Minocycline

Minocycline is probably one of the more common drugs associated with the induction of lupus at the present time. It is interesting to note that although minocycline has been available for 30 years, its association with lupus has only recently been appreciated (Matsuura et al. 1992). There are three major idiosyncratic adverse reactions associated with minocycline therapy: a serum sickness-like syndrome, liver toxicity, and a lupus-like syndrome. The serum sickness-like syndrome occurs after only approximately 2 weeks of therapy. In contrast, liver toxicity occurs after a mean of 20 months of therapy, and lupus has a mean time to onset of 28 months (range, 10 days to 10 years) (Schaffer et al. 2001). Most of the reported cases have been in women. There is a large amount of overlap between liver toxicity and the lupus-like syndrome, and many patients with elevated liver enzymes also have fever and arthralgias. Some patients report impaired concentration and poor memory, which suggest central nervous system involvement, and one patient had a peripheral sensory neuropathy (Lawson et al. 2001). Minocycline seems to be the only tetracycline associated with the induction of lupus (Shapiro et al. 1997).

In one study of the lupus-like syndrome to minocycline, all 14 patients had anti-neutrophil cytoplasmic antibodies with a perinuclear pattern (p-ANCAs). P-ANCAs are usually against either myeloperoxidase or elastase, and 11 of the 14 patients had antimyeloperoxidase antibodies and 10 had antielastase antibodies. None of the minocycline-treated controls had detectable p-ANCAs, and this led to the suggestion that p-ANCAs could be used as a marker for the development of a lupus-like syndrome to minocycline (Dunphy et al. 2000).

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