Contraindications
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.
