Can doxycycline (tetracycline antibiotic) cause paresthesia?

Doxycycline and Paresthesia

Doxycycline can cause paresthesia as a rare neurological adverse effect, particularly when used in combination with other medications or in specific clinical contexts. While not among the most common side effects, paresthesia has been documented in the medical literature as a potential adverse reaction to doxycycline therapy.

Evidence for Doxycycline-Associated Paresthesia

Clinical Guidelines and Documentation

The British Thoracic Society guidelines (2017) specifically list paresthesia as a recognized adverse effect of doxycycline, noting that it occurs in approximately 7% of patients treated with the medication 1. This is documented among the serious adverse effects that clinicians should be aware of when prescribing this tetracycline antibiotic.

Specific Clinical Scenarios

1. Lyme Disease Treatment:

   • The Infectious Diseases Society of America guidelines (2006) describe cases where patients with Lyme arthritis who later developed neuroborreliosis reported "subtle distal paresthesias" during treatment with amoxicillin-probenecid regimens 1.
   • While this specific observation was made with amoxicillin-probenecid, the guidelines highlight the importance of monitoring for neurologic symptoms in patients receiving antibiotic therapy for Lyme disease, including those on doxycycline.

2. Case Reports:

   • A case report from 2021 documented paresthesia as part of the symptom complex in a patient with suspected disseminated Lyme disease who was treated with ceftriaxone followed by doxycycline 2.

Mechanism and Risk Factors

The exact mechanism by which doxycycline may cause paresthesia is not fully elucidated, but several factors may contribute:

1. Neurological Effects: Tetracyclines, including doxycycline, have been associated with various neurological adverse effects.

2. Drug Interactions: The risk of neurological side effects may increase when doxycycline is used concurrently with certain medications.

3. Pseudotumor Cerebri: Tetracyclines have been associated with pseudotumor cerebri (idiopathic intracranial hypertension), which can manifest with neurological symptoms including paresthesia 3. This is particularly noted when tetracyclines are used concomitantly with other medications like isotretinoin.

Other Neurological Side Effects of Doxycycline

Beyond paresthesia, doxycycline has been associated with other neurological adverse effects:

1. Hand Tremors: Case reports have documented doxycycline-induced hand tremors that resolved after discontinuation of the medication 4.

2. Dizziness: Guidelines mention dizziness as a potential adverse effect, particularly with minocycline but also possible with doxycycline 1.

3. Headache: Systematic reviews of doxycycline safety report headache among the neurological symptoms that may occur 5.

Management Recommendations

If a patient develops paresthesia while taking doxycycline:

1. Evaluate Severity and Impact:

   • Determine the extent and location of paresthesia
   • Assess whether it interferes with daily activities

2. Consider Alternative Causes:

   • Rule out underlying conditions that might cause paresthesia
   • Evaluate for drug interactions that might potentiate neurological effects

3. Decision Algorithm:

   • For mild, non-progressive paresthesia: Consider continuing treatment with close monitoring if the infection being treated is severe and alternative antibiotics are limited
   • For moderate to severe paresthesia or progression of symptoms: Discontinue doxycycline and switch to an alternative antibiotic

4. Special Caution:

   • Exercise particular caution when prescribing doxycycline to patients with a history of neurological disorders
   • Avoid concomitant use with medications known to increase risk of neurological side effects

Prevention

To minimize the risk of paresthesia and other neurological adverse effects:

1. Use appropriate dosing (typically 100 mg twice daily for adults)
2. Ensure adequate hydration during treatment
3. Monitor patients for early signs of neurological symptoms
4. Avoid concomitant use of doxycycline with medications that might increase risk of neurological effects

Conclusion

While paresthesia is not among the most common adverse effects of doxycycline, it is a recognized potential neurological complication that clinicians should be aware of when prescribing this antibiotic. Prompt recognition and appropriate management of this side effect are important to prevent progression to more severe neurological complications.