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Intracranial Pressure Returns to Normal About a Month After Stopping Tetracycline Antibiotics

Bryan J. Winn, MD; Yaping Joyce Liao, MD, PhD; Jonathan C. Horton, MD, PhD
Arch Ophthalmol. 2007;125(8):1137-1138. doi:10.1001/archopht.125.8.1137.
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Tetracycline antibiotics are used widely, especially for the treatment of teenage acne vulgaris. Raised intracranial pressure with fulminant papilledema can occur as a rare, idiosyncratic adverse effect.13 The diagnosis is often delayed because obesity, a diagnostic clue associated with pseudotumor cerebri, is usually absent. Consequently, patients may have advanced visual field loss and impending blindness. To guide treatment, it would be useful to know how long intracranial pressure remains elevated after halting the use of tetracycline-class antibiotics.

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Figure 1.

Case 3. Humphrey 24-2 threshold perimetry, size III stimulus, showing severe visual field loss from papilledema. Three months later, the visual fields had improved but the patient was left with permanent constriction. Fundus pictures show papilledema observed just after stopping tetracycline use (top) and 6 weeks later (bottom). Mild papilledema persisted, although the intracranial pressure had returned to normal 3 weeks earlier.

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Figure 2.

Time course for return of intracranial pressure to normal after stopping tetracycline antibiotics, shown by plotting pressure vs time for our 4 cases and the case previously reported by Mochizuki et al.4

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