doxycycline (Rx)

Brand and Other Names:Vibramycin, Monodox, more...Acticlate, Atridox, Avidoxy, Doxy, Doxycin, Doryx, Oracea, Periostat, Adoxa, Ocudox, Doryx MPC
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 50mg (Monodox, generic)
  • 75mg (Monodox)
  • 100mg (Monodox, Vibramycin, generic)
  • 150mg (Adoxa)

solution, reconstituted powder for IV

  • 100mg (Doxy, generic)

syrup

  • 50mg/5mL (Vibramycin)

oral suspension

  • 25mg/5mL (Vibramycin, generic)

tablet

  • 20mg (generic)
  • 50mg (Adoxa, generic)
  • 75mg (Acticlate, Adoxa, generic)
  • 100mg (Adoxa, generic)
  • 150mg (Acticlate, generic)

tablet, delayed-release

  • 50mg (Doryx)
  • 60mg (Doryx MPC)
  • 75mg (generic)
  • 100mg (generic)
  • 120mg (Doryx MPC)
  • 150mg (Doryx, generic)
  • 200mg (Doryx)

capsule, delayed-release

  • 40mg (Oracea, generic)

periodontal extended-release liquid

  • 10%
more...

General Dosage

Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given qDay), THEN

Maintenance: 100-200 mg/day qDay or divided q12hr PO/IV (IV may be given qDay)

Doryx MPC

  • Mild to moderate infections: 240 mg PO divided q12hr on first day of treatment
  • Maintenance: 120 mg PO qDay; in the management of more severe infections (particularly chronic infections of the urinary tract), 120 mg q12hr recommended

Specific Bacterial Infections

Typical dosage and frequency: 100 PO q12hr on day 1, then 100 mg PO qDay

Severe infections (particularly chronic infections of the urinary tract): 100 mg q12hr is recommended

Doryx MPC

  • 240 mg/day divided twice daily PO on first day; THEN
  • Maintenance: 120 mg PO qDay; for more severe infections administer BID (particularly chronic UTI)

Bartonella bacilliformis

  • Bacillary angiomatosis, peliosis hepatitis, bacteremia, or osteomyelitis: 100 mg PO q12hr
  • CNS infections: 100 mg q12 hr PO/IV with or without rifampin 300 mg PO/IV q12hr
  • Equivalent dose of Doryx MPC: 120 mg PO BID

Brucellosis

  • Brucellosis due to Brucella species
  • 100 mg PO twice daily for 6 weeks with rifampin or streptomycin
  • Equivalent dose of Doryx MPC: 120 mg PO BID

Cholera

  • Indicated for cholera caused by Vibrio cholerae
  • 300 mg PO once; adjunct to fluid and electrolyte replacement
  • Equivalent dose of Doryx MPC is 360 mg PO

Other infections include

  • Relapsing fever due to Borrelia recurrentis
  • Plague due to Yersinia pestis
  • Tularemia due to Francisella tularensis
  • Campylobacter fetus infections caused by Campylobacter fetus

Gram-negative bacteria

  • Because many strains of the following groups of microorganisms have been shown to be resistant to doxycycline, culture and susceptibility testing are recommended
  • Escherichia coli
  • Enterobacter aerogenes
  • Shigella species
  • Acinetobacter species
  • Urinary tract infections caused by Klebsiella species

Infections when Penicillin is Contraindicated

When penicillin is contraindicated, doxycycline is an alternative drug in the treatment of the following infections:

-Syphilis caused by Treponema pallidum

-Yaws caused by Treponema pallidum subspecies pertenue

-Listeriosis due to Listeria monocytogenes

-Vincent’s infection caused by Fusobacterium fusiforme

-Actinomycosis caused by Actinomyces israelii

-Infections caused by Clostridium species

Acute Bacteria Rhinosinusitis

200 mg/day PO qDay or divided BID for 5-7 days

Respiratory Tract Infections

100 PO q12hr on day 1, then 100 mg PO qDay

Doryx MPC: 120 mg PO q12hr on day 1, then 120 mg PO qDay

Respiratory infections

  • Respiratory tract infections caused by Mycoplasma pneumoniae
  • Psittacosis (ornithosis) caused by Chlamydophila psittaci
  • Indicated for the following microorganisms, when bacteriological testing indicates appropriate susceptibility to doxycycline:
  • -RTIs caused by Haemophilus influenzae
  • -RTIs caused by Klebsiella species
  • -Upper RTIs caused by Streptococcus pneumoniae

