Minocycline

Safetychecker Summary for Minocycline
(for details about the summarized interactions, read the full article)

May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.	Calcium Iron Magnesium Vitamin K* Zinc
May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.	Probiotics* Vitamin C Lactobacillus casei * Lactobacillus acidophilus * Saccharomyces boulardii * Saccharomyces cerevisiae * Bifidobacterium longum * Vitamin K*
May be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.	Nicotinamide* Saccharomyces boulardii *
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.	Calcium Iron Magnesium Zinc
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Vitamin A*

Interactions with Dietary Supplements

Calcium, Iron, Magnesium, Zinc
Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug¹ ² and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

Vitamin C
Tooth discoloration is a side effect of minocycline observed primarily in young children, but it may occur in adults as well. Vitamin C supplementation may prevent staining in adults taking minocycline.³

Nicotinamide (Niacinamide)
Niacinamide taken in combination with minocycline has produced beneficial effects in an individual with cicatricial pemphigoid, an autoimmune blistering disease,⁴ as well as in a 46-year-old woman with pemphigus vegetans, another blistering disease.⁵ Several other studies have confirmed the efficacy of this combination for bullous (blistering) pemphigoid.⁶ ⁷ ⁸ ⁹ ¹⁰

Probiotics
A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.¹¹

The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii ¹² or Saccharomyces cerevisiae (baker’s or brewer’s yeast)¹³ —helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.¹⁴ Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.¹⁵

Vitamin A
A 16-year-old girl developed headaches and double vision following treatment for acne with vitamin A and minocycline. These side effects disappeared once the compounds were discontinued.¹⁶ More research is needed to determine whether the symptoms could have been caused by an interaction between vitamin A and the drug.

Vitamin K
Several cases of excessive bleeding have been reported in people who take antibiotics.¹⁷ ¹⁸ ¹⁹ ²⁰ This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.²¹ Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

References:

1. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1535–7.

2. Brion M, Lambs L, Berthon G. Metal ion-tetracycline interactions in biological fluids. Part 5. Formation of zinc complexes with tetracycline and some of its derivatives and assessment of their biological significance. Agents Actions 1985;17:229–42.

3. Cheek CC, Heymann HO. Dental and oral discolorations associated with minocycline and other tetracycline analogs. J Esthet Dent 1999;11:43–8.

4. Reiche L, Wojnarowska F, Mallon E. Combination therapy with nicotinamide and tetracyclines for cicatricial pemphigoid; further support for its efficacy. Clin Exp Dermatol 1998;23:254–7.

5. Sawai T, Kitazawa K, Danno K, et al. Pemphigus vegetans with oesophageal involvement: successful treatment with minocycline and nicotinamide. Br J Dermatol 1995;132:668–70.

6. Yomoda M, Komai A, Hasimoto T. Sublamina densa-type linear IgA bullous dermatosis successfully treated with oral tetracycline and niacinamide. Br J Dermatol 1999;141:608–9.

7. Berk MA, Lorincz AL. The treatment of bullous pemphigoid with tetracycline and niacinamide. A preliminary report. Arch Dermatol 1986;122:670–4.

8. Kawahara Y, Hashimoto T, Ohata K, Nishikawa T. Eleven cases of bullous pemphigoid treated with combination of minocycline and nicotinamide. Eur J Dermatol 1996;6:427–9.

9. Peoples D, Fivenson DP. Linear IgA bullous dermatosis: successful treatment with tetracycline and nicotinamide. J Am Acad Dermatol 1992;26:498–9.

10. Chaffins ML, Collison D, Fivenson DP. Treatment of pemphigus and linear IgA dermatosis with nicotinamide and tetracycline: a review of 13 cases. J Am Acad Dermatol 1993;28:998–1000.

11. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

12. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

13. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer’s yeast. Lancet 1994;343:171–2.

14. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981–8.

15. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870–6 [review].

16. Moskowitz Y, Leibowitz E, Ronen M, Aviel E. Pseudotumor cerebri induced by vitamin A combined with minocycline. Ann Ophthalmol 1993;25:306–8.

17. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292–4.

18. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706–7.

19. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610–2.

20. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524–5.

21. Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531–9.

22. Sifton DW, ed. Physicians Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1535–7.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over-the-counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2003.