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

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

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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            Contraindicated (5)

            • acitretin

              tetracycline, acitretin. Other (see comment). Contraindicated. Comment: Both acitretin and tetracyclines can cause increased intracranial pressure.

            • flibanserin

              tetracycline will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.

            • lomitapide

              tetracycline increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

            • lonafarnib

              tetracycline will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.

            • tretinoin

              tetracycline, tretinoin. Either increases toxicity of the other by unspecified interaction mechanism. Contraindicated. Both tretinoin and tetracyclines can cause increased intracranial pressure.

            Serious - Use Alternative (95)

            • abametapir

              abametapir will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • aluminum hydroxide

              aluminum hydroxide decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • aminolevulinic acid oral

              aminolevulinic acid oral, tetracycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

            • aminolevulinic acid topical

              tetracycline increases toxicity of aminolevulinic acid topical by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of photosensitizing drugs may enhance the phototoxic reaction to photodynamic therapy with aminolevulinic acid.

            • amoxicillin

              tetracycline decreases effects of amoxicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

            • ampicillin

              tetracycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

            • apalutamide

              apalutamide will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • atracurium

              tetracycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • avapritinib

              tetracycline will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications.

            • axitinib

              tetracycline increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

            • BCG vaccine live

              tetracycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • bismuth subsalicylate

              bismuth subsalicylate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • bosutinib

              tetracycline increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • calcium acetate

              calcium acetate, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium carbonate

              calcium carbonate, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium chloride

              calcium chloride, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium citrate

              calcium citrate, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium gluconate

              calcium gluconate, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • carbamazepine

              carbamazepine will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • carbonyl iron

              carbonyl iron decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • cholera vaccine

              tetracycline, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

            • cisatracurium

              tetracycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • cobimetinib

              tetracycline will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).

            • dicloxacillin

              tetracycline decreases effects of dicloxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • eliglustat

              tetracycline increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .

            • entrectinib

              tetracycline will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of moderate CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce dose to 200 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing moderate CYP3A inhibitor for 3-5 elimination half-lives.

            • enzalutamide

              enzalutamide will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • fentanyl

              tetracycline will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • fentanyl intranasal

              tetracycline will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • fentanyl transdermal

              tetracycline will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • fentanyl transmucosal

              tetracycline will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • ferric maltol

              ferric maltol decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ferrous fumarate

              ferrous fumarate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ferrous gluconate

              ferrous gluconate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ferrous sulfate

              ferrous sulfate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • idelalisib

              idelalisib will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • infigratinib

              tetracycline will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • irinotecan

              tetracycline will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • irinotecan liposomal

              tetracycline will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • iron dextran complex

              iron dextran complex decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • iron sucrose

              iron sucrose decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • isotretinoin

              isotretinoin, tetracycline. Mechanism: unknown. Contraindicated. Risk of pseudotumor cerebri.

            • ivabradine

              tetracycline will increase the level or effect of ivabradine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of ivabradine with moderate CYP3A4 inhibitors.

            • ivosidenib

              ivosidenib will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternative therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • lemborexant

              tetracycline will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.

            • lurbinectedin

              tetracycline will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • magnesium chloride

              magnesium chloride decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium citrate

              magnesium citrate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium hydroxide

              magnesium hydroxide decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium oxide

              magnesium oxide decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium sulfate

              magnesium sulfate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • methoxyflurane

              tetracycline, methoxyflurane. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of nephrotoxicity.

            • methyl aminolevulinate

              tetracycline, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.

            • midazolam intranasal

              tetracycline will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of moderate CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.

            • mobocertinib

              tetracycline will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use of moderate CYP3A4 inhibitor unavoidable, reduce mobocertinib dose by ~50% (eg, 160 to 80 mg); closely monitor QTc interval.

            • nafcillin

              tetracycline decreases effects of nafcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • naloxegol

              tetracycline will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministation of naloxegol with moderate CYP3A4 inhibitors is unavoidable, reduce naloxegol dose to 12.5 mg qDay

            • neratinib

              tetracycline will increase the level or effect of neratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of neratinib with strong/moderate CYP3A4 inhibitors.

            • olaparib

              tetracycline will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.

            • onabotulinumtoxinA

              tetracycline increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • oxacillin

              tetracycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • pancuronium

              tetracycline increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • pemigatinib

              tetracycline will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.

            • penicillin G aqueous

              tetracycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • penicillin VK

              tetracycline decreases effects of penicillin VK by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • pexidartinib

              tetracycline will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.

            • phenobarbital

              phenobarbital will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • phenytoin

              phenytoin will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • pivmecillinam

              tetracycline decreases effects of pivmecillinam by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • polysaccharide iron

              polysaccharide iron decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • primidone

              primidone will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • rapacuronium

              tetracycline increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • rocuronium

              tetracycline increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • rose hips

              rose hips decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • selumetinib

              tetracycline will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.

            • siponimod

              tetracycline will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.

