Published: 3 March 2016

Publications

Idiopathic Intracranial Hypertension

Prescriber Update 37(1): 7
March 2016

Key Messages

  • The incidence of idiopathic intracranial hypertension is increasing.
  • Idiopathic intracranial hypertension is associated with a range of medicines, in particular vitamin A derivatives, contraceptives and tetracyclines.


Idiopathic intracranial hypertension (IIH, previously known as pseudotumor cerebri) is a disorder of increased cerebrospinal fluid pressure in which patients maintain an alert and oriented mental state. Signs and symptoms include headache, pulsatile tinnitus, diplopia, papilloedema and visual loss1,2.

IIH occurs more often in women than men and most commonly occurs in obese women of childbearing age. More than 90% of patients with IIH are obese and the incidence is rising in parallel with the increasing prevalence of obesity2.

Other risk factors for IIH include hyperaldosteronism, Cushing’s syndrome, hypervitaminosis A, use of recombinant growth factor and some medicines.

Medicines known to be associated with IIH include1-4:

  • antibiotics including tetracyclines (eg, minocycline, doxycycline), naldixic acid and nitrofurantoin
  • steroids (on withdrawal)
  • contraceptives
  • vitamin A derivatives such as isotretinoin
  • indomethacin or ketoprofen in patients with Bartter’s syndrome
  • amiodarone
  • thyroid replacement therapy in hypothyroid children.

Because of the risk of IIH, concomitant use of tetracyclines and vitamin A or retinoids is contraindicated.

Prompt discontinuation of the causative medicine leads to resolution of the disorder, usually over two to four weeks3. Weight loss is associated with improvement of IIH in overweight patients4.

Of the reports of IIH received by the Centre for Adverse Reactions Monitoring (CARM), 84% occurred in females and 69% of reports in females were associated with a tetracycline or a contraceptive medicine.

Any suspected or confirmed case of IIH in association with medicines should be reported to CARM (https://nzphvc.otago.ac.nz/).

References
  1. Ko MW, Liu GT. 2010. Pediatric Idiopathic Intracranial Hypertension (Pseudotumor Cerebri). Hormone Research in Paediatrics 74: 381-389.
  2. Wall M. 2010. Idiopathic Intracranial Hypertension. Neurologic Clinics 28(3): 593-617.
  3. Lochhead J, Elston JS. 2003. Doxycycline induced intracranial hypertension. BMJ 326: 641-642.
  4. Andrews LE, Liu GT, Ko MW. 2014. Idiopathic Intracranial Hypertension and Obesity. Hormone Research in Paediatrics 81: 217-225.
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