Minocin/ Pulsing vs daily dosing

[Nason]

Does anyone have any information as to the effectiveness of minocin with daily dosing of 100mg 2X a day as compared with pulsing of lets say 100mg  three times a week?  I realize that everyone is different as to what they can tolerate, but for the sake of argument lets say that tolerance is not a problem.  What  protocol do most people on this site use? Does anyone have an opinion as to which is better?  Or should I say more effective?  Does a higher dose kill bacteria faster? Does the pulsing work better over a longer period of time? I am looking for personal opinions as to what works better for the majority of people. Thanks

[JeffN]

What are you taking the mino for? SD, RA, or?

[Nason]

I am taking mino for RA.

[Trudi]

For me the pulsing caused more activity, i.e. herxing, which I considered to be a good thing because it meant bacteria die-off.  I did start off with daily, but switched to pulsing about a month in–BIG difference.

Trudi

Lyme/RA; AP 4/2008 off and on to 3/2010; past use of quinolones may be the cause of my current problems, (including wheelchair use); all supplements (which can aggravate the condition) were discontinued on 10/14/2012. Am now treating for the homozygous MTHFR 1298 mutation. Off of all pain meds since Spring '14 (was on them for years--doctor is amazed--me too). Back on pain med 1/2017. Reinfected? Frozen shoulder?

[Nason]

Hi, Thanks for the reply.  Did you discuss this with your doctor?  Did he give you a reason pulsing caused more herxing? Does the bacteria get fooled (so to speak) and the minocin works better every other day? Do you take 100mg  every other day?  Thanks

[Trudi]

[user=1470]Nason[/user] wrote:

Did you discuss this with your doctor? 

Did he give you a reason pulsing caused more herxing? Does the bacteria get fooled (so to speak) and the minocin works better every other day?

Do you take 100mg  every other day?  Thanks

Hi Nason–

I didn't discuss this with my doctor.  My doctor wasn't familiar with AP, so I got a lot of information from this board; it just seemed that pulsing would be the route to take to make things happen.

I think the pulsing works better because the bacteria are fooled, as you say.

At the moment I don't take minocycline (when I pulsed, it was MWF).  The treatment actually brought the real culprit–Lyme–to the surface.  I was put on doxycycline for a month to treat the Lyme; instead of getting better, I had increasing pain (probably herxing big time) and the doctor referred me to a specialist.  I am seeing a Lyme Literate doctor now.  It's a slow process–but moving forward!

Trudi

Lyme/RA; AP 4/2008 off and on to 3/2010; past use of quinolones may be the cause of my current problems, (including wheelchair use); all supplements (which can aggravate the condition) were discontinued on 10/14/2012. Am now treating for the homozygous MTHFR 1298 mutation. Off of all pain meds since Spring '14 (was on them for years--doctor is amazed--me too). Back on pain med 1/2017. Reinfected? Frozen shoulder?

[Maz]

[user=1470]Nason[/user] wrote:

Does anyone have any information as to the effectiveness of minocin with daily dosing of 100mg 2X a day as compared with pulsing of lets say 100mg  three times a week?  I realize that everyone is different as to what they can tolerate, but for the sake of argument lets say that tolerance is not a problem.  What  protocol do most people on this site use? Does anyone have an opinion as to which is better?  Or should I say more effective?  Does a higher dose kill bacteria faster? Does the pulsing work better over a longer period of time? I am looking for personal opinions as to what works better for the majority of people. Thanks

Hi Nason,

You'll find a good deal of information on the rationale for intermittant (aka pulsed) dosing on the main site and also in The New Arthritis Breakthrough, by Henry Scammell.

Here's a couple of links on the main site that should help to answer your questions:

Intermittent Therapy
Why Is It Important to Prescribe Antibiotics Every Other Day

https://www.roadback.org/index.cfm/fuseaction/education.display/display_id/122.html

Historical Protocol

https://www.roadback.org/index.cfm?fuseaction=studies.display&display_id=184

Current Protocol

https://www.roadback.org/index.cfm?fuseaction=studies.display&display_id=183

I, personally, could not tolerate minocycline in daily doses, as I was in a highly hypersensitive state after being on heavy Lyme protocols for a year. I started out on 100mg once a day and increased in the second week to 100mg twice a day (the Harvard Protocol), but the herx was montrous, so I back down to 100mg twice a day on MWF and did very well on this dose. It's interesting to note that some people feel better on mino days and worse on off days or vice-versa in the early days. It's not clear why the difference, but it does appear to have something to do with the waxing and waning blood serum levels of antibiotic.

