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Drug Safety

, Volume 23, Issue 4, pp 333–349 | Cite as

Liver Damage Associated with Minocycline Use in Acne

A Systematic Review of the Published Literature and Pharmacovigilance Data
  • Ross A. Lawrenson
  • Helen E. Seaman
  • Anders Sundström
  • Timothy J. Williams
  • Richard D.T. Farmer
Original Research Article

Abstract

Objective: Minocycline is an antibacterial drug used in the treatment of acne. Concern has been expressed over the possibility of severe adverse reactions to minocycline, including hepatitis. This study set out to identify and characterise reported cases of hepatotoxicity associated with the use of minocycline.

Methods: A systematic review of the literature including a search of computerised databases and analysis of data from the Uppsala Monitoring Centre (WHO Collaborating Centre for International Drug Monitoring) was conducted. The review involved a search for original case reports involving liver damage in people using minocycline. Patients taking minocycline for reasons other than acne or those given intravenous minocycline were excluded. The search strategy involved an enquiry of computerised databases and a search for secondary references. Cases were then classified appropriately.

Results: 65 reported cases of hepatitis or liver damage in association with minocycline from either case reports or case series were identified from the literature review. 58% of cases occurred in females and 94% were aged under 40 years. For 20 case reports there was insufficient information to classify the type of event, but for the remaining 45, 2 types of hepatic reaction were recognised: autoimmune hepatitis associated with lupus-like symptoms occurring after a median duration of exposure to minocycline of 365 days in females (n = 20) and 730 days in males (n = 9), hypersensitivity reaction associated with eosinophilia and exfoliative dermatitis occurring within 35 days of therapy (n = 16).

Reports to the WHO of hepatic adverse drug reactions associated with minocycline accounted for 6% (493) of all minocycline-related adverse drug reactions (8025). The pattern of distribution in relation to exposure demonstrated 2 groups, similar to that described by the case reports.

Conclusions: Severe cases of minocycline-associated hepatotoxicity appear to be a hypersensitivity reaction and occur within a few weeks of commencing therapy. An autoimmune hepatitis usually presents after exposure to minocycline of a year or more, is more common in women and is sometimes associated with lupus-like symptoms.

Keywords

Adverse Drug Reaction Acne Hypersensitivity Reaction Minocycline Autoimmune Hepatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We gratefully acknowledge the help of the Uppsala Monitoring Centre (WHO Collaborating Centre for International Drug Monitoring), Uppsala, Sweden, and Intercontinental Medical Statistics, UK, for providing data for this study. The work was supported by an unconditional grant from John Wyeth & Brother Ltd, UK.

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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Ross A. Lawrenson
    • 1
  • Helen E. Seaman
    • 2
  • Anders Sundström
    • 2
  • Timothy J. Williams
    • 2
  • Richard D.T. Farmer
    • 2
  1. 1.Primary Care Research Unit, Postgraduate Medical SchoolUniversity of SurreyGuildfordEngland
  2. 2.Department of Pharmacoepidemiology and Public Health, Postgraduate Medical SchoolUniversity of SurreyGuildfordEngland

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