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Minocycline vs doxycycline: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Minocycline and doxycycline are tetracycline antibiotics commonly used in the treatment of acne and other common infectious skin disorders. These antibiotics cover a wide range of bacterial types that make them effective in a variety of other infectious processes as well. Acne is the most common skin condition in America. More than 50 million Americans suffer from acne each year. While both minocycline and doxycycline can both effectively treat acne, there are some significant differences between the two drugs.

What are the main differences between minocycline and doxycycline?

Minocycline is a prescription antibiotic medication belonging to a drug class known as tetracyclines. It is commonly used to treat acne, rosacea, respiratory tract infections, urinary tract infections, and certain sexually transmitted infections. Minocycline interferes with protein synthesis by binding to the mRNA ribosome complex. Gram-positive bacteria are more susceptible to minocycline than gram-negative bacteria.

Minocycline is available as oral immediate-release capsules and tablets in 50 mg, 75 mg, and 100 mg strengths. It is also available in extended-release capsules and tablets. Minocycline is also available as a powder to be reconstituted for injection as well as a topical-only use foam.

Doxycycline is a prescription antibiotic medication that also belongs to the class of tetracycline antibiotics. Doxycycline is indicated to treat acne, rosacea, respiratory infections, and non-gonococcal urethritis and cervicitis. Doxycycline works similarly to minocycline, by inhibiting protein synthesis in the bacterial cell. However, doxycycline is effective against both gram-positive and gram-negative bacteria.

Doxycycline is available in two salt forms, doxycycline hyclate and doxycycline monohydrate. Doxycycline hyclate is the more soluble of the two salt forms. Doxycycline hyclate is available in immediate-release tablets in strengths of 20 mg, 50 mg, 75 mg, 100 mg, and 150 mg, immediate-release capsules, and as an oral suspension.

Doxycycline hyclate is also available in delayed-release capsules and tablets. The final form of doxycycline hyclate is a powder to be reconstituted for injection.

Doxycycline monohydrate is available as an immediate-release capsule, bi-phasic release oral tablet, as well as an oral reconstituted suspension in a 25 mg/ 5 ml concentration.

Main differences between minocycline and doxycycline
Minocycline Doxycycline
Drug class Tetracycline antibiotics Tetracycline antibiotics
Brand/generic status Brand and generic available Brand and generic available
What is the brand name? Dynacin, Minocin,  Ximino, Solodyn Vibramycin, Doryx, Targadox, Acticlate, Periostat, Monodox, Adoxa, Oracea
What form(s) does the drug come in? Immediate and extended-release tablets and capsules, injection, topical foam Immediate and extended-release tablets and capsules, oral liquid, injection
What is the standard dosage? 100 mg daily 100 mg twice daily
How long is the typical treatment? 30+ days 10 days
Who typically uses the medication? Children 8 years old and older, adolescents, adults Children 8 years old and older, adolescents, adults

Conditions treated by minocycline vs. doxycycline

Minocycline and doxycycline share indications for common infectious processes, but also each have unique uses in clinical practice. Acne rosacea and acne vulgaris are two of the most common uses of both minocycline and doxycycline. Acne vulgaris can happen all over the body and is most typical in younger people. It may present with a variety of lesions including blackheads, pustules, and nodules. Acne rosacea is more common in people aged 30 and older and is typically isolated to the face. Each of these infectious diseases may require oral antibiotic therapy to achieve remission of symptoms.

Minocycline is indicated in meningococcal prophylaxis as well as the treatment of meningitis. It also carries an indication for the treatment of chlamydial infection of the eye.

Doxycycline is indicated in the prophylaxis of both anthrax and plague. Doxycycline has also been proven effective in community-acquired pneumonia.

The following list may not include all uses of minocycline and doxycycline. Consult your healthcare provider with questions about specific use.

Condition Minocycline Doxycycline
Acne rosacea Yes Yes
Acne vulgaris Yes Yes
Bacterial conjunctivitis No Yes
Chlamydia Yes Yes
Chlamydial conjunctivitis Yes No
Gonorrhea Yes Yes
Malaria prophylaxis No Yes
Mycobacterium marinum infection Yes No
Necrotizing ulcerative gingivitis Yes Yes
Non-gonococcal urethritis (NGU) Yes Yes
Q fever Yes Yes
Relapsing fever Yes Yes
Rickettsialpox Yes Yes
Rocky Mountain spotted fever Yes Yes
Scrub typhus No Yes
Sinusitis No Yes
Skin and skin structure infections Yes Yes
Urinary tract infections (URI) Yes Yes
Rheumatoid arthritis Off-label No

This is not a complete list of treatments.

Is minocycline or doxycycline more effective?

