tetracycline (Rx)

Brand and Other Names:Sumycin, Actisite, more...Achromycin V
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule/tablet

  • 250mg
  • 500mg
more...

Chronic Bronchitis, Acute Exacerbation

Usual daily dose: 500 mg PO q12hr or 250 mg PO q6hr (ie, 1000 mg/day)

Higher doses (eg, 500 mg PO q6hr) may be required for severe infections or for those infections which do not respond to the smaller doses

Moderate-to- Severe Acne

Recommended initial dosage: 1 g/day PO in divided doses (based on the judgement of the clinician)

When improvement is noted, gradually reduce dose to maintenance levels ranging from 125-500 mg/day

Some patients may be able to maintain adequate remission of lesions with alternate day or intermittent therapy

Duration of long-term treatment which can safely be recommended has not been established

Brucellosis

500 mg PO q6hr for 3 weeks accompanied by streptomycin, 1 g IM BID for the first week, THEN qDay the second week

Syphilis

Patients allergic to penicillin

  • Early syphilis (duration <1 year): 500 mg PO q6hr for 15 days
  • Syphilis (duration >1 year [except neurosyphilis]): 500 mg PO q6hr for 30 days

Gonorrhea

Recommended dose: 500 mg PO q6hr for 7 days

Uncomplicated urethral, endocervical or rectal infections

Infections in adults caused by Chlamydia trachomatis

500 mg PO q6hr for at least seven days

Other Infections

Upper respiratory tract infections caused by Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae; tetracycline should not be used for streptococcal disease unless the organism has been demonstrated to be susceptible

Lower respiratory tract infections caused by Streptococcus pyogenes, Streptococcus pneumoniae, Mycoplasma pneumoniae (Eaton agent, and Klebsiella spp)

Skin and soft tissue infections caused by Streptococcus pyogenes, Staphylococcus aureus; tetracyclines are not the drugs of choice in the treatment of any type of staphylococcal infections

Infections caused by rickettsia including Rocky Mountain spotted fever, typhus group infections, Q fever, rickettsialpox

Psittacosis caused by Chlamydophila psittaci

Infections caused by Chlamydia trachomatis (eg, uncomplicated urethral, endocervical or rectal infections, inclusion conjunctivitis, trachoma, and lymphogranuloma venereum)

Granuloma inguinale caused by Klebsiella granulomatis Relapsing fever caused by Borrelia spp Bartonellosis caused by Bartonella bacilliformis

Chancroid caused by haemophilus ducreyi

Tularemia caused by Francisella tularensis

Plaque caused by Yersinia pestis

Cholera caused by Vibrio cholerae

Brucellosis caused by Brucella species (tetracycline may be used in conjunction with an aminoglycoside)

Infections due to Campylobacter fetus

As adjunctive therapy in intestinal amebiasis caused by Entamoeba histolytica

Urinary tract infections caused by susceptible strains (eg, Escherichia coli, Klebsiella)

Other infections caused by susceptible gram-negative organisms such as E coli, Enterobacter aerogenes, Shigella spp, Acinetobacter spp, Klebsiella spp, and Bacteroides spp

In severe acne, adjunctive therapy with tetracycline may be useful

Other Infections (Penicillin-Resistant)

Syphilis and yaws caused by Treponema pallidum and pertenue, respectively

Vincent’s infection caused by Fusobacterium fusiforme

Infections caused by Neisseria gonorrhoeae

Anthrax caused by Bacillus anthracis Infections due to Listeria monocytogenes

Actinomycosis caused by Actinomyces spp

Infections due to Clostridium spp

Dosage Modifications

Renal impairment

  • Total dosage should be decreased by reduction of recommended individual doses and/or by extending time intervals between doses

Dosing Considerations

Also see Administration

In the treatment of streptococcal infections, administered for at least 10 days

As with other antibacterials, use of this drug may result in overgrowth of nonsusceptible organisms, including fungi

If superinfection occurs, discontinue antibacterial and institute appropriate therapy

Treat all infections due to Group A beta-hemolytic streptococci for at least 10 days

Perform incision and drainage or other surgical procedures in conjunction with antibacterial therapy, when indicated

Prescribing tetracycline in the absence of proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria

Susceptible organisms

  • Acinetobacter spp, Actinomyces israelii, Afipia felis, Bacillus anthracis, Bacteroides spp, Bartonella bacilliformis, Bartonella quintana, Bordetella pertussis, Borrelia recurrentis, Brucella spp, Capnocytophaga canimorsus, Campylobacter jejuni, Chlamydia spp, Citrobacter spp, Coxiella burnetii, Eikenella corrodens, Escherichia coli, Francisella tularensis, Leptospira interrogans, Helicobacter pylori, Klebsiella spp, Listeria monocytogenes, Moraxella catarrhalis, Mycoplasma pneumoniae, Neisseria gonorrhoeae, Propionibacterium acnes, Rickettsiae, Shigella spp, Staphylococcus aureus, Streptococcus pneumoniae, Treponema pallidum, Ureaplasma urealyticum, Vibrio cholerae, Yersinia pestis, Yersinia enterocolitica, Yersinia pseudotuberculosis

Dosage Forms & Strengths

capsule/tablet

  • 250mg
  • 500mg
more...

