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1. Presented by – Maniz Joshi
B.Pharmacy 8th sem
HOPE International College
Satdobato, Lalitpur, Nepal.
Adverse Drug Reactions of
Tetracycline Antibiotics

2. Introduction
 Tetracyclines are a class of antibiotics having a
nucleus of four cyclic rings.
 They were discovered in the 1940s, are a family
of antibiotics that inhibit protein synthesis by
preventing the attachment of aminoacyl-tRNA to
the ribosomal acceptor (A) site. Tetracyclines are
broad-spectrum agents, exhibiting activity against
a wide range of gram-positive and gram-negative
bacteria, atypical organisms such as chlamydiae,
mycoplasmas, and rickettsiae, and protozoan
parasites.
 Tetracycline has been assigned to pregnancy
category D by the FDA.

3. Irritative effects
 Tetracyclines have irritant property, can cause:
a) Epigastric pain b) Nausea and
vomiting

4. c) Diarrhoea
Note* Odynophagia and esophageal ulceration has been
reported due to the release of the material from capsules in
the esophagus during swallowing, specially with Doxycycline.

5. Liver Damage
 Fatty infiltration of liver and jaundice occurs
occassionally. Oxytetracycline and tetracycline
are safer in this regard. Tetracyclines are risky in
pregnant women; can precipitate acute hepatic
necrosis which may be fatal.

6. Kidney damage
 It is a risk only in the presence of existing kidney
disease.
 All tetracyclines, except doxycycline, accumulate and
enhance renal failure.
 A reversible fanconi syndrome like condition is
produced by outdated tetracyclines. This is caused by
degraded products – epitetracycline,
anhydrotetracycline and epianhydrotetracycline.

7. Phototoxicity
 A sunburn-like or other severe skin reaction on
exposed parts is seen in some individuals.
 The relative scale of toxicity magnification ranges
from the most to the least toxic is: doxycycline >
chlortetracycline > demeclocycline > tetracycline.
 Minocycline is the least phototoxic.

8. Teeth and bones
 Tetracyclines have chelating property. Calcium-tetracycline
chelate gets deposited in developing teeth and bone.
 Given during late pregnancy or childhood, tetracyclines can
cause temporary suppression of bone growth and permanent
tooth staining.
 The period of greatest danger is from mid pregnancy to about 4
to 6 months of the postnatal period for the deciduous anterior
teeth, and from a few months to 5 years of age for the permanent
anterior teeth

9.  Tetracyclines are not recommended for treatment
in children younger than 8 years of age.
 BNF C 2006 lists tetracycline, demeclocycline,
doxycycline, lymecycline,minocycline and
oxytetracycline for use in children above 12 yrs.

10. Others
1) Anti anabolic effect
Tetracyclines reduce protein synthesis and have an
overall catabolic effect.They induce negative
nitrogen balance and can increase blood urea.
2) Increased intracranial pressure is noted in some
infants.
3) Diabetes Insipidus
Demeclocycline antagonizes ADH action and
reduces urine concentrating ability of the kidney.
4) Vestibular toxicity
Minocycline can cause ataxia, vertigo and
nystagmus, which subside when the drug is
discontinued.

11. Reference
 Essentials of Medical pharmacology by K.D
tripathi 7th Edition
 Second Meeting of the Subcommittee of the
Expert Committee on the Selection and Use of
Essential Medicines Geneva, 29 September to 3
October 2008
 http://www.hindawi.com/journals/atox/2015/78712
9/
 http://www.drugs.com/pregnancy/tetracycline.html

12. Thank You!
Any Query??