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Minocycline, Tetracycline and Doxycycline

Before a doctor prescribes a drug, he must decide whether the side effects can cause more harm than good. Many doctors have asked why I treat some of my patients with acne, arthritis, chronic fatigue syndrome and late-onset asthma with the antibiotic, doxycycline, when minocycline is probably more effective. Doxycycline is a fairly safe drug, although it can cause a sore throat, sunlight sensitivity, pigmentation and abnormal liver tests. It causes a sore throat and heartburn when it gets stuck in your esophagus, so take it with large amounts of water to wash it down to your stomach. To prevent sunburn, avoid excessive exposure to the sun. Minocycline is also fairly safe, but it can cause more serious serum sickness-like reaction, hypersensitivity syndrome reaction, and drug-induced lupus: characterized by fever, joint pain, a rash, a feeling of being sick, hives, itching and severe pain (1); Other reported side effects include dark colored eye balls (2), and liver damage (3).

One of my patients developed a disease called lupus while taking doxycycline, an antibiotic that I prescribe to treat arthritis. Lupus can cause terrible arthritis and even kidney damage. I reviewed the world's literature and could not find one case of lupus caused by doxycycline or tetracycline (although 33 cases were caused by a similar drug called minocycline, and then only after an average of two years.

Minocycline is more effective than doxycycline because it achieves much higher concentrations in the tissues where it does its work in reducing swelling, killing germs and stopping pain. Although minocycline and doxycycline are in the same class of antibiotics as tetracycline, we rarely use tetracycline because it does not achieve high tissue concentrations. Doxycycline achieves much higher tissue concentrations than tetracycline, while minocycline penetrates tissue far more effectively than doxycycline.

1) SR Knowles, L Shapiro, NH Shear. Serious adverse reactions induced by minocycline: Report of 13 patients and review of the literature. Archives of Dermatology 132: 8 (AUG 1996):934-939. serum sickness-like reaction, hypersensitivity syndrome reaction, and drug-induced lupus.

2) RA Sabroe, CB Archer, D Harlow, JW Bradfield, RDG Peachey. Minocycline-induced discolouration of the sclerae. British Journal of Dermatology 135: 2 (AUG 1996):314-316.

3) A Malcolm, TR Heap, RP Eckstein, MR Lunzer. Minocycline-induced liver injury. American Journal of Gastroenterology 91: 8 (AUG 1996):1641-1643. intrahepatic cholestasis with bile duct depletion.

4) O Elkayam, M Yaron, D Caspi. Minocycline induced arthritis associated with fever, livedo reticularis, and pANCA. Annals of the Rheumatic Diseases 55: 10(OCT 1996):769-771. All three fever, arthritis/arthralgia and livedo reticularis.

4a) L Xenard, JL George, T Maalouf, T Malet, P Lesure. Adverse effects of tetracyclines. A report of two cases. Semaine Des Hopitaux 72:29-30 (NOV 7 1996):924-927. benign intracranial hypertension and palpebral photosensitization.

5) excellent review on safety. Joshi N, Miller DQ. Doxycycline revisited. Archives of Internal Medicine 1997(July);157:1421-1428.

6) MA Dodd, EJ Dole, WG Troutman, DA Bennahum. Minocycline-associated tooth staining. Annals of Pharmacotherapy 32: 9 (SEP 1998):887-889.

7) SE Knights, MJ Leandro, MA Khamashta, GRV Hughes. Minocycline-induced arthritis. Clinical and Experimental Rheumatology 16: 5(SEP-OCT 1998): 587-590. .

8) D Eisen, MD Hakim. Minocycline-induced pigmentation: Incidence, prevention and management. Drug Safety 18: 6 (JUN 1998):431-440.

9) Minocycline is the first non-toxic drug with a proven human safety record that has been shown to inhibit cytochrome c release. It also crosses the blood-brain barrier and is effective when taken orally, which makes it a good candidate for human clinical trials. Zhu S, Stavrovskaya IG, Drozda M, Kim BYS, Ona V, Li M, Sarang S, Liu AS, Hartley DM, Wu DC, Gullans S, Ferrante RJ, Przedborski S, Kristal BS, Friedlander RM. "Minocycline inhibits cytochrome c release and delays progression of amyotrophic lateral sclerosis in mice." Nature, May 2, 2002, Vol. 417, No. 6884, pp.74-78.

10) JR ODell, KW Blakely, JA Mallek, PJ Eckhoff, RD Leff, SJ Wees, KM Sems, AM Fernandez, WR Palmer, LW Klassen, GA Paulsen, CE Haire, GF Moore. Treatment of early seropositive rheumatoid arthritis - A two-year, double-blind comparison of minocycline and hydroxychloroquine. Arthritis and Rheumatism, 2001 (October), Vol 44, Iss 10, pp 2235-2241. O'Dell JR,Univ Nebraska,Med Ctr,Nebraska Med Ctr 983025,600 S 42nd St,Omaha,NE 68198 USA 11) JR ODell, G Paulsen, CE Haire, K Blakely, W Palmer, S Wees, PJ Eckhoff, LW Klassen, M Churchill, D Doud, A Weaver, GF Moore. Treatment of early seropositive rheumatoid arthritis with minocycline - Four-year followup of a double-blind, placebo-controlled trial.Arthritis and Rheumatism, 1999, Vol 42, Iss 8, pp 1691-1695.

12) Review of evidence for a connection between Chlamydia pneumoniae and atherosclerotic disease. Clinical Therapeutics, 2002, Vol 24, Iss 5, pp 719-735. JP Dugan, RR Feuge, DS Burgess. Burgess DS, Univ Texas, Hlth Sci Ctr, Clin Pharm Program, MSC 6220, 7703 Floyd Curl Dr, San Antonio,TX 78229 USA.

13) roxithromycin treatment prevents progression of peripheral arterial occlusive disease in Chlamydia pneumoniae seropositive men - A randomized, double-blind, placebo-controlled trial. Circulation, 2002, Vol 105, Iss 22, pp 2646-2652. P Wiesli, W Czerwenka, A Meniconi, FE Maly, U Hoffmann, W Vetter, G Schulthess. Schulthess G, Univ Zurich Hosp, Med Poliklin, Dept Internal Med, CH-8091 Zurich, SWITZERLAND

14) The value of Chlamydia trachomatis antibody testing in predicting tubal factor infertility. Human Reproduction, 2002, Vol 17, Iss 3, pp 695-698. LMW Veenemans, PJQ vanderLinden. van der Linden PJQ, Deventer Ziekenhuis, Dept Obstet & Gynaecol, POB 5002, NL-7400 GC Deventer, NETHERLANDS.

15) Chlamydia antibody testing in screening for tubal factor subfertility: the significance of IgG antibody decline over time. Human Reproduction, 2002, Vol 17, Iss 3, pp 699-703. AP Gijsen, JA Land, VJ Goossens, MEP Slobbe, CA Bruggeman. Gijsen AP, Acad Ziekenhuis Maastricht, POB 5800, NL-6202 AZ Maastricht, NETHERLANDS

Checked 2/9/15

May 29th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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