SERIOUS ADVERSE REACTIONS INDUCED BY MINOCYCLINE - REPORT OF 13 PATIENTS AND REVIEW OF THE LITERATURE

Background: Minocycline has been reported to cause serious, albeit rar e, adverse events, including serum sickness-like reaction, hypersensit ivity syndrome reaction, and drug-induced lupus. A retrospective revie w of patients seen in our Adverse Drug Reaction Clinic as well as info rmation obtained from the Health Protection Branch was done to identif y patients with minocycline-induced reactions. In addition, the litera ture concerning serious reactions to minocycline was reviewed. Observa tions: Six patients with a hypersensitivity syndrome reaction, 6 patie nts with a serum sickness-like reaction, and 1 patient wile had sympto ms 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 hypersensitivit y syndrome reactions (15.6 vs 23.7 days, P=.04). Drug-induced lupus oc curs on average 2 years after the start of minocycline therapy. Conclu sions: Dermatologists need to be aware of the serious adverse reaction s that can develop after minocycline use. In patients who may require long-term therapy with minocycline (>1 year), we suggest that antinucl ear 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.