The effectiveness of minocycline or doxycycline is relative to the indication being compared. One of the most common mutual indications for these two drugs is acne rosacea. A randomized controlled trial, published in 2017, sought to compare the efficacy and safety of these two drugs in the treatment of rosacea. Eighty patients with mild to severe rosacea were randomized to either doxycycline 40 mg or minocycline 100 mg. The results of the study found that improvement scores were significantly better for the minocycline group. The minocycline group also had fewer relapses in symptoms and had a longer remission period. There was no significant difference in safety between the two drugs.

A systematic review of literature was done to also compare and evaluate the safety and adverse events between minocycline and doxycycline. The review looked at 15 years of data. Doxycycline was prescribed three times more often than minocycline. While adverse events for either drug are relatively low, doxycycline was associated with fewer adverse events than minocycline.

Coverage and cost comparison of minocycline vs. doxycycline

Minocycline is a prescription drug that is typically covered by both commercial and Medicare prescription drug plans. The out-of-pocket price for a typical minocycline prescription can be almost $130. With a coupon from SingleCare, the price drops to about $37.

Doxycycline is a prescription drug that is also typically covered by commercial and Medicare prescription drug plans. The out-of-pocket price for doxycycline hyclate can be more than $200. The price with a SingleCare coupon can be as low as $31.

Minocycline Doxycycline
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Standard dosage 30, 100 mg capsules 20, 100 mg capsules
Typical Medicare copay $10 or less $10 or less
SingleCare cost $39-$54 $31-$55

Common side effects of minocycline vs. doxycycline

Minocycline and doxycycline each have a tendency to cause gastrointestinal side effects including nausea, vomiting, diarrhea, and anorexia. These side effects can be difficult to tolerate over longer periods of time and may be responsible for premature termination of therapy due to intolerability.

Minocycline has been associated with rare instances of liver failure and hepatitis. Patients with known hepatic impairment should avoid minocycline or be monitored closely while taking.

Doxycycline has been associated with the rare but serious adverse event of Stevens-Johnson syndrome. SJS may present with small purple or red spots, blisters, skin peeling, and/or rash. It is a very serious condition that requires immediate medical attention.

The following list is not intended to be a complete list of adverse events. Please consult a pharmacist, doctor, or another medical professional for a complete list of possible side effects.

Minocycline Doxycycline
Side effect Applicable? Frequency Applicable? Frequency
Anorexia Yes Not defined Yes Not defined
Nausea Yes Not defined Yes Not defined
Vomiting Yes Not defined Yes Not defined
Diarrhea Yes Not defined Yes Not defined
Glossitis Yes Not defined Yes Not defined
Dysphagia Yes Not defined Yes Not defined
Enterocolitis Yes Not defined Yes Not defined
Pancreatitis Yes Not defined No n/a
Increase in liver enzymes Yes Not defined No n/a
Hepatitis Yes Not defined No n/a
Liver failure Yes Not defined No n/a
Rash Yes Not defined Yes Not defined
Exfoliative dermatitis Yes Not defined Yes Not defined
Urticaria Yes Not defined Yes Not defined
Edema Yes Not defined Yes Not defined
Pericarditis Yes Not defined Yes Not defined
Anemia Yes Not defined Yes Not defined
Thrombocytopenia Yes Not defined Yes Not defined
Neutropenia Yes Not defined Yes Not defined
Stevens-Johnson syndrome No n/a Yes Not defined

Source: Minocycline (DailyMed), Doxycycline (DailyMed)

Drug interactions of minocycline vs. doxycycline

Minocycline and doxycycline are both antibiotics from the same class of tetracyclines, and their list of potential drug interactions is similar. Common antacids containing aluminum hydroxide, such as Gaviscon, may impair the absorption of minocycline and doxycycline. This can lead to a decreased efficacy of minocycline and doxycycline. To avoid this interaction, antacids should not be taken with these antibiotics. Ideally, there would be at least two hours between the administration of an antacid and either minocycline or doxycycline.

Tetracycline antibiotics such as minocycline and doxycycline interfere with the bactericidal action of another common antibiotic class, penicillins. This class includes common antibiotics such as amoxicillin and penicillin. There are instances where patients may need to take more than one antibiotic at a time, and it is important to be aware of this interaction when selecting therapies.

The following list is not intended to be a complete list of drug interactions. It is best to consult your provider or pharmacist for a complete list.

