To the Editor.
Minocycline, a synthetic derivative of tetracycline, is the most widely prescribed oral systemic antibiotic for acne vulgaris because it does not appear to induce resistance in Propionobacterium acnes and can be administered only once or twice a day. Interestingly, minocycline is lipophilic and penetrates the blood-brain barrier more readily than other tetracyclines, thus attaining higher cerebrospinal fluid (CSF) levels. Despite its widespread use among adolescents, it does not appear that adequate prospective studies have been published to investigate its specific effects on the maturing teenager.
Recent personal experience allowed for more careful study of the effects of minocycline. Specifically, our then 12-year-old son initiated minocycline (100 mg twice a day) by mouth for the treatment of moderately severe acne. Four weeks later, he was examined by a senior pediatric ophthalmologist for his annual assessment of myopia. An entirely normal examination (including pupil dilation and...
I recently had a brush with pseudotomor cerebri as a result of taking minocycline for acne, as well. After increasing my dosage to twice daily, i experienced an intense headache and the next morning forgot entirely and stupidly took it with my other medications. The headache started again very quickly and i reported it to my parents and we stopped the minocycline. That was a Friday morning. As the day progressed, my vision became splotchy and slightly blurred. My headache became worse and i asked for some tylenol, which did not help. I later on became nauseous and when i returned home i tried to sleep it off. I got up late in the afternoon and tried to have some dinner, which made me feel very nauseous. The next morning my headache continued and i couldn't keep anything down. My mother called our pediatrician's office. They said that a virus was going around and it'd pass in a day or two. Sunday i was still sick, still vomiting. By the afternoon my stomach had settled but my neck hurt quite a bit. Same went for Monday. Tuesday my mother finally scheduled an appointment at my pediatrician and they told me my fundus was blurred and sent me downstairs to get an MRI. The MRI came back negative, but by the time they got it back it was 5 o'clock and the opthomolegist was out, so they sent me ot the ER. I spent about six hours in the ER, where they figured out it might be that i had too much spinal fluid because of the minocycline. So, they gave me a spinal tap which immediately relieved the pressure and helped my headache and neck pain. The headache came back very soon, but by then i was home and trying to fall asleep. The next morning i told my parents the headache was back and just as bad, so they took me to the ER at Children's Hospital in Boston where i was quickly given a room and they tried to ease the pain. Since i've already said quite a bit, i'll sum this one up. I spent about 10 hours in the ER and got another spinal tap, which also helped. They told me i'd probably have to get another in a week or two. Just wanted to reiterate your pont that minocycline's extreme side effects are not often mentioned when it is prescribed, but as rare as they may be, they have to happen to someone.
Conflict of Interest:
None declared