You may or may not have heard of Minocin, yet it has been in the
spotlight over recent years, in connection with SLE. There
are varying reports regarding this drug, some say it can help the
symptoms of SLE, others say it can cause a form of drug-induced
SLE. I have come across different reports on the internet,
& also have some personal experience with minocin.
What is minocin?
Minocin/Minocycline is a treatment used for acne.
What are the reported problems with Minocin?
It has been claimed that Minocin can induce a lupus-like syndrome,
possibly even drug-induced lupus.
My experience with minocin
I took minocin as a treatment for mild acne, for approximately
two years. About a year after I stopped taking minocin, I
started to get joint pain, & other lupus symptoms. When
I saw the rheumatologist, he asked if I was taking minocin, &
I explained that I had stopped taking it a year ago. He
explained that minocin could cause these symptoms, but if minocin
was the cause, the symptoms would go away when minocin was discontinued.
At the same time, minocin hit the headlines in England, it
was reported that it could cause crippling joint pain, & lupus
like symptoms, the manufacturers of the drug even set up a helpline
to deal with the problem. I was later diagnosed with lupus,
& my case seems to be unrelated to minocin. With this
in mind, I was very surprised to hear of Minocin being used to treat lupus! I personally remain very sceptical at these claims, simply
because I know that Minocin has been implicated in causing a
lupus like syndrome.
that I have found on the internet about Minocin
Lupuslike Reaction Associated With Minocycline
To the Editor.--Minocycline hydrochloride is a semisynthetic derivative
of tetracyline. Although approved by the US Food and Drug Administration
(FDA) for the treatment of infections caused by a variety of microorganisms,
recent data indicate that from 1990 through July 1996, approximately
65% of oral minocycline use in the United States was for treatment
In a recent article, Gough and colleagues described cases of
autoimmune hepatitis, systemic lupus erythematosus, or both associated
with the use of minocycline in the United Kingdom. Lupuslike symptoms
and autoimmune hepatitis in association with minocycline use in
US patients have not been described in the literature. However,
US product labeling for minocycline lists "hepatitis," "exacerbation
of systemic lupus erythematosus," and "[a] transient lupus-like
syndrome" as possible adverse reactions.
From 1972 through February 1996, the FDA's medWatch Reporting
Program had received only 1 report of a case resembling the autoimmune
hepatitis described in the article by Gough et al. However, in
the same time period, 32 reports were received of a systemic lupus
erythematosus-like syndrome similar to the cases described by Gough
et al. All patients were described either as having antinuclear
antibody-positive arthralgia/arthritis, or simply as having lupus,
lupuslike symptoms, or systemic lupus erythematosus. The patients
were young and were receiving no other medications known to cause
lupuslike symptoms; none reportedly had any relevant medical history
(Table). Five reports specifically stated that the patient had been
healthy until the onset of the event. Lupuslike symptoms persisted
as long as 18 months prior to discontinuation of minocycline. Symptoms
abated in 17 of 18 cases after discontinuation of minocycline and
the time to disappearance of symptoms ranged from 2 days to 6 weeks
in the 8 patients for whom that information was provided. Seven
patients were rechallenged with minocycline and all experienced
a recurrence of lupuslike symptoms.
Although minocycline continues to provide a relatively safe therapy
in the treatment of acne, health professionals should consider its
potential role in patients exhibiting lupuslike symptoms while receiving
minocycline. Based on these findings, the word "transient" will
be removed from the phrase "[a] transient lupus-like syndrome" in
the adverse reactions section of the US product labeling.
Sarah J. Singer, RPh, Toni
D. Piazza-Hepp, PharmD, Luigi S. Girardi,
MD, Nasim R. Moledina, MD, Food and Drug Administration, Rockville,
This letter contains the professional views of the
authors and does not necessarily represent the official position
of the FDA.
1. Minocin [package insert]. Wayne, NJ: Lederle
Laboratories; October 1995.
2. National Disease and Therapeutic Index. Plymouth
Meeting, Pa: IMS America Ltd. September 1996.
3. Gough A, Chapman S, Wagstaff K, Emery P, Elias
E. Minocycline-induced autoimmune hepatitis and systemic lupus erythematosus-like
syndrome. BMJ. 1996;312:169-172.
From the British Medical Journal-
Minocycline induced autoimmune hepatitis and systemic lupus
Gough A, Chapman S, Wagstaff K, Emery P, Elias E, Department of Rheumatology, Harrogate District Hospital.
Minocycline is the most widely prescribed systemic antibiotic
for acne largely because it needs to be given only once or twice
a day and seems not to induce resistance. Up to April 1994 11 cases
of minocycline induced systemic lupus erythematosus and 16 cases
of hepatitis had been reported to the Committee on Safety of Medicines.
An analysis of these cases together with seven other cases shows
the severity of some of these reactions. Two patients died while
taking the drug for acne and a further patient needed a liver transplant.
Acne itself can induce arthritis and is often seen in association
with autoimmine liver disease, but the clinical and biochemical
resolution seen after withdrawal of the drug, despite deterioration
of the acne, suggests a drug reaction. In five cases re-exposure
led to recurrence. Because reactions may be severe early recognition
is important to aid recovery and also to avoid invasive investigations
and treatments such as corticosteroids and immunosuppresants. Safer
alternatives should be considered for treating acne.
Cycline antibiotics are sometimes used to treat acne (Minocycline,
Doxycycline, and Tetracycline) and may be implicated in some activation
of established SLE. Studies have shown that Minocycline should also
be avoided in those with a history of SLE in a first degree relative.
There is also weak evidence that this group of drugs may cause drug
induced lupus, although the more common association for drug induced
lupus is still procainamide (used to treat irregular heart beats)
or hydralazine (used to treat high blood pressure).
experience of Minocin
"I developed full blown lupus with 3 100 mg. doses of Minocin.
It was in 1991. Slowly I developed the most severe case of photosensitvity
that physicians have ever seen. I wear three pairs of glasses, and
Sun precautions clothing, plus sunscreen. I cover up with a trench
coat in my car. And I can still develop a reaction if I'm in the
car for any length of time. I have limo tint on my windows. I had
some symptoms of lupus, but it had never fully kicked in, I feel
the Minocin was the definite trigger. My deceased husband physician
diagnosed me. I plan on doing some research with the University
of Alabama in B'ham, AL in photosensitivity. The Head of Dermatology
is interested in this field. I want a couple of months off first.
I'm going to the mountains to escape this heat. And I'm tired of
Dr.'s appts. I am an RN. I facilitated a two county support group,
serve on the nominating committee for the Greater FL. Chapter, LFA
and have been appointed to the National Review Committee for LFA.
Our meeting is in Washington DC in July. I will fly in at night
and should be OK when I get in the hotel.It would be nice if you
could ask your subscribers to go to the home page for LFA and click
in to Government Advocacy, then put in their zip-code. This automatically
will send an e-mail to support 75 million dollars in research that
was to be introduced by Sen. Bennett this past week. The Head of
Dermatology was not familiar with DIL studies of Lupus and Mnocin.
I will fax the information to him that you sent to me. You have
a great site, and it is very informative. I enjoyed viewing it very
much. Sincerely, Susan McNaughton"