Successful minocycline therapy hinges on proactive counseling about vestibular effects, monitoring for autoimmune syndromes, and stewardship-minded duration limits.
Reassess every three months, switch to maintenance topicals or isotretinoin if ongoing antibiotics are needed, and document start/stop dates in the chart.
Vestibular side effects (dizziness, vertigo, tinnitus) often start within the first week; dose reduce or switch to doxycycline if symptoms impair school or sports participation.
Obtain LFTs and ANA before therapy exceeding 6 weeks, repeat every 3–4 months, and stop immediately for arthralgia, rash, or fatigue suggesting autoimmune hepatitis or drug-induced lupus.
Document baseline photos for adolescents with acne—blue-gray discoloration of skin, gums, or scars may develop with cumulative doses >70 g.
Discuss teratogenicity and tooth/bone effects; ensure reliable contraception and immediate discontinuation if pregnancy occurs.