From the Guidelines
Minocycline is associated with several adverse effects, including dermatological, gastrointestinal, and neurological effects.
Adverse Effects of Minocycline
- Dermatological: photosensitivity, rash, and hyperpigmentation 1
- Gastrointestinal: nausea, vomiting, diarrhea, and dysphagia 1
- Neurological: dizziness and headache 1
- Other: pneumonia and eosinophilia have been reported in a few cases, necessitating immediate withdrawal of minocycline 1
- Minocycline can also cause staining of skin, nails, sclera, teeth, conjunctiva, tongue, and bone 1 The optimum doses of minocycline are 100-200 mg daily 1, and it should be avoided in patients with hepatic impairment 1.
From the FDA Drug Label
Hepatic toxicity: Hyperbilirubinemia, hepatic cholestasis, increases in liver enzymes, fatal hepatic failure, and jaundice. Hepatitis, including autoimmune hepatitis, and liver failure have been reported Skin: Alopecia, erythema nodosum, hyperpigmentation of nails, pruritus, toxic epidermal necrolysis, and vasculitis, maculopapular and erythematous rashes Exfoliative dermatitis has been reported. Fixed drug eruptions have been reported. Lesions occurring on the glans penis have caused balanitis. Erythema multiforme and Stevens-Johnson syndrome have been reported. Photosensitivity is discussed above Pigmentation of the skin and mucous membranes has been reported. Local Reactions: Injection site erythema and injection site pain Respiratory: Cough, dyspnea, bronchospasm, exacerbation of asthma, and pneumonitis. Renal toxicity: Interstitial nephritis. Elevations in BUN have been reported and are apparently dose related Acute renal failure has been reported. Musculoskeletal: Arthralgia, arthritis, bone discoloration, myalgia, joint stiffness, and joint swelling Hypersensitivity reactions: Urticaria, angioneurotic edema, polyarthralgia, anaphylaxis/anaphylactoid reaction (including shock and fatalities), anaphylactoid purpura, myocarditis, pericarditis, exacerbation of systemic lupus erythematosus, and pulmonary infiltrates with eosinophilia have been reported. A lupus-like syndrome and serum sickness-like reactions also have been reported Blood: Agranulocytosis, hemolytic anemia, thrombocytopenia, leukopenia, neutropenia, pancytopenia, and eosinophilia have been reported. Central Nervous System: Convulsions, dizziness, hypesthesia, paresthesia, sedation, and vertigo. Pseudotumor cerebri (benign intracranial hypertension) in adults and bulging fontanels in infants Headache has also been reported Other: Thyroid cancer has been reported in the post-marketing setting in association with minocycline products. When minocycline therapy is given over prolonged periods, monitoring for signs of thyroid cancer should be considered. When given over prolonged periods, tetracyclines have been reported to produce brown-black microscopic discoloration of the thyroid gland Cases of abnormal thyroid function have been reported. Tooth discoloration in pediatric patients less than 8 years of age and in adults has been reported. Oral cavity discoloration (including tongue, lip, and gum) have been reported. Tinnitus and decreased hearing have been reported in patients on MINOCIN® (minocycline for injection). The following syndromes have been reported In some cases involving these syndromes, death has been reported As with other serious adverse reactions, if any of these syndromes are recognized, the drug should be discontinued immediately: Hypersensitivity syndrome consisting of cutaneous reaction (such as rash or exfoliative dermatitis), eosinophilia, and one or more of the following: hepatitis, pneumonitis, nephritis, myocarditis, and pericarditis. Fever and lymphadenopathy may be present Lupus-like syndrome consisting of positive antinuclear antibody; arthralgia, arthritis, joint stiffness, or joint swelling; and one or more of the following: fever, myalgia, hepatitis, rash, and vasculitis. Serum sickness-like syndrome consisting of fever; urticaria or rash; and arthralgia, arthritis, joint stiffness, or joint swelling. Eosinophilia may be present.
The adverse effects of minocycline include:
- Hepatic toxicity: hyperbilirubinemia, hepatic cholestasis, increases in liver enzymes, fatal hepatic failure, and jaundice
- Skin reactions: alopecia, erythema nodosum, hyperpigmentation of nails, pruritus, toxic epidermal necrolysis, and vasculitis
- Respiratory problems: cough, dyspnea, bronchospasm, exacerbation of asthma, and pneumonitis
- Renal toxicity: interstitial nephritis, elevations in BUN, and acute renal failure
- Musculoskeletal problems: arthralgia, arthritis, bone discoloration, myalgia, joint stiffness, and joint swelling
- Hypersensitivity reactions: urticaria, angioneurotic edema, polyarthralgia, anaphylaxis/anaphylactoid reaction, and exacerbation of systemic lupus erythematosus
- Blood disorders: agranulocytosis, hemolytic anemia, thrombocytopenia, leukopenia, neutropenia, pancytopenia, and eosinophilia
- Central nervous system problems: convulsions, dizziness, hypesthesia, paresthesia, sedation, and vertigo
- Other adverse effects: thyroid cancer, tooth discoloration, oral cavity discoloration, tinnitus, and decreased hearing 2
From the Research
Adverse Effects of Minocycline
The adverse effects of minocycline are numerous and can be severe. Some of the reported adverse effects include:
- Drug reaction with eosinophilia and systemic symptoms syndrome 3
- Autoimmune syndromes like hepatitis, lupus, and vasculitis 3, 4, 5, 6
- Acute eosinophilic pneumonia 3
- Pseudotumor cerebri 3
- Hyperpigmentation 3, 4, 7
- Serum sickness-like reaction 3, 4, 5
- Sweet's syndrome 3
- Drug fever 3
- Gastrointestinal adverse effects 7
- Dizziness 7
- Rash 7
- Headaches 7
- Intracranial hypertension 7
- Pneumonitis 7
- Lupus-like syndrome 7, 5, 6
- Acute hepatic injury 7, 6
Severity of Adverse Effects
The severity of the adverse effects of minocycline can vary. Some of the reported adverse effects can be life-threatening, and eight cases resulted in the death of the patients 3. The adverse effects can also cause significant morbidity and may be associated with multiple events 3.
Risk Factors
The risk factors for the adverse effects of minocycline are not fully understood. However, it is recommended that minocycline be prescribed with caution, especially in the first-line treatment for moderate to severe acne 3. Patients who may require long-term therapy with minocycline (> 1 year) should have antinuclear antibody and hepatic transaminase levels determined at baseline 5. Rechallenge with minocycline or other tetracyclines is currently not recommended for patients who develop serious reactions 5.