Minocycline is an antibiotic available by prescription that is most often used in the treatment of acne. I presently recommend against its use until more clinical trial information is available.

Mechanism of Action: Minocycline works to prevent cell damage, and is an inhibitor of inflammation.

Rationale for use in Huntington's: Research studies show that minocycline reduces brain injury in some mouse models [Chen M 2000], but not others [Choi Y 2007]. It adds benefit when combined with Coenzyme Q-10 in another mouse model [Stack EC 2006]. It has also been shown to decrease progression of motor and functional capacity loss in a human pilot trial for the two year time period of study [Bonelli RM 2003], but there has been a human trial in amyotrophic lateral sclerosis suggesting potential harm when this drug is used long term [Gordon PH 2007].

Dosage: The Bonelli study used 100 mg per day. Dr. Joseph Jankovic and collaborators from Baylor University are using 200 mg per day in their study [Thomas M 2004]. An ongoing HSG study is using 200 mg per day.

Side Effects: This drug promotes sunburn and interferes with oral contraceptive pills. It should not be used in pregnancy. It can cause vertigo (dizziness) and nausea. Yeast vaginitis and pigmentation of teeth or skin are common side effects of chronic use of this medicine.

Sources: Available by prescription.

References

Chen M, Ona VO, Li M, Ferrante RJ, Fink KB, Zhu S, Bian J, Guo L, Farrell LA, Hersch SM, Hobbs W, Vonsattel JP, Cha JH, Friedlander RM. Minocycline inhibits caspase-1 and caspase-3 expression and delays mortality in a transgenic mouse model of Huntington disease. Nat Med. 2000 Jul;6(7):797-801. PubMed abstract

Choi Y, Kim HS, Shin KY, Kim EM, Kim M, Kim HS, Park CH, Jeong YH, Yoo J, Lee JP, Chang KA, Kim S, Suh YH. Minocycline attenuates neuronal cell death and improves cognitive impairment in Alzheimer's disease models. Neuropsychopharmacology. 2007 Nov;32(11):2393-404. Epub 2007 Apr 4. PubMed abstract

Stack EC, Smith KM, Ryu H, Cormier K, Chen M, Hagerty SW, Del Signore SJ, Cudkowicz ME, Friedlander RM, Ferrante RJ. Combination therapy using minocycline and coenzyme Q10 in R6/2 transgenic Huntington's disease mice. Biochim Biophys Acta. 2006 Mar;1762(3):373-80. Epub 2005 Dec 5. PubMed abstract

Bonelli RM, Heuberger C, Reisecker F. Minocycline for Huntington's disease: an open label study. Neurology. 2003 Mar 11;60(5):883-4. PubMed abstract

Gordon PH, Moore DH, Miller RG, Florence JM, Verheijde JL, Doorish C, Hilton JF, Spitalny GM, MacArthur RB, Mitsumoto H, Neville HE, Boylan K, Mozaffar T, Belsh JM, Ravits J, Bedlack RS, Graves MC, McCluskey LF, Barohn RJ, Tandan R; Western ALS Study Group. Efficacy of minocycline in patients with amyotrophic lateral sclerosis: a phase III randomised trial. Lancet Neurol. 2007 Dec;6(12):1045-53. Epub 2007 Nov 5. PubMed abstract

Thomas M, Ashizawa T, Jankovic J. Minocycline in Huntington's disease: a pilot study. Mov Disord. 2004 Jun;19(6):692-5. PubMed abstract