DTB
2013;51:49
doi:10.1136/dtb.2013.5.0176
- Articles
Minocycline has been licensed for over 35 years for a wide range of bacterial infections (a Summary of Product Characteristics
[SPC] lists 16 indications) including respiratory, genitourinary and skin conditions.1,2 However, much of its popularity has been for its use in treating acne.
Minocycline was associated with claims that it was
“more effective, less likely to
cause bacterial resistance and easier to take than other tetracyclines”.3
In addition, the availability of an adherence-friendly, once-daily,
modified-release preparation and a lack of restriction
when taken with food or ‘moderate
amounts of milk’, quickly made it a favourite with general practitioners
and patients. It
became particularly popular for use
for teenagers with acne, a group notorious for non-adherence and for
whom a single daily
dose was seen as an advantage.
Between 1997 and 2006 about 500,000 prescriptions for minocycline were
dispensed each year
in England, accounting for about one
third of all tetracycline prescriptions by volume and two thirds by
cost.4 Partly as a result of concerns
over its safety, the amount of minocycline prescribed has fallen by
about two thirds, while
the overall volume of prescribing of
all tetracyclines has increased by 10%. However, given that over
100,000 prescriptions
for minocycline are still issued
each year, is further action required in light of the adverse effect
profile of the drug?
Doubts about the safety of
minocycline started in the 1990s with reports of rare but serious and
apparently idiosyncratic
adverse effects that included
hypersensitivity reactions of eosinophilia, pneumonitis and nephritis,
autoimmune hepatitis
and lupus erythematosus-like
syndrome.5,6 Such reactions seem to be more common with minocycline than with other tetracyclines.7 In addition, minocycline appears to be the only tetracycline that can cause potentially irreversible slate-grey pigmentation
of the skin.1 The ‘Special warnings and precautions …
