Jundishapur J Nat Pharm Prod. 2017 August; 12(3):e63792. Published online 2017 August 31. doi: 10.5812/jjnpp.63792. Research Article Effect of Oral Minocycline on Clinical Recovery Process in Patients with Acute Ischemic Stroke: A Randomized Clinical Trial Gholamreza Shamsaei, 1,* and Payam Mohammadi 1 1 Neurology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran * Corresponding author: Gholamreza Shamsaei, Golestan Hospital, Farvardin Street, Ahvaz, Iran. Tel: +98-6133743012, Fax: +98-6133743012, E-mail: grshamsaei@gmail.com Received 2016 December 10; Revised 2017 February 08; Accepted 2017 February 19. Abstract Background: Acute ischemic stroke is one of the most common causes of death worldwide with one new case being diagnosed every five seconds. The mortality rate and permanent disability are very high and the current treatment still needs to improve to a large extent. Minocycline drug, a derivative of tetracycline, is an anti-inflammatory and anti-apoptotic protection of neurons, the role of which has been studied recently in recovery from nerve degenerative diseases, especially stroke. This study aimed at evaluating the effect of minocycline in the recovery of patients with a history of stroke. Methods: In this randomized clinical trial, 42 patients with ischemic stroke were divided to 2 groups: receiving minocycline 200 mg for 5 days and receiving the placebo. Aspirin was prescribed to all patients. Clinical assessment before and 90 days after the intervention was performed by the National institutes of health stroke scale score (NIHSS). Results: A total of 36 patients completed the study. The number of females in the case and control groups was 55.5% and 51.1%, respectively. In the case group, NIHSS decreased from 9.55 to 6.1 and in the control group, it decreased from 10.2 to 7.33, which was statistically significant. Although the NIHSS decreased in patients taking minocycline more than the control group, this difference was not statistically significant. Conclusions: According to the findings of this study, it seems that minocycline could be used as a complementary therapy in pa- tients with ischemic stroke. However, these results need to be confirmed by further studies in this field. Keywords: Oral Minocycline, Acute Ischemic Stroke, Aspirin 1. Background Diagnosis and intervention in patients with acute is- chemic stroke at emergency departments is vital to im- prove the outcome of patients. Studies have shown that stroke is the third leading cause of death after heart dis- ease and cancer, and deaths occur every 3 to 4 minutes (1). According to the world health organization (WHO), a new case of stroke is diagnosed every 5 seconds. About 15 mil- lion cases of stroke are diagnosed each year and of these, 5 million die and five million develop permanent disabil- ities and become a social and family burden (2). The in- cidence of stroke has been studied in Iran and 103 in ev- ery 100 000 people has been reported (3). Several risk fac- tors have been found for stroke, the most important of which include older age (75 to 84 years), high blood pres- sure, smoking, diabetes mellitus, increased cholesterol, in- creased body mass index (BMI), alcohol consumption, hy- perhomocysteinemia, and vascular diseases (4). In order to definitively diagnose stroke, evaluations should be done quickly that include imaging (the most important test that must be performed within less than 24 hours after admis- sion), blood tests, chest radiography, electrocardiography, and echocardiography (5). All patients with stroke must be immediately trans- ferred and treated at emergency centers. A timely refer- ral could cause a reduction of 20% in morbidity and mor- tality of these patients (6). According to the cause of stroke, different therapies could be considered for this dis- ease. The most commonly used drugs in these patients are thrombolytic medications, such as tissue plasmino- gen activator of recombinant (rtPA) and aspirin, to pre- vent stroke recurrence (6). However, in developing coun- tries, such as Iran, the use of RtPA has been limited and mostly aspirin is used (7). Aspirin at a dose of 160 to 300 mg causes a reduction in morbidity and mortality of acute ischemic stroke, up to 48 hours after onset of stroke symptoms. However, the efficacy of aspirin has not been sufficient according to some studies; its consumption in patients with ischemic hemorrhagic could harm the pa- tients (8). Minocycline is a tetracycline antibiotic that has anti-inflammatory, anti-apoptotic, and protective effects on nerve properties of cerebral ischemia models and neu- rodegenerative diseases. Studies have been conducted on the effectiveness of the drug in the recovery of patients with stroke, yet their results need further studies (9). Lamp et al. showed that minocycline caused a significant de- Copyright © 2017, Jundishapur Journal of Natural Pharmaceutical Products. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.