Drug Drug class Minocycline Doxycycline
Aluminum hydroxide
Bismuth salicylate
Magnesium hydroxide
Sodium bicarbonate
Antacids Yes Yes
Amoxicillin
Ampicillin
Carbenicillin
Dicloxacillin
Penicillin
Piperacillin
Penicillin antibiotics Yes Yes
Calcium carbonate
Calcium acetate
Calcium chloride
Calcium gluconate
Calcium compounds Yes Yes
Zinc salts Zinc supplements Yes Yes
Cholestyramine
Colesevelam
Colestipol
Bile acid sequestrant Yes Yes
Didanosine Antiretroviral Yes Yes
Digoxin Antiarrhythmic Yes Yes
Drospirenone, Estradiol, progestins Oral contraceptives Yes Yes
Quinapril Angiotensin converting enzyme (ACE) inhibitor Yes Yes
Iron
Iron salts
Iron sucrose
Sodium ferric gluconate complex
Ferric pyrophosphate citrate
Iron supplements Yes Yes
Isotretinoin Retinoid Yes Yes
Lomitapide Microsomal triglyceride transfer protein (MTP) inhibitor Yes Yes
Magnesium
Magnesium Citrate
Magnesium salts
Magnesium supplements/ Laxatives Yes Yes
Methotrexate (MTX) Folate antimetabolite/ immunosuppressant Yes Yes
Pyridostigmine Parenteral cholinesterase inhibitor Yes Yes

Warnings of minocycline and doxycycline

Minocycline and doxycycline are categorized by the Food and Drug Administration (FDA) as a category D drug, meaning that there is positive evidence of potential fetal risk. These drugs should be used only when there is a life-threatening risk to the mother. There is evidence of a negative impact on the skeletal development of the fetus.

The use of tetracycline antibiotics during tooth development may cause permanent discoloration of the teeth to a yellow, gray, or brown color. This effect is most common with long-term use, though it has been noted with short-term use as well. When possible, the use of tetracycline antibiotics should be avoided during the last half of pregnancy through the age of 8 whenever possible.

Minocycline has been associated with Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome. This is characterized by rash, fever, and organ injury, typically liver and kidney. Some instances can be fatal.

Tetracyclines have been associated with photosensitivity. Patients are more prone to sunburn when taking these medications and should take precautions such as sun avoidance, shields, and sunscreen.

Intracranial hypertension (IH) has also been associated with the use of tetracyclines such as minocycline and doxycycline. IH may present with headache, blurred vision, diplopia, and/or vision loss. Women who are of childbearing age who are overweight have a higher risk of IH.

Frequently asked questions about minocycline vs. doxycycline

What is minocycline?

Minocycline is a prescription tetracycline antibiotic used most commonly to treat skin conditions such as acne vulgaris and acne rosacea, respiratory tract infections, urinary tract infections, and certain sexually transmitted infections. Minocycline is available in tablets and capsules in a variety of immediate and extended-release formulations.

What is doxycycline?

Doxycycline is a prescription tetracycline antibiotic commonly used in acne vulgaris, acne rosacea, respiratory infections, and non-gonococcal urethritis and cervicitis. Doxycycline is available in tablets and capsules in a variety of immediate and extended-release formulations.

Are minocycline and doxycycline the same?

Minocycline and doxycycline are both tetracycline antibiotics, but they are not the same drug. They do have slightly different bacterial coverage, which makes them each useful in some unique infections.

Is minocycline or doxycycline better?

When evaluating patients being treated specifically for acne rosacea, one clinical review suggested that minocycline was associated with a longer remission of symptoms. A separate literature review suggests that doxycycline may be associated with fewer adverse events than minocycline. Both drugs have been proven effective for their approved indications.

Can I use minocycline or doxycycline while pregnant?

Minocycline and doxycycline are pregnancy category D, meaning that there is proof that taking these drugs during pregnancy may cause harm to the fetus. The use of these drugs in pregnancy should be limited to treating only life-threatening conditions for which there is no other safer option.

Can I use minocycline or doxycycline with alcohol?

Tetracycline antibiotics like minocycline and doxycycline have been associated with liver toxicity. Alcohol use while taking these drugs is discouraged, especially in those patients who have a history of liver impairment or hepatitis.

Is minocycline a strong antibiotic?

Minocycline covers a broad spectrum of bacterial types, including some gram-negative and many bacteria. This coverage spectrum makes it effective in various skin, urinary, respiratory, and sexually transmitted diseases.

Why can’t you lay down after taking minocycline?

Minocycline can cause esophageal irritation or ulceration and therefore should be administered when the patient can remain upright for at least 30 minutes to one hour. Laying down may delay the drug’s transit through the esophagus and increase the chance of irritation or ulceration.

Should I take minocycline in the morning or at night?

If a patient is taking minocycline only once daily, ideally this dose would occur in the morning as patients would be expected to be upright for a long period of time following a morning dose. If an evening dose is required, it is best that the evening dose is given early enough to allow the patient to be upright for at least 30 minutes to one hour prior to laying down.