Intrapericardial minocycline sclerosis for malignant pericardial effusion

Study objective: To evaluate the effectiveness and safety of minocycline hydrochloride (minocycline) intrapericardially in patients with malignant pericardial effusion. Design: Consecutive patients admitted to the hospital during a 32-month period received intrapericardial minocycline. Setting: A 900-bed university hospital. Patients: Fourteen consecutive patients with malignant pericardial effusion. Intervention: Following percutaneous insertion of a pericardial drain, minocycline was administered at a dosage of 10 mg/kg every 48 h until fluid drainage stopped or until further therapy was deemed necessary. Measurements: Complications associated with therapy, total minocycline requirements, immediate and late failure of therapy, and clinical and echocardiographic follow-up of at least 6 months. Results: Mean amount of minocycline administered was 1.9 +/- 1.0 g given in 2.4 divided doses. Total drainage time was 5.4 +/- 2.5 days. Recurrence of malignant pericardial effusion was seen in only 1 of 14 patients. Death occurred in 10 patients due to severe metastatic disease in all. Minocycline instillation was associated with severe chest pain in seven patients, and with ECG changes suggesting pericardial or subepicardial injury in two patients. Conclusion: (1) Intrapericardial minocycline instillation is very effective in preventing recurrence of malignant pericardial effusion. (2) Minocycline is irritative to tile pericardium and may cause severe chest pain with transient ECG changes, suggesting pericardial or subepicardial injury.