Minocycline and risk of benign intracranial hypertension

HSA has recently reviewed the safety profile of minocycline in relation to the risk of benign intracranial hypertension. Minocycline is indicated for the treatment of several infections caused by susceptible strains. It is registered locally as Apo-minocycline® (Pharmaforte Singapore Pte Ltd) and Borymycin® (Yung Shin Pharmaceutical (S) Pte Ltd) since 1998.

Benign intracranial hypertension (also known as pseudotumour cerebri) involves a persistent rise in cerebrospinal fluid pressure and is characterised by headache, nausea, vomiting and vision disturbances, including papilloedema with occasional sixth-nerve palsy. While rare, benign intracranial hypertension is known to be associated with tetracyclines, and in particular, with minocycline treatment. Concomitant use of isotretinoin (or other systemic retinoids) with minocycline should be avoided because isotretinoin is also known to be associated with benign intracranial hypertension.

The local package inserts of minocycline-containing products are being strengthened to include warnings to avoid the administration of isotretinoin or other systemic retinoids/retinol shortly before, during, and shortly after minocycline therapy. To date, HSA has not received any reports of benign intracranial hypertension associated with the use of minocycline. Healthcare professionals are recommended to take note of the above safety information and to consider the possibility of benign intracranial hypertension in patients treated with minocycline, if signs and symptoms consistent with this diagnosis are identified.