Sexually Transmitted Diseases

CDC STD guidelines: MMWR Recomm Rep. June 5, 2015:64(RR3);1-137

Uncomplicated gonococcal infection of the cervix, urethra, and rectum: Ceftriaxone 250 mg IM once plus azithromycin 1 g PO once (preferred) or alternatively doxycycline 100 mg PO q12hr for 7 days

Uncomplicated urethral, endocervical, or rectal infection caused by Chlamydia trachomatis: 100 mg PO BID x 7 days

Nongonococcal urethritis caused by C. trachomatis and U. urealyticum: 100 mg PO BID x 7 days

Syphilis (early): Patients who are allergic to penicillin should be treated with doxycycline 100 mg PO BID x 2 weeks

Syphilis >1 year duration: Patients who are allergic to penicillin should be treated with doxycycline 100 mg PO BID x 4 weeks

Acute epididymo-orchitis caused by N. gonorrhoeae or C trachomatis: 100 mg PO BID x least 10 days

Equivalent dose of Doryx MPC is 120 mg PO BID

Periodontal Disease

100-200 mg PO qDay

Atridox: Apply subgingivally; dose depends on size, shape, and number of pockets treated

Rosacea

Oracea: 40 mg PO qAM; on an empty stomach

Chlamydia trachomatis

Trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated as judged by immunofluorescence; also approved for inclusion conjunctivitis caused by chlamydia trachomatis

100 PO q12hr on day 1, then 100 mg PO qDay

Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1, then 120 mg PO qDay

Anthrax

Postexposure prophylaxis: 100 mg PO BID for 60 days

Equivalent dose of Doryx MPC is 120 mg PO BID for 60 days

Malaria

Indicated for prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (ie, <4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strain

Prophylaxis: 100 mg PO qDay; begin taking 1-2 days before travel and continue daily during travel and for 4 weeks after traveler leaves malaria infested area

Severe infection (off-label): 100 mg PO/IV q12hr x 7 days with 3-7 days quinidine gluconate

Uncomplicated infection (off-label): 100 mg PO q12hr x 7 days with 3-7 days quinine sulfate depending on region

Equivalent dose of Doryx MPC is 120 mg

Intestinal Amebiasis

Indicated for adjunctive therapy to amebicides for acute intestinal amebiasis

100 PO q12hr on day 1, then 100 mg PO qDay

Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1, then 120 mg PO qDay

Rickettsial Infections

Indicated for Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsial pox, and tick fevers caused by Rickettsiae

100 PO q12hr on day 1, then 100 mg PO qDay

Equivalent dose of Doryx MPC is 120 mg PO q12h on day 1, then 120 mg PO qDay

Infective Endocarditis

Suspected Bartonella infection with a negative culture: 100 mg PO BID x 6 weeks in combination with gentamicin and ceftriaxone

Positive culture Bartonella infection: 100 mg PO BID x 6 weeks in combination with gentamicin or rifampin

Equivalent dose of Doryx MPC is 120 mg PO BID

Purulent Cellulitis from Community Acquired MRSA (Off-label)

100 mg PO q12hr for 5-10 days

Dosing Considerations

Susceptible organisms

  • Propionibacterium acnes, Actinomyces israelii, Acinetobacter spp, Bacillus anthracis, Bacteroides spp., Bartonella bacilliformis, Bartonella henselae, Bartonella quintana, Borrelia recurrentis, Brucella spp, Campylobacter jejuni, Chlamydia psittaci, Chlamydia trachomatis, Capnocytophaga canimorsus, Citrobacter diversus, Citrobacter freundii, Escherichia coli, Eikenella corrodens, Francisella tularensis, Haemophilus ducreyi, Helicobacter pylori, Klebsiella granulomatis, Klebsiella pneumoniae, Listeria monocytogenes, Mycoplasma hominis, Mycoplasma pneumoniae, Neisseria gonorrhoeae, Propionibacterium acnes, Rickettsiae, Shigella spp., MRSA, Staphylococcus saprophyticus, Streptococcus spp, Treponema pallidum, Ureaplasma urealyticum, Vibrio cholerae, Yersinia enterocolitica, Yersinia pestis, VRE, mycobacteria other than tuberculosis

