Minocycline adverse effects

Tetracyclines are used as alternative dnigs in a variety of circumstances when the patient is unable to take the dnig of choice, eg, in patients allergic to penicillin (88,89). Tetracyclines are widely known to cause staining of teeth (and are therefore contra-indicated in children developing permanent teeth), photosensitivity, and, in the case of minocycline, vestibular toxicity. Details of these adverse effects and others associated with administration of tetracyclines have been comprehensively reviewed (96—101). 

Adverse effects with the tetracyclines include gastrointestinal upset drug interactions with dairy products, antacids, and iron and phototoxicity. Minocycline can also cause vestibular complications (headache and dizziness) and skin discoloration that is not typical with tetracycline and doxycycline.16... 

Doxycycline is commonly used for moderate to severe acne vulgaris. It is more effective and produces less resistance than tetracycline. The initial dose is 100 or 200 mg daily, followed by 50 mg daily as a maintenance dose after improvement is seen. Doxycycline maybe given with food, but it is more effective when taken 30 minutes before meals. / Minocycline is also commonly used for moderate to severe acne vulgaris. It is more effective than tetracycline. It is dosed similar to doxycycline (100 mg/day or 50 mg twice daily) and on an indefinite basis in selected patients. Minocycline has the most reported adverse effects of the tetracyclines, some of which may be serious. 

Amifostine Amifostine is incompatible with many drugs such as acyclovir sodium, amphotericin, cefoperazone sodium, hydroxyzine hydrochloride, miconazole, minocycline hydrochloride, and prochlorpherazine edisylate.239 Care should be exercised when handling amyl nitrate, since it is highly flammable. Volatile nitrites, such as poppers, are abused and fatal adverse effects are reported.240,241... 

Tetracyclines are recommended as first-line treatment. When tetracyclines are not tolerated or contraindicated, erythromycin is an alternative. However erythromycin has problems with resistance and gastrointestinal adverse effects. If compliance is a problem, either doxycycline or lymecycline may be prescribed (can be taken once daily with food). Minocycline is second-line treatment (e.g. if oral antibiotic has failed). 

Treatment of facial comedonic and papulopustular acne with azithromycin (500 mg/day for 4 days in four cycles every 10 days) may be at least as effective as minocycline (100 mg/day for 6 weeks). Both were well tolerated and mild adverse effects were reported in 10% of patients given azithromycin and 12% of those given minocycline (14). 

Clarithromycin (0.75-2 g/day), minocycline (200 mg/ day), and clofazimine (100 mg/day) for 15 months were investigated as treatment of MAC lung disease in 30 HIVnegative patients. Eight patients did not complete the study owing to deviations from protocol or adverse effects. Persistently negative cultures were found in 14 of the other patients. There were three cases of hepatic disturbances and three of ototoxicity, which required a reduction in clarithromycin dosage after a short interruption of treatment (10). 

Doxycycline and minocycline are more lipophilic tetracyclines. They are well absorbed after oral administration. Their half-lives are 16-18 hours. Their higher affinity for fatty tissues improves their effectiveness and changes their adverse effects profile. Local gastrointestinal irritation and disturbance of the intestinal bacterial flora occur less often than with the more hydrophilic drugs, which have to be given in higher oral doses for sufficient absorption. 

Adverse effects of minocycline are reported far more often than adverse effects of other tetracycline derivatives. Whatever the mechanisms underlying this larger number of reports might be, they continue to appear. With increasing use of minocycline in acne and other conditions, adverse reactions may become increasingly common early recognition is important to prevent further deterioration, to hasten recovery, and to avoid invasive investigations and treatment (2). The authors of this review recommended that safer alternatives be considered in the treatment of acne. 

The authors reviewed some other cases of serum sickness after the use of minocycline. They suggested that the syndrome is under-reported, either because of unawareness that it can be an adverse effect or lack of willingness of physicians to document the event. 

The use of minocycline as an agent for inducing chemical pleurodesis has been reported in only a few patients and there is little information regarding its adverse effects. In... 

Malakar S, Dhar S, Shah Malakar R. Is serum sickness an uncommon adverse effect of minocycline treatment Arch Dermatol 2001 137(1) 100-1. 

Minocycline has more adverse effects than the other tetracyclines. 

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