Max dose of minocycline? - 1245291

fortmyr
Posts:128

Hello doctors,

As I mentioned elsewhere, I am now in California with my sister and her two daughters. My sister is taking 40 mg of Afatinib daily and is having major rashes in reaction to this treatment. At the moment, she has a particularly bad painful rash that is covering all of her face. She's taking 200 mg of minocycline to control for this but the rash is still there. She was therefore wondering if she could increase the dose to better control for the rash and if so, what is the max dose that she could take.

Thank you so much for your help,

Myriam

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Reply # - July 17, 2012, 10:30 AM

JimC
Posts: 2753

Hi Myriam,

I hope you are enjoying California. I'm sorry to hear of your sister's rash problems. A dose increase would of course be something to discuss with her doctors; this site (http://www.mims.com/USA/drug/info/minocycline/minocycline?type=full) states that the maximum daily dosage of minocycline is 400 mg/day, so it might be possible.

I will forward your question to the GRACE faculty for response.

JimC
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Reply # - July 17, 2012, 10:35 AM

fortmyr
Posts: 128

Thank you very much for the info Jim. Given that we are not in our country at the moment, everything is a bit more complicated to manage. I'll wait to hear from faculty and then may be we could phone in Gatineau to make sure everything is OK.

Myriam

Reply # - July 17, 2012, 10:42 AM

dr walko
Posts: 102

Fortmyr,

I'm sorry to hear about the Afatinib toxicity, but glad that your sister was able to get on the clinical trial. Higher doses than 200 mg daily of minocycline can be used, but the benefits you would likely see from a higher dose are probably minimal and the GI effects can be much worse. The reason for using the minocycline is actually more as an antiinflammatory than an antibiotic.

Is your sister using any alcohol containing skin products or sitting out in the sun, as both of these can worsen the rash. Also, if the rash is localized, steroid creams can be helpful. I would recommend adding on to the minocycline rather changing the drug or the dose.

Best wishes,
Dr. Walko

Reply # - July 17, 2012, 07:26 PM

fortmyr
Posts: 128

Dr. Walko, thank you so much for your answer. What kind of steroid cream could she use and is it sold over the counter? Given that we are on vacation it would be really difficult for her to get a prescription.

Myriam

Reply # - July 17, 2012, 09:10 PM

Dr West
Posts: 4735

Something like hydrocortisone 1% cream should be readily available over the counter at just about any pharmacy and is dirt cheap.

-Dr. West

Reply # - July 17, 2012, 09:24 PM

fortmyr
Posts: 128

Thank you very much Dr. West, that's what my sister thought (she already has cortisone cream that she puts on her face when the rash becomes too bad).

On another note, I wanted to let Afatinib users know that having her fingers cauterized (by a dermatologist) helped my sister a great deal - it seems to have taken care of the infections caused by this treatment. Hope this is useful,

Myriam

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