ICH

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Dear All

After being on Doxy/Roxy with pulsed metronizadole for about 8 months, ther persistant difuse headache was worrying me. Perhaps this is the answer. Bugger, I've been so much better on antibiotics.

Regards

Windsor

From http://www.tga.health.gov.au/adr/aadrb/aadr0302.htm

Minocycline and not so benign intracranial hypertension

"Benign" intracranial hypertension, also known as pseudotumour cerebri, involves a persistent rise in cerebrospinal fluid pressure. It is characterised by headache, nausea, vomiting and papilloedema with occasional sixth-nerve palsy. It is sometimes associated with drug therapy and tetracyclines are a well-recognised cause. Of the 76 cases reported to ADRAC over the past 30 years, 32 have been associated with minocycline.

All of these 32 patients were young, ranging in age from 12 to 30 (median: 16) years, and almost all were taking long-term minocycline for acne. Most (28) were female. The time to onset ranged from two weeks to 18 months with a median of approximately 2 months. There was also one case in which the patient developed the condition one day after she was switched from doxycycline to minocycline. The majority of the cases reported to ADRAC had recovered after minocycline was withdrawn but recovery was often prolonged, taking from 2 to 12 weeks in most cases. In those cases where treatment was reported, lumbar puncture, acetazolamide and steroids were used. There were also cases where the patient had not recovered at the time the report was submitted. Some of the reports described the use of multiple lumbar punctures, one patient required "prolonged hospitalisation", and one required a lumbo-peritoneal shunt. In one patient, lower nasal quadrantanopia persisted after 6 months.1

ADRAC has previously drawn attention to this association but with 3 cases reported in the past 6 months, a reminder is timely.2 The possibility of drug-induced benign intracranial hypertension should be considered in any young patient presenting with persistent unexplained headache, and women taking minocycline appear to be at particular risk.

References

Lander CM. Minocycline-induced benign intracranial hypertension. Clin Exp Neurol 1989;26:161-7.

Boyd I. Benign intracranial hypertension induced by minocycline. Current Therapeutics 1995;36:70-71.

BMJ 2003;326:641-642 ( 22 March )

And from http://www.bmj.com/cgi/content/extract/326/7390/641?maxtoshow= & HITS=10 & hits=10 & RESULTFORMAT= & fulltext=ICH%2C+doxycycline & searchid=1 & FIRSTINDEX=0 & resourcetype=HWCIT

Clinical reviewLesson of the week

Doxycycline induced intracranial hypertension Doxycycline prescribed for malaria prophylaxis may cause intracranial hypertension that threatens sight J Lochhead, specialist registrar, J S Elston, consultant.

Department of Ophthalmology, Oxford Eye Hospital, Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: J S Elston mary.spearman@...

Preventing malaria in travellers is difficult because of the widespread emergence of drug resistance and the increasing popularity of travel to endemic locations. Mefloquine is the most effective recommended antimalarial, but doxycycline (a tetracycline derivative) is being increasingly used in areas where there is resistance to mefloquine or in patients who have side effects to this drug.1

Intracranial hypertension is a well recognised side effect of tetracyclines and has been associated with the medium to long term use of minocycline for acne vulgaris.2-6 We report on two patients with acute onset of severe intracranial hypertension associated with doxycycline, in one instance causing permanent loss of most vision.