General Dosing Guidelines

≤8 years: Not recommended; tooth discoloration and enamel hypoplasia may occur with use in young children

>8 years: 25-50 mg/kg/day PO divided q6hr; not to exceed 3 g/day 

Also see Administration

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Interactions

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            Adverse Effects

            Frequency Not Defined

            Gastrointestinal: anorexia, nausea, epigastric distress, vomiting, diarrhea, glossitis, esophagitis, esophageal ulceration, black hairy tongue, dysphagia, enterocolitis, and inflammatory lesions (with Candida overgrowth) in the anogenital region

            Teeth: Permanent discoloration of teeth, enamel hypoplasia

            Skin: Maculopapular and erythematous rashes, exfoliative dermatitis, onycholysis and discoloration of the nails, photosensitivity

            Renal toxicity: Increased BUN (dose-related)

            Liver: Hepatotoxicity, liver failure

            Hypersensitivity reactions: Urticaria, angioneurotic edema, anaphylaxis, anaphylactoid purpura, pericarditis, exacerbation of systemic lupus erythematosus, and serum sickness-like reactions, as fever, rash, and arthralgia

            Blood: Hemolytic anemia, thrombocytopenia, thrombocytopenic purpura, neutropenia and eosinophilia have been reported

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            Warnings

            Contraindications

            Documented hypersensitivity

            Severe hepatic dysfunction

            Pregnancy 2nd and 3rd trimesters

            Cautions

            Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment

            Reduce dose in 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

            Antianabolic action of the tetracyclines may cause an increase in BUN; in patients with significantly impaired renal function, higher serum levels of tetracycline may lead to azotemia, hyperphosphatemia and acidosis

            Fanconi-like syndrome may occur with outdated tetracyclines

            Intracranial hypertension (IH, pseudotumor cerebri) has been associated with the use of tetracyclines; although IH typically resolve after discontinuing treatment, the possibility for permanent visual loss exists; if visual disturbance occurs during treatment, prompt ophthalmologic evaluation is warranted

            All tetracyclines form a stable calcium complex in any bone forming tissue; decrease in fibula growth rate has been observed in premature infants given oral tetracycline in doses of 25 mg/kg q6hr; reaction was shown to be reversible when discontinuing drug

            IV/IM no longer commercially available

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            Pregnancy & Lactation

            Pregnancy

            Avoid 1st trimester; contraindicated 2nd and 3rd trimesters

            Pregnant women with renal disease may be more prone to develop tetracycline-associated liver failure

            The effect of tetracyclines on labor and delivery is unknown

            Lactation

            Short-term use of tetracycline is acceptable in nursing mothers

            A number of reviews have stated that tetracycline is contraindicated during breastfeeding because of possible staining of infants' dental enamel or bone deposition of tetracyclines; however, a close examination of available literature indicates that there is not likely to be harm in short-term use of tetracycline during lactation because milk levels are low and absorption by the infant is inhibited by the calcium in breast milk

            Tetracycline is excreted into breast milk in low concentrations (milk:plasma ratio ranges between 0.25 and 1.5)

            NIH LactMed and the American Academy of Pediatrics classifies tetracycline as compatible with breastfeeding

            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.

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            Pharmacology

            Mechanism of Action

            Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s)

            Absorption

            Absorption: 75% (PO)

            Peak plasma time: 2-4 hr (PO)

            Distribution

            Small amount appears in bile; relative diffusion from blood into CSF: good only with inflammation (exceeds usual MICs) CSF: blood level ratio: inflamed meninges: 25%

            Protein bound: 65%

            Elimination

            Half-life: 8-11 hr (normal renal function); 57-108 hr (end-stage renal disease)

            Excretion: Urine (60% as unchanged drug); feces (as active form)

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            Administration

            Oral Administration

            Administer with adequate amounts of fluid with the capsule formulation to wash down the drug and reduce the risk of esophageal irritation and ulceration

            Absorption of tetracycline is impaired by antacids containing aluminum, calcium or magnesium and preparations containing iron, zinc or sodium bicarbonate

            Food and some dairy products also interfere with absorption

            Storage

            Dispense in a tight, light-resistant containers

            Use child-resistant closure (as required)

            Store at 20-25°C (68-77°F)

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            Formulary

            FormularyPatient Discounts

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

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            • View the formulary and any restrictions for each plan.
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            • 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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.