    Permanently discontinue subgingival minocycline if symptoms of autoimmune syndrome develop. Evaluate the patient using appropriate tests, including liver function tests, antinuclear antibody (ANA) tests, and CBCs.

    Acute Periodontitis

    Use of subgingival minocycline in acutely abscessed periodontal pockets not studied and not recommended.

    Superinfection/Candidiasis

    Possible overgrowth of nonsusceptible organisms, including fungi. Effects of subgingival minocycline administered for >6 months not studied. If superinfection is suspected, take appropriate measures.

    Use with caution in patients with a history of or predisposition to oral candidiasis. Safety and efficacy for treatment of periodontitis not established in patients with concomitant oral candidiasis.

    Immunocompromised Patients

    Not studied in immunocompromised patients (e.g., those with diabetes mellitus or HIV infection, those receiving chemotherapy or radiation therapy).

    Dental Implants

    Not studied for use in the regeneration of alveolar bone, either in preparation for or in conjunction with placement of endosseous (dental) implants or in the treatment of failing dental implants.

    Specific Populations

    Pregnancy

    Do not use tetracyclines during pregnancy. If a tetracycline used during pregnancy, apprise patient of potential hazards to the fetus.

    Subgingival minocycline not evaluated in pregnant women; effects of tetracyclines on labor and delivery unknown.

    Lactation

    Distributed into milk.

    Discontinue nursing or the drug.

    Pediatric Use

    Safety and efficacy not established in pediatric patients <18 years of age. (See Dental and Bone Effects under Cautions.)

    Common Adverse Effects

    Periodontitis, tooth disorder, tooth caries, dental pain, gingivitis, headache, infection, stomatitis, mouth ulceration, flu syndrome, pharyngitis, pain, dyspepsia, dental infection, mucous membrane disorder.

    What other drugs will affect Minocycline (EENT)

    No formal drug interaction studies performed with subgingival minocycline.

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