Translation of a-t 2019; 50: 24
 

CURRENT ADR NETWORK REPORT

Psychiatric adverse events with minocycline (e.g. SKID)

A 32 year-old woman took the tetracycline minocycline (SKID amongst other generics) for several weeks due to acne which started after she stopped taking the pill. Hitherto unknown panic attacks, derealisation and depersonalisation disorders occurred during treatment. As symptoms regressed following treatment withdrawal, the reporting physician anticipates total remission (NETWORK Report 17.588). A 17 year-old male student developed hallucinations, self-aggression and loss of control during the first few days of minocycline treatment. These symptoms disappeared four days after treatment withdrawal (16.311). Minocycline-related depersonalisation symptoms are also mentioned in the literature: A few days after starting medication, a 24 year-old woman felt detached from her surroundings, as though watching a film of her daily activities. The symptoms completely regressed within 48 hours of tetracycline withdrawal but recurred when treatment was reinstated (1). The WHO adverse drug reaction database currently holds 12,446 suspected reports on minocycline, 2,698 reports on nervous system disorders (21.7%) and 538 reports on psychiatric effects (4.3%) including 30 cases of depersonalisation and/or derealisation disorders and 14 cases of panic attacks (2). With high lipid solubility, central nervous effects such as headaches, ataxia and increased intracranial pressure are known adverse reactions associated with the tetracycline. They are listed as such in the Summary of Product Characteristics (SPC), e.g. of SKID, with no reference to psychiatric disorders, however (3). In any case, we discourage from using minocycline as acne therapy due to hepatitis and severe immune reactions including Lupus erythematosus (a-t 1999; No. 4: 48 and 2013; 44: 56) and potentially life-threatening DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome (4). If topical acne treatment proves inadequate, a more effective and better tolerated tetracycline is available in the form of doxycycline (DOXYDERMA and other generics), for instance.

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