Serious adverse reactions induced by minocycline. Report of 13 patients and review of the literature.

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Arch Dermatol. 1996 Aug;132(8):934-9.

Serious adverse reactions induced by minocycline. Report of 13

patients and review of the literature.

Knowles SR, Shapiro L, Shear NH.

Division of Clinical Pharmacology, Sunnybrook Health Science Centre,

Toronto, Ontario.

BACKGROUND: Minocycline has been reported to cause serious, albeit

rare, adverse events, including serum sickness-like reaction,

hypersensitivity syndrome reaction, and drug-induced lupus. A

retrospective review of patients seen in our Adverse Drug Reaction

Clinic as well as information obtained from the Health Protection

Branch was done to identify patients with minocycline-induced

reactions. In addition, the literature concerning serious reactions

to minocycline was reviewed. OBSERVATIONS: Six patients with a

hypersensitivity syndrome reaction, 6 patients with a serum sickness-

like reaction, and 1 patient who had symptoms consistent with drug-

induced lupus were identified. A review of the literature identified

11 cases of hypersensitivity syndrome reaction, 1 case of serum

sickness-like reaction, and 24 cases of drug-induced lupus. Serum

sickness-like reactions occur sooner than hypersensitivity syndrome

reactions (15.6 vs 23.7 days, P = .04). Drug-induced lupus occurs on

average 2 years after the start of minocycline therapy. CONCLUSIONS:

Dermatologists need to be aware of the serious adverse reactions that

can develop after minocycline use. In patients who may require long-

term therapy with minocycline ( > 1 year), we suggest that

antinuclear antibody and hepatic transaminase levels be determined at

baseline. Rechallenge with minocycline or other tetracyclines is

currently not recommended for patients who develop these serious

reactions.

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