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

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.