Dosage Forms & Strengths

capsule

  • 50mg (Monodox, generic)
  • 75mg (Monodox)
  • 100mg (Monodox, Vibramycin, generic)
  • 150mg (Adoxa)

solution, reconstituted powder for IV

  • 100mg (Doxy, generic)

syrup

  • 50mg/5mL (Vibramycin)

oral suspension

  • 25mg/5mL (Vibramycin, generic)

tablet

  • 20mg (generic)
  • 50mg (Adoxa, generic)
  • 75mg (Acticlate, Adoxa, generic)
  • 100mg (Adoxa, generic)
  • 150mg (Acticlate, generic)

tablet, delayed-release

  • 50mg (Doryx)
  • 60mg (Doryx MPC)
  • 75mg (generic)
  • 100mg (generic)
  • 120mg (Doryx MPC)
  • 150mg (Doryx, generic)
  • 200mg (Doryx)

capsule, delayed-release

  • 40mg (Oracea, generic)
more...

General Dosing Guidelines

≤8 years: Not recommended for midle-to-moderate infections; may cause tooth discoloration and enamel hypoplasia during tooth development

>8 years, <45 Kg

  • Load: 4.4 mg/kg/day PO/IV divided q12hr day 1 
  • Maintenance: 2.2-4.4 mg/kg/day IV/PO qDay (may divide BID for higher doses)
  • Doryx MPC
    • Severe or life-threatening infections (eg, anthrax, Rocky Mountain spotted fever): 2.6 mg/kg PO BID
    • Less severe infections: 5.3 mg/kg PO divided into 2 doses on day 1, then a maintenance dose of 2.6 mg/kg PO qDay

>8 years, ≤45 kg

  • 100 mg PO q12hr or 50 mg PO q6hr on day 1, followed by maintenance dose of 100 mg/day as single dose or as 50 mg q12hr
  • Doryx MPC: Doryx MPC: 120 mg PO q12h on day 1, followed by maintenance dose of 120 mg/day; may increase frequency to q12hr for more severe infections, particularly chronic UTI

Anthrax

Postexposure prophylaxis

≤8 years: 2.2 mg/kg PO/IV q12hr for 60 days (change to amoxicillin as soon as penicillin susceptibility confirmed) 

>8 years (≤45kg): 2.2 mg/kg PO/IV q12hr for 60 days (Doryx MPC: 2.6 mg/kg PO q12hr for 60 days)

>8 years (>45kg): 100 mg PO/IV q12hr for 60 days (Doryx MPC: 120 mg PO q12hr for 60 days)

Malaria

>8 years

Prophylaxis

  • 2 mg/kg PO qDay; not to exceed 100 mg /day
  • Doryx MPC: 2.4 mg/kg PO qDay
  • Initiate treatment 1-2 days prior to travel to endemic area and continue for 4 weeks after leaving the area

Severe infection

  • <45 kg: 2.2 mg/kg q12hr for 7 days with quinidine gluconate
  • ≥45 kg (Off label): 100 mg PO/IV q12hr for 7 days with quinidine gluconate

Uncomplicated

  • >8 years: 2.2 mg/kg; not to exceed 100 mg dose PO q12hr for 7 days with quinine sulfate

Tularemia

<45 kg: 2.2 mg/kg PO twice daily for 14-21 days

≥45 kg: 100 mg PO twice daily for 14-21 days

Cholera

Single dose: 7 mg/kg PO/IV; not to exceed 300 mg/dose; adjunct to fluid and electrolyte replacement  

Multiple dose: 2 mg/kg PO/IV twice daily on day 1; THEN, 2 mg/kg qDay on days 2 and 3; not to exceed 100 mg/dose; adjunct to fluid and electrolyte replacement

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Interactions

Interaction Checker

and doxycycline

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Anorexia

            Dental discoloration

            Diarrhea

            Dysphagia

            Enterocolitis

            Erythema multiform

            Esophageal ulcer

            Esophagitis

            Exacerbation of systemic lupus erythematosus

            Exfoliative dermatitis

            Glossitis

            Headache

            Hemolytic anemia

            Hepatotoxicity

            Hypoglycemia

            Inflammatory anogenital lesion

            Intracranial hypertension

            Nausea

            Neutropenia

            Pericarditis

            Serum sickness

            Skin hyperpigmentation

            Toxic epidermal necrolysis

            Thrombocytopenia

            Upper abdominal pain

            Urticaria

            Vomiting

            Drug rash with eosinophilia and systemic symptoms

            Postmarketing Reports

            Pancreatitis

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            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            Not drug of choice for any staphylococcal infection