            • sodium bicarbonate

              sodium bicarbonate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Administer tetracyclines at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Administer tetracyclines at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

            • strontium ranelate

              strontium ranelate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Suspend strontium ranelate during antibiotic therapy.

            • succinylcholine

              tetracycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • tazemetostat

              tetracycline will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with moderate CYP3A4 inhibitors. If coadministration is unavoidable, reduce tazemetostat current dose (see drug monograph Dosage Modifications).

            • temocillin

              tetracycline decreases effects of temocillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • ticarcillin

              tetracycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • tretinoin

              tetracycline, tretinoin. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

            • tretinoin topical

              tetracycline, tretinoin topical. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

            • tripotassium dicitratobismuthate

              tripotassium dicitratobismuthate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • tucatinib

              tucatinib will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • typhoid vaccine live

              tetracycline decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • vecuronium

              tetracycline increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • venetoclax

              tetracycline will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a moderate CYP3A inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

            • voxelotor

              voxelotor will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (83)

            • acalabrutinib

              tetracycline will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease acalabrutinib dose to 100 mg once daily if coadministered with a moderate CYP3A inhibitor.

            • atogepant

              tetracycline will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • avanafil

              tetracycline will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce avanafil clearance increasing systemic exposure to avanafil; increased levels may result in increased associated adverse events; the maximum recommended dose of STENDRA is 50 mg, not to exceed once every 24 hours for patients taking concomitant moderate CYP3A4 inhibitors

            • bazedoxifene/conjugated estrogens

              tetracycline will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • bosentan

              bosentan will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • brexpiprazole

              tetracycline will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor.

            • buprenorphine subdermal implant

              tetracycline will increase the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inhibitors for signs and symptoms of overmedication. If the dose of the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, implant removal may be necessary and the patient should then be treated with a buprenorphine dosage form that permits dose adjustments. If a CYP3A4 inhibitor is discontinued in a patient who has been stabilized on buprenorphine, monitor the patient for withdrawal.

            • buprenorphine, long-acting injection

              tetracycline will increase the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who transfer to buprenorphine long-acting injection from transmucosal buprenorphine coadministered with CYP3A4 inhibitors should be monitored to ensure buprenorphine plasma levels are adequate. Within 2 weeks, if signs and symptoms of buprenorphine toxicity or overdose occur and the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, transition the patient back to a buprenorphine formulation that permits dose adjustments.

            • cabazitaxel

              tetracycline will increase the level or effect of cabazitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution should be exercised with concomitant use of moderate CYP3A4 inhibitors.

            • cabozantinib

              tetracycline will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cannabidiol

              tetracycline will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP3A4 inhibitor.

            • cefdinir

              tetracycline decreases effects of cefdinir by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefditoren

              tetracycline decreases effects of cefditoren by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefoxitin

              tetracycline decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefpodoxime

              tetracycline decreases effects of cefpodoxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • ceftriaxone

              tetracycline decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefuroxime

              tetracycline decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cenobamate

              cenobamate will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

            • cholestyramine

              cholestyramine decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • conjugated estrogens

              tetracycline will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • crofelemer

              crofelemer increases levels of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • dabrafenib

              dabrafenib will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • deflazacort

              tetracycline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • diazepam intranasal

              tetracycline will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.

            • didanosine

              didanosine will decrease the level or effect of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Oral tetracycline should not be administered simultaneously with didanosine (chewable tablets or powder for oral solution); use alternatives if available. Tetracycline antibiotics should be taken 1 hour before or 4 hours after administration of didanosine.

            • digoxin

              tetracycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

            • efavirenz

              efavirenz will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix decreases levels of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • encorafenib

              encorafenib, tetracycline. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • estradiol

              tetracycline will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estrogens conjugated synthetic

              tetracycline will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estropipate

              tetracycline will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • ethinylestradiol

              tetracycline will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • etravirine

              etravirine will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fedratinib

              fedratinib will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • finerenone

              tetracycline will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • ifosfamide

              tetracycline decreases effects of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use of a CYP3A4 inhibitor may decrease metabolism of ifosfamide, potentially reducing ifosfamide therapeutic effects.

            • iloperidone

              iloperidone increases levels of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • isavuconazonium sulfate

              tetracycline will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • istradefylline

              istradefylline will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • ivosidenib

              tetracycline will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with moderate CYP3A4 inhibitors may increase ivosidenib plasma concentrations, thus increasing the risk of QTc prolongation. Monitor for increased risk of QTc interval prolongation.

            • lanthanum carbonate

              lanthanum carbonate decreases levels of tetracycline by cation binding in GI tract. Use Caution/Monitor. Administer oral tetracycline antibiotics at least 2 hr before or after lanthanum. Interaction applies only to oral tetracyclines.

            • lefamulin

              tetracycline will increase the level or effect of lefamulin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for adverse effects if lefamulin is coadministered with moderate CYP3A inhibitors.

            • levamlodipine

              tetracycline will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.

            • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

              tetracycline will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

            • lorlatinib

              lorlatinib will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • magnesium supplement

              magnesium supplement will decrease the level or effect of tetracycline by Other (see comment). Modify Therapy/Monitor Closely. Formation of an insoluble complex reduces absorption of the drug through intestinal tract; administer magnesium 2hr before the tetracycline or 4hr after the tetracycline

            • mefloquine

              tetracycline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • mestranol

              tetracycline will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • methotrexate

              tetracycline increases levels of methotrexate by decreasing elimination. Use Caution/Monitor. If tetracyclines cannot be avoided in patients receiving high-dose methotrexate, closely monitor methotrexate plasma concentrations and patients for signs and symptoms of toxicity.

            • methoxsalen

              methoxsalen, tetracycline. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive photosensitizing effects.

            • mipomersen

              mipomersen, tetracycline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

            • mitotane

              mitotane decreases levels of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

            • nafcillin

              nafcillin will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • naldemedine

              tetracycline increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.

            • oliceridine

              tetracycline will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

            • palbociclib

              tetracycline will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • piperacillin

              tetracycline decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • polycarbophil

              polycarbophil decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • porfimer

              tetracycline, porfimer. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced photosensitivity.

            • rifabutin

              rifabutin will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rimegepant

              tetracycline will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid repeating rimegepant dose within 48 hr if coadministered with a moderate CYP3A4 inhibitor.

            • rucaparib

              rucaparib will increase the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • ruxolitinib

              tetracycline will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              tetracycline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of tetracycline by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation.

            • sonidegib

              tetracycline will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.

            • stiripentol

              stiripentol, tetracycline. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

            • sufentanil SL

              tetracycline will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.

            • suvorexant

              tetracycline will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitors

            • tadalafil

              tetracycline will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce tadalafil clearance increasing systemic exposure to tadalafil; increased levels may result in increased associated adverse events.

            • tazemetostat

              tazemetostat will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • tezacaftor

              tetracycline will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust tezacaftor dosage regimen if coadministered with a moderate CYP3A inhibitor.

            • tinidazole

              tetracycline will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tofacitinib

              tetracycline increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors .

            • trabectedin

              tetracycline will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • trimagnesium citrate anhydrous

              trimagnesium citrate anhydrous decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of tetracyclines; administer tetracycline at least 2 hr before or 6 hr after magnesium; use alternatives if available.

            • voclosporin

              tetracycline will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • zanubrutinib

              tetracycline will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib dose when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous dose of zanubrutinib. See zanubrutinib Dosage Modifications for precise recommendation.

            • zinc

              zinc will decrease the level or effect of tetracycline by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration of oral tetracycline derivatives and oral zinc salts by at least 2 hr.

            Minor (25)

            • antithrombin alfa

              tetracycline increases effects of antithrombin alfa by pharmacodynamic synergism. Minor/Significance Unknown.

            • antithrombin III

              tetracycline increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • argatroban

              tetracycline increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • atovaquone

              tetracycline decreases levels of atovaquone by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Effect may be minor, due to pharmacodynamic synergism.

            • balsalazide

              tetracycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • bemiparin

              tetracycline increases effects of bemiparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • biotin

              tetracycline will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • bivalirudin

              tetracycline increases effects of bivalirudin by pharmacodynamic synergism. Minor/Significance Unknown.

            • colestipol

              colestipol decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • dalteparin

              tetracycline increases effects of dalteparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • enoxaparin

              tetracycline increases effects of enoxaparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • estradiol vaginal

              tetracycline will increase the level or effect of estradiol vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • fondaparinux

              tetracycline increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • heparin

              tetracycline increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • niacin

              tetracycline will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • pantothenic acid

              tetracycline will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • phenindione

              tetracycline increases effects of phenindione by pharmacodynamic synergism. Minor/Significance Unknown.

            • protamine

              tetracycline increases effects of protamine by pharmacodynamic synergism. Minor/Significance Unknown.

            • pyridoxine

              tetracycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • pyridoxine (Antidote)

              tetracycline will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • rose hips

              tetracycline decreases levels of rose hips by increasing elimination. Minor/Significance Unknown.

            • sucralfate

              sucralfate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • thiamine

              tetracycline will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • verteporfin

              tetracycline, verteporfin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased phototoxicity.

            • warfarin

              tetracycline increases effects of warfarin by pharmacodynamic synergism. Minor/Significance Unknown.

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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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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            tetracycline oral
            -
            500 mg capsule
            tetracycline oral
            -
            250 mg capsule
            tetracycline oral
            -
            500 mg capsule
            tetracycline oral
            -
            500 mg capsule
            tetracycline oral
            -
            250 mg capsule
            tetracycline oral
            -
            250 mg capsule
            tetracycline oral
            -
            500 mg capsule
            tetracycline oral
            -
            250 mg capsule
            tetracycline oral
            -
            500 mg capsule
            tetracycline oral
            -
            250 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            tetracycline topical

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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.
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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.
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            Code Definition
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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.