Minocycline treatment and pseudotumor cerebri syndrome

Chiu, Ann M; Chuenkongkaew, Wanicha; Cornblath, Wayne T.; Trobe, Jonathan D.; Digre, Kathleen B.; Dotan, Shlomo; Musson, Kenneth H; Eggenberger, Eric

doi:10.1016/s0002-9394(98)00063-4

Cited by 126 publications

(81 citation statements)

References 40 publications

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“…It is thought that this occurs due to effects on cyclic adenosine monophosphate, causing decreased cerebrospinal fluid outflow at the arachnoid villi level. 34 This interaction can induce pseudotumor cerebri in as few as 3 weeks. 35 Therefore, combination therapy with these agents is not recommended.…”

Section: Macrolides Cyclosporinementioning

confidence: 99%

Common Adverse Drug-Drug Interactions in Dermatology: Oral Therapies

2017

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Pharmacotherapy in dermatology can be especially complex and challenging: the wide array of comorbidities that patients present to care with and the spectrum of systemic oral therapies that are commonly prescribed in a standard dermatology practice increase the likelihood of adverse drug-drug interactions. Such interactions can range from neutralized drug efficacy to fatal adverse effects and are most commonly due to the potentiation or antagonism of cytochrome P450 metabolism or competitive renal excretion by an offending drug to affect the pharmacokinetics of concurrently dosed drugs. Drug-drug interactions can contribute to up to 60% of adverse drug reactions seen in the inpatient or immediate discharge setting, representing a potentially significant iatrogenic source of preventable healthcare costs, morbidity, and mortality in patient care.1,2 We review here the most common systemic treatments causing drug-drug interactions in standard dermatology practice.Methotrexate (MTX) acts through inhibition of dihydrofolate reductase and thymidylate synthetase, reducing folate formation and impairing DNA synthesis/repair, respectively. It is used at high doses in standard chemotherapy regimens and at low doses in psoriasis, Crohn disease, rheumatoid arthritis, and other autoimmune conditions. Toxicities, which can occur at all doses, include myelosuppression, hepatotoxicity, renal impairment, and pneumonitis. A near total reliance on renal excretion without production of inactive metabolites makes MTX vulnerable to drug-drug interactions when kidney function is affected. 3 In fact, MTX represents the highest severity of drug-drug interactions of all medications prescribed in the outpatient setting. Drug-drug interactions between systemic oral therapies in dermatology can result in preventable iatrogenic causes of patient morbidity and mortality. Most of these interactions are due to cytochrome P450 or renal excretion interactions. We review here a number of drugs and drug-drug interactions seen in general dermatology, including methotrexate, bexarotene, macrolides, cyclosporine, epinephrine, isotretinoin, spirinolactone, allopurinol, and oral contraceptives.

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Section: Macrolides Cyclosporinementioning

confidence: 99%

Common Adverse Drug-Drug Interactions in Dermatology: Oral Therapies

2017

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“…8 Desde el primer caso registrado en el año 1978 por Chiu et al, 9 numerosos informes describen la asociación de la HEI con el consumo de minociclinas. En un estudio de dos centros de referencia neurooftalmológica, se estudiaron pacientes que desarrollaron el síndrome de HEI después del tratamiento con tetraciclina y se realizó un seguimiento por un mínimo de 2 años después del cese de dicho antibiótico.…”

Section: Comentariounclassified

“…La mayor serie publicada de pacientes tratados con estos antibióticos consta de 12 casos: 6 tuvieron grave papiledema al momento del diagnóstico y 3 tuvieron pérdida del campo visual. 12 Kesler et al, han reportado 18 pacientes con una historia de uso de tetraciclina asociada con pseudotumor cerebral y encontraron que 6 de ellos tuvieron un curso recidivante, mientras que 12 presentaron una rápida recuperación de la enfermedad después de suspender el consumo del antibiótico. 10 Los autores sugirieron que la tetraciclina había jugado solo un papel menor en los pacientes que habían recaído; sin embargo, varios de los niños eran obesos, en contraste con el caso que se presenta en este reporte.…”

Section: Figura 3 Tomografías De Coherencia óPtica Papilares Evolucunclassified

Pseudotumor cerebral secundario al consumo de minociclina en un paciente pediátrico

2016

Arch Argent Pediat

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Presentación de casos clínicos RESUMENEl pseudotumor cerebral se caracteriza por una elevación de la presión intracraneal mayor de 20 cmH 2 O, con ventrículos y líquido cefalorraquídeo de características normales. El consumo de minociclina es una de las causas asociadas a este síndrome. Presentamos una paciente de 13 años de edad con antecedentes de acné tratado con minociclina. Comenzó con cefalea intensa, diplopía y visión borrosa. Se constató el diagnóstico de pseudotumor cerebral y se indicó la suspensión inmediata del antibiótico y el inicio del tratamiento con acetazolamida. Aunque la patogénesis de pseudotumor cerebral no es totalmente conocida, se ha observado una asociación con el empleo de minociclina. Este antibiótico es de uso frecuente para el manejo del acné, por lo que es importante considerar sus complicaciones antes de ser prescrito. Palabras clave: pseudotumor cerebral, minociclina, niños. ABSTRACTPseudotumor cerebri is a syndrome characterized by an elevated intracranial pressure greater than 20 cmH 2 O with ventricles and cerebrospinal fluid of normal characteristics. Consumption of minocycline have been described among the causes associated with this syndrome. We present a 13-year old female patient with a history of acne treated with minocycline who began with severe headache, diplopia and blurred vision. The diagnosis of pseudotumor cerebri was made, indicating the immediate antibiotic suspension and the beginning of the treatment with acetazolamide. Although the pathogenesis of pseudotumor cerebri is not fully known, an association with minocycline has been observed. This antibiotic is often used by health professionals for the management of acne, so it is important to consider its complications before being prescribed.

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“…In a retrospective study of 12 patients who developed IIH following minocycline therapy, Chiu et al [19] found that 75% of the patients developed symptoms of IIH within 8 weeks of the initiation of therapy. Once minocycline was stopped, no patient had recurrence of IIH, although three patients were left with residual visual loss.…”

Section: Minocyclinementioning

confidence: 99%