            Risk of thrombophlebitis when given IV

            History of candidiasis overgrowth

            Hepatotoxicity may occur; if symptoms occur, measure LFTs and discontinue drug

            Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment

            May increase BUN due to its anti-anabolic effects; use caution in patients with renal impairment

            Consider drug serum level determinations in prolonged therapy

            Tetracycline use during tooth development (last half of pregnancy through age 8 years) can cause permanent discoloration of teeth; use doxycycline in pediatric patients 8 years of age or less only when potential benefits expected to outweigh risks in severe or life-threatening conditions (e.g., anthrax, Rocky Mountain spotted fever); particularly when there are no alternative therapies

            Fanconi-like syndrome may occur with outdated tetracyclines

            Intracranial hypertension (pseudotumor cerebri) reported (rare) may occur; symptoms include headache, blurred vision, diplopia, and vision loss; papilledema can be found on funduscopy; women of childbearing age who are overweight or have a history of IH are at greater risk; possibility for permanent visual loss exists; if visual disturbance occurs during treatment, prompt ophthalmologic evaluation is warranted; intracranial pressure can remain elevated for weeks after drug cessation; monitor patients until they stabilize

            Doxycycline offers substantial but not complete suppression of asexual blood stages of Plasmodium strains; doxycycline does not suppress P. falciparum’s sexual blood stage gametocytes; subjects completing prophylactic regimen may still transmit infection to mosquitoes outside endemic areas

            Prolonged use may result in superinfection

            Overgrowth of non-susceptible organisms, including fungi, may occur; if such infections occur, discontinue use and institute appropriate therapy

            May induce hyperpigmentation in many organs including skin, eyes, nails, thyroid and bone

            If Clostridium difficile associated diarrhea suspected or confirmed, may need to discontinue ongoing antibacterial use not directed against C. difficile; may also need to institute appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation as clinically indicated

            Use in pediatric patients 8 years of age or less only when potential benefits are expected to outweigh risks in severe or life-threatening conditions (e.g., anthrax, Rocky Mountain spotted fever), particularly when there are no alternative therapies

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Enters breast milk; Not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria; may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

            Absorption

            Oral: Almost complete; reduced 20% by food or milk

            Peak serum time: 1.5-4 hr

            Bioavailability: Reduced at high pH

            Distribution

            Protein bound: 90%

            Metabolism

            Liver

            Elimination

            Half-life: 15-25 hr

            Excretion: Urine (23%); feces (30%)

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            Administration

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            Administration

            Oral Administration

            Absorption decreased when taken with food, particularly food containing calcium

            Doryx MPC, delayed-release tablet

            • Do not substitute on a mg-per-mg basis with other oral doxycyclines because of differing bioavailability
            • Do not chew or crush tablets
            • The recommended dosage, frequency of administration, and weight-based dosage recommendations differ from that of other doxycyclines; exceed the recommended dose may increase incidence of adverse effects
            • Administer with adequate amount of fluid to was down the drug and reduce risk of esophageal irritation/ulceration
            • Switching from Doryx to Doryx MPC
              • Doryx MPC 60 mg replaces Doryx 50 mg
              • Doryx MPC 120 mg replaces Doryx 100 mg

            IV Incompatibilities

            Additive: Meropenem (comp at 1 g/L mero and 200 mg/L doxy; incomp at 20 g/L and 200 mg/L doxy)

            Y-site: Allopurinol, heparin, piperacillin/tazobactam

            IV Compatibilities

            Solution: D5W, NS

            Additive: Ranitidine

            Syringe: Doxapram

            Y-site (partial list): Acyclovir, amiodarone, aztreonam, hydromorphone, linezolid, MgSO4, meperidine, meropenem (comp at 1 mg/mL mero and 1 mg/mL doxy; incomp at 50 mg/mL mero and 1 mg/mL doxy), morphine SO4, propofol, remifentanil

            IV Preparation

            For IV infusion dilute to a final concentration of 0.1-1 mg/mL w/ NS, D5W, LR, or D5/LR

            IV Administration

            Administer by slow IV infusion, usually over 1-2 hr

            Use central line if possible

            Avoid rapid administration

            Other parenteral routes not recommended

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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