(2003; 77 pages)
Minocycline and intracranial hypertension
Benign intracranial hypertension, also known as pseudotumour cerebri, involves a persistent rise in cerebrospinal fluid pressure. It is characterized by headache, nausea, vomiting and papilloedema with occasional sixth-nerve palsy. It is sometimes associated with drug therapy and tetracyclines are a well-recognized cause. Of the 76 cases reported to the Australian Adverse Drug Reactions Committee (ADRAC) over the past 30 years, 32 have been associated with minocycline.
All of these 32 patients were young, ranging in age from 12 to 30 (median: 16) years, and almost all were taking long-term minocycline for acne. Most (28) were female. The time to onset ranged from two weeks to 18 months with a median of approximately 2 months. There was also one case in which the patient developed the condition one day after she was switched from doxycycline to minocycline. The majority of the cases reported to ADRAC had recovered after minocycline was withdrawn but recovery was often prolonged, taking from 2 to 12 weeks in most cases. In those cases where treatment was reported, lumbar puncture, acetazolamide and corticosteroids were used. There were also cases where the patient had not recovered at the time the report was submitted. Some of the reports described the use of multiple lumbar punctures, one patient required prolonged hospitalization and another a lumboperitoneal shunt. In one patient, lower nasal quadrantanopia persisted after 6 months (1).
ADRAC has previously drawn attention to this association but with 3 cases reported in the past 6 months, a reminder is timely (2). The possibility of drug-induced benign intracranial hypertension should be considered in any young patient presenting with persistent unexplained headache, and women taking minocycline appear to be at particular risk (3).
1. Lander CM. Minocycline-induced benign intracranial hypertension. Clinical and Experimental Neurology, 26: 161-167 (1989).
2. Boyd, I. Benign intracranial hypertension induced by minocycline. Current Therapeutics, 36: 70-71 (1995).
3. ADRAC. Minocycline and not so benign intracranial hypertension. Australian Adverse Drug Reactions Bulletin, 22(1): 2 (2003).