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%

Rickettsial Infections

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

Day 1: 200 mg/day PO/IV divided BID (IV may be given qDay), THEN

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

Sexually Transmitted Infections

Lymphogranuloma venereum, uncomplicated urethral, endocervical or rectal infections caused by Chlamydia trachomatis

  • Uncomplicated urethral or endocervical infections
    • 100 mg PO BID or 200 mg PO qDay (delayed-release) x 7 days
    • For empiric therapy, give in combination with single dose of ceftriaxone if patient at high risk for gonorrhea, if follow up is a concern, or if local prevalence of gonorrhea elevated
  • Rectal infections
    • Empiric therapy for acute proctitis or proctocolitis or pathogen-directed therapy for Chlamydia trachomatis (off-label): 100 mg PO BID x 7 days
    • For empiric therapy, give in combination with a single dose of ceftriaxone
    • Lymphogranuloma venereum: Extend duration to 21 days for presumptive therapy of lymphogranuloma venereum if patient has severe rectal symptoms (eg, bloody discharge, tenesmus, perianal ulcers or mucosal ulcers) and a positive rectal chlamydia or HIV infection

Nongonococcal urethritis caused by Ureaplasma urealyticum

  • 100 mg PO BID x 7 day

Granuloma inguinale caused by Klebsiella granulomatis

  • 100 mg PO BID x 3 weeks and until resolution of lesions
  • Consider adding additional antibiotic if symptoms do not improve within first few days

Post-exposure prophylaxis (PEP) (Off-label)

  • Postexposure prophylaxis after unprotected anal sex: 200 mg PO x 1 dose within 24-72 hr after sex among males who have sex with males and transgender women
  • CDC is evaluating doxycycline post-exposure prophylaxis (doxy-PEP) to prevent gonorrhea, chlamydia, and syphilis

Syphilis caused by Treponema pallidum (when penicillin contraindicated)

  • Syphilis (<1 year duration): 100 mg PO BID for 2 weeks
  • Syphilis (≥1 year duration): 100 mg PO BID for 4 weeks
  • Close serologic and clinical follow-up warranted as data are limited

Uncomplicated gonorrhea caused by Neisseria gonorrhoeae

Respiratory Tract Infections

Indications

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

Dosage

  • Day 1: 200 mg/day PO/IV divided BID (IV may be given qDay), THEN
  • Maintenance: 100-200 mg/day PO/IV qDay or divided q12hr PO/IV (IV may be given qDay)

Specific Bacterial Infections

Indications

  • Relapsing fever due to Borrelia recurrentis
  • Plague due to Yersinia pestis
  • Tularemia due to Francisella tularensis
  • Cholera caused by Vibrio cholerae
  • Campylobacter fetus infections caused by Campylobacter fetus
  • Brucellosis due to Brucella species (in conjunction with streptomycin)
  • Bartonellosis due to Bartonella bacilliformis
  • Gram negative microorganisms (eg, Escherichia coli, Enterobacter aerogenes, Shigella species, Acinetobacter species, urinary tract infections caused by Klebsiella species)

Dosage

  • Day 1: 200 mg/day PO/IV divided BID (IV may be given qDay), THEN
  • Maintenance: 100-200 mg/day PO/IV qDay or divided q12hr PO/IV (IV may be given qDay)

Ophthalmic infections

Indicated for trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated as judged by immunofluorescence

Inclusion conjunctivitis caused by Chlamydia trachomatis

Anthrax

Indicated for anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure)

100 mg PO BID for 60 days

Select Infections When Penicillin is Contraindicated

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

  • Yaws caused by Treponema pallidum subspecies pertenue
  • Vincent’s infection caused by Fusobacterium fusiforme
  • Actinomycosis caused by Actinomyces israelii. Infections caused by Clostridium species

Acute Intestinal Amebiasis

Indicated as adjunctive therapy for acute intestinal amebiasis

Day 1: 200 mg/day PO/IV divided BID (IV may be given qDay), THEN

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

Acne Vulgaris

Indicated as adjunctive therapy for severe acne

Immediate-release: 50-100 mg PO BID or 100 mg PO qDay

Extended-release: 100 mg PO BID on day 1, then 100 mg qDay

Low-dose (subantimicrobial) dosing: 20 mg PO BID (immediate-release) or 40 mg PO qDay (delayed-release)

Rosacea

Oracea only

Indicated for treatment of only inflammatory lesions (papules and pustules) of rosacea in adults

20 mg once daily (delayed release; Oracea) or 20 mg twice daily (immediate release)

Malaria

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

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

Periodontal Disease

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

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)

General Dosing Guidelines

≤8 years: Not recommended for mild-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: 120 mg PO q12hr on day 1, followed by maintenance dose of 120 mg/day; may increase frequency to q12hr for more severe infections, particularly chronic UTI

Anthrax

Anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure)

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

>8 years

  • ≤45 kg: 2.2 mg/kg PO/IV q12hr for 60 days (Doryx MPC: 2.6 mg/kg PO q12hr for 60 days)
  • >45 kg: 100 mg PO/IV q12hr for 60 days (Doryx MPC: 120 mg PO q12hr for 60 days)

Malaria

Prophylaxis

  • Indicated for prophylaxis of malaria due to Plasmodium falciparum in short-termtravelers (<4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxineresistant strains
  • 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

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Interactions

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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

            Stevens-Johnson syndrome

            Maculopapular and erythematous rashes

            Angioneurotic edema

            Anaphylaxis

            Anaphylactoid purpura

            Jarisch-Herxheimer reaction in the setting of spirochete infections

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            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            Use of tetracyclines during tooth development (last half of pregnancy through age 8 years) can cause permanent discoloration of teeth; this adverse reaction is more common during long-term use but has been observed following repeated short-term courses; enamel hypoplasia has also been reported

            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 (eg, anthrax, Rocky Mountain spotted fever); particularly when there are no alternative therapies

            Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, and may range in severity from mild diarrhea to fatal colitis

            Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines

            May result in overgrowth of non-susceptible organisms, including fungi. If such infections occur, discontinue use and institute appropriate therapy

            Severe skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) reported; if severe skin reactions occur, discontinue therapy immediately and institute appropriate therapy

            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 until they stabilize

            All tetracyclines form a stable calcium complex in any bone-forming tissue; decrease in fibula growth rate has been observed in prematures given an oral tetracycline; reaction was shown to be reversible when the drug was discontinue

            Antianabolic action of the tetracyclines may cause an increase in BUN; studies to date indicate that this does not occur with the use of doxycycline in patients with impaired renal function

            Doxycycline offers substantial but not complete suppression of the asexual blood stages of Plasmodium strains

            Prescribing doxycycline in the absence of a 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

            In long-term therapy, periodic laboratory evaluation of organ systems, including hematopoietic, perform renal and hepatic studies

            Drug interaction overview

            • Because tetracyclines have been shown to depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage
            • Since bacteriostatic drugs may interfere with the bactericidal action of penicillin, it is advisable to avoid giving tetracyclines in conjunction with penicillin
            • Absorption of tetracyclines is impaired by antacids containing aluminum, calcium, or magnesium, bismuth subsalicylate, and iron-containing preparations
            • Concurrent use of tetracyclines, may render oral contraceptives less effective
            • Barbiturates, carbamazepine, and phenytoin decrease the half-life of doxycycline
            • Coadministration of tetracycline and methoxyflurane has been reported to result in fatal renal toxicity
            • False elevations of urinary catecholamines may occur due to interference with the fluorescence test
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            Pregnancy & Lactation

            Pregnancy

            Therapy may cause discoloration deciduous teeth, and reversible inhibition of bone growth when administered during second and third trimester of pregnancy, infancy, and childhood

            All tetracyclines form a stable calcium complex in any bone-forming tissue; a decrease in fibula growth rate has been observed in premature human infants given oral tetracycline in doses of 25 mg/kg every 6 hours; this reaction was shown to be reversible when drug was discontinued

            Available data from published studies over decades have not shown a difference in major birth defect risk compared to unexposed pregnancies with doxycycline exposure in first trimester of pregnancy

            The vast majority of reported experience during human pregnancy is short-term, first trimester exposure; there are no human data available to assess effects of long-term therapy in pregnant women such as that proposed for treatment of anthrax exposure

            An expert review of published data on experiences with doxycycline use during pregnancy concluded that therapeutic doses during pregnancy are unlikely to pose substantial teratogenic risk (the quantity and quality of data were assessed as limited to fair), but the data are insufficient to state that there is no risk; there are no adequate and well-controlled studies on use of drug in pregnant women

            A small prospective study of 81 pregnancies describes 43 pregnant women treated for 10 days with doxycycline during early first trimester; all mothers reported their exposed infants were normal at 1 year of age

            There are no available data on risk of miscarriage following exposure to doxycycline in pregnancy; evidence of embryotoxicity also has been noted in animals treated early in pregnancy; advise patient of potential risk to fetus if drug is used during pregnancy

            Based on findings from a fertility study in animals, doxycycline may impair female and male fertility; the reversibility of this finding is unclear

            Lactation

            Based on available published data, doxycycline is present in human milk; there are no data that inform about levels of doxycycline in breastmilk, effects on breastfed infant, or on milk production

            Short-term use by lactating women not necessarily contraindicated; effects of prolonged exposure to doxycycline in breast milk are unknown; because of potential for serious adverse reactions in nursing infants from drug, the developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for this medication and any potential adverse effects on the breastfed child from the drug or from the underlying maternal condition

            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 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

            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

            Periodontal Preparation (Atridox)

            If refrigerated, remove Atridox from refrigeration at least 15 minutes prior to mixing

            Inject liquid contents of Syringe A (indicated by red stripe) into Syringe B (doxycycline powder) and then push the contents back into Syringe A

            Complete 100 mixing cycles at a pace of 1 cycle per second using brisk strokes

            Subgingival Administration (Atridox)

            Does not require local anesthesia for subgingival placement

            If desired, using an appropriate dental instrument, may be packed into the pocket

            Dipping the edge of the instrument in water before packing will help keep Atridox from sticking to the instrument, and will help speed coagulation of Atridox

            A few drops of water dripped onto the surface of Atridox once in the pocket will also aid in coagulation; if necessary, add more Atridox as described above and pack it into the pocket until the pocket is full

            Storage

            Tablets or capsules: Store at 20-25ºC (68-77ºF) excursions permitted to 15-30ºC (59-86ºF); protect from light and moisture; dispense in a tight, light-resistant container

            Atridox: Store at 2-30ºC (36-86ºF)

            Vibramycin (all formulations): Store <30ºC (86ºF) and dispensed in tight, light-resistant containers

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            doxycycline monohydrate oral
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            25 mg/5 mL suspension
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            75 mg capsule
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            doxycycline monohydrate oral
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            doxycycline monohydrate oral
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            100 mg tablet
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            75 mg tablet
            doxycycline monohydrate oral
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            100 mg tablet
            doxycycline monohydrate oral
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            150 mg capsule
            doxycycline monohydrate oral
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            100 mg tablet
            doxycycline monohydrate oral
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            50 mg tablet
            doxycycline monohydrate oral
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            100 mg capsule
            doxycycline monohydrate oral
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            50 mg capsule
            doxycycline monohydrