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|Hepatic reactions with minocycline|
Minocycline is an effective long-term treatment for severe acne, but it is associated with serious adverse reactions, including rare cases of hepatic dysfunction. In one study the incidence of hepatic reactions in new users was one case/10,000 person-months.
ADRAC has received 42 reports of hepatic reactions with minocycline including 21 of hepatitis. It was the only drug taken by most of these patients, and was used for acne by 28. Fifteen patients were under 21 years of age. Where liver enzyme results were provided, they showed a hepatocellular pattern (12) more often than a cholestatic (3) or mixed picture (2). Time to onset was provided in 13 reports and suggested that cholestatic reactions occurred earlier (= 4 weeks) than hepatocellular damage (usually after months or years). Of the 42 cases, 25 had recovered by the time of reporting, usually in less than 12 weeks. None of the patients died or required liver transplantation.
A published case series suggests that hepatic react-ions with minocycline may present either with features of a hypersensitivity syndrome (onset within 35 days) or resemble autoimmune chronic active hepatitis (onset after months or years). Despite well-documented reports, no ADRAC cases conformed to the criteria for a hypersensitivity syndrome. However, five reports were suggestive of an autoimmune reaction. All cases had antinuclear antibodies, and one had other features of lupus erythematosus. A time to onset of 11 or 12 months was specified in two cases.
Other serious adverse reactions associated with minocycline include CNS effects, skin discolouration and benign intracranial hypertension. Prescribers are particularly advised to note that hepatitis developing in a patient on long-term minocycline may be indistinguishable from autoimmune hepatitis both serologically and histologically. Discontinuation of minocycline usually results in complete recovery.
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