Adverse Reactions Induced by Minocycline: A Review of Literature

Abstract

Background: Minocycline is a tetracycline antibiotic that is widely used to treat infections, and is a first-line oral antibiotic in the treatment of moderate to severe inflammatory acne. Although it has high efficacy, several adverse reactions, including life-threatening ones have been reported in association with its use. Objective: To identify all the potential adverse reactions due to minocycline and analyze them in terms of the number of cases reported so far, salient features, severity and clinical outcome. Methods: Comprehensive PubMed search of English and non-English literature for case reports of adverse reactions to minocycline. Results: A total of 550 cases were identified from over 200 publications. The major reported adverse events caused by minocycline are drug reaction with eosinophilia and systemic symptoms syndrome, autoimmune syndromes like hepatitis, lupus and vasculitis, acute eosinophilic pneumonia, pseudotumor cerebri, hyperpigmentation, serum sickness like reaction, Sweet’s syndrome and drug fever. Several other reactions involving multiple organ systems have also been reported. All of these show an overlap of clinical features and may be associated with multiple events causing considerable morbidity. Eight of these cases resulted in the death of the patients. Conclusion: In view of the evident potential of minocycline to cause long-lasting and severe adverse effects, significant morbidity and even mortality, it should be prescribed with caution in the first-line treatment for moderate to severe acne.

Doxycycline-Associated Hyperpigmentation: A Case Report and Literature Review

“…Drug-induced hyperpigmentation has been associated with several classes of medications [ 4 ]. Tetracyclines, and in particular minocycline, not only cause cutaneous pigmentation but also mucosal (including the sclera and tongue) and subungual pigmentation [ 5 , 6 ]. However, albeit less common, doxycycline can cause hyperpigmentation [ 7 - 16 ].…”

“…Tetracyclines, and in particular minocycline, are among the most common agents associated with drug-induced pigmentation. Four types of mechanisms have been described in the literature in the pathogenesis of drug-induced pigmentation: accumulation of melanin, accumulation of the triggering medication, synthesis of special pigments, and deposition of iron [ 3 - 6 ].…”

Nodular vasculitis (erythema induratum) associated with systemic minocycline

“…Minocycline or its metabolites may lead to antigen specific T‐cell mediated inflammation cascade, leading to immune complex deposition in the cutaneous tissue, and tissue inflammation secondary to neutrophil and macrophage activation 6 . This may result in numerous autoimmune syndromes such as polyarteritis nodosa, autoimmune hepatitis and drug‐induced lupus, 8 drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, dermatomyositis, sweets syndrome, serum sickness‐like reaction, Stevens‐Johnson syndrome, toxic epidermal necrolysis and acute generalized exanthematous pustulosis 6,8,9 . Some autoimmune‐related effects of minocycline may lead to positive ANA ± ANCA positive vasculitis 7,10 .…”

New Insights Regarding Diagnosis and Medication for Schizophrenia Based on Neuronal Synapse–Microglia Interaction

“…In clinical trials, minocycline treatment improved the working memory [ 134 ], and verbal and visual learning [ 135 ] of patients with schizophrenia. Although minocycline is infrequently prescribed partly because of the increased risk of autoimmune disease [ 136 ], these outcomes demonstrate the clinical effectiveness of this strategy targeting microglia in schizophrenia. N-acetylcysteine (NAC), a precursor of antioxidant glutathione, exerts a wide range of protective effects, such as the regulation of oxidative status, inflammation, and monoamine neurotransmission in rodent models and human patients [ 137 , 138 ].…”