Mycoplasma are slow replicating organisms and, as such, do not require daily doses in order to combat them (see first link above) and so this therapy is a bit counter-intuitive in that it is not treating an acute infection, which requires a heavy-hitting short-courses of antibiotics, but longerm, low dose therapy to counteract the morphed L-forms of mycoplasma. In fact, higher dosing is counterproductive in many cases where there is a lot of inflammation, leading to the creation of an inflammatory barrier in the joints, preventing the antibiotic from reaching its target. The purpose of low dose, pulsing is, to over time, retrain the immune system to do what it is supposed to be doing by gradually lowering the pathogen load.

In the case of minocycline, some patients need to daily dose. E.g for scleroderma. In the case of RA, the American College of Rheumatology recommends daily dosing, too, however this is because minocycline is viewed as a weak DMARD and prescribed primarily for its immune-modulating effects (not for its anti-microbial effects). What is interesting is that people with RA do very well on low, pulsed dosing, sometimes only taking 50mg or 100mg three times a week. At this level of doing, it's very arguable that there is not enough immune-modulation to make any real difference (in other words, it must be the antibacterial action on these slow-replicating bugs). 

I think you mentioned in another post that you were taking a break from mino due to hyperpigmentation issues and on allicin? Certainly, it seems that those who pulse dose are less likely to experience hyperpigmentation, too. As you are taking allicin, do you suspect chronic Lyme disease may be the cause of your RA? If so, have you considered the possibility of untreated coinfections of Lyme disease?

Hope something here might help, Nason!

Peace, Maz

[lynnie_sydney]

Nason – Maz puts the case extremely well. There are good reasons for pulse dosing (with the exception of treatment for SD). It is counter-intuitive to the way we (and most docs) are used to taking/prescribing antibiotics. Daily dosing is thought to be more immuno-suppressive, which is, in effect, acting as a DMARD and which is not the aim of this treatment if you subscribe to infectious origin of these diseases. The aim is to target cause. Additionally, with pulse dosing, hyper-pigmentation is less likely to be an issue, as are fungal or yeast problems. I did extremely well (pretty symptom-free) on pulse dosing of mino 100mg MWF. Lynnie    

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[Nason]

Thanks to all for the information.  I have read the New Arthritis Breakthough book but I wanted to hear from people who have actually used the pulse method as that is what I am considering.  My local doc is a natualpath and Lyme is his specialty. That is why I am on the allicin.  We thought we would give it a try to see how my Ra would react.  I definitely herxed for the first several weeks so it must be somewhat effective for RA.  I had all the Lyme tests and was negative.  Thanks again.

[Maz]

[user=1470]Nason[/user] wrote:

My local doc is a natualpath and Lyme is his specialty. That is why I am on the allicin.  We thought we would give it a try to see how my Ra would react.  I definitely herxed for the first several weeks so it must be somewhat effective for RA.  I had all the Lyme tests and was negative.

Oh, okay…understand now. I think you mentioned your daughter had Lyme so was wondering if you might have considered this potential. Just out of interest, did you have the standard or IGeneX testing done through your naturopathic doctor? The standard testing for Lyme is notoriously inaccurate, missing up to 50% of cases, but IGeneX testing is a bit more sensitive, including more bands on the western blot. I tested equivocal on standard tests, but positive on some very significant bands for Lyme through IGeneX.

Peace, Maz

[Nason]

Yes I had the  IGENEX testing done. The only thing questionable was the fact that I had been on mino for over a year before these tests were done, so he was not quite sure the negative results were 100% accurate.  I did test positive for RA the very first time I was tested back in 2002.  I figured the Lyme treatment could not hurt as I took the break from minocin. As I mentioned before I do want to go back on minocin.  My only decision is whether to go back on 200mg per day or do the pulsed doses.

[Maz]

[user=1470]Nason[/user] wrote:

Yes I had the  IGENEX testing done. The only thing questionable was the fact that I had been on mino for over a year before these tests were done, so he was not quite sure the negative results were 100% accurate.  I did test positive for RA the very first time I was tested back in 2002.  I figured the Lyme treatment could not hurt as I took the break from minocin. As I mentioned before I do want to go back on minocin.  My only decision is whether to go back on 200mg per day or do the pulsed doses.

 

Nason, if you still have a copy of your IGeneX results and there were any bands positive or just equivocal, you might find this link helpful in interpreting your results. You're right, though…it's possible that a year of antibiotics would drive Bb into cystic form to hide out, resulting in no bands showing up. Some people will do repeat testing, if this is the case.

http://flash.lymenet.org/ubb/ultimatebb.php/topic/1/42077

Thing is, if you did well on mino alone before, then it's likely you will do well on it again. 😉 What a number of people do here is to use low dose pulsed mino and, if this is not as effective as daily dosing (after initial herxing period is over and things have stabilised), then asking your physician about adding a second antibiotic, a macrolide like clarithromycin or azithromycin, can be the ticket. This might help avert further hyperpigmentation issues that occurred while on daily dosing before.

Peace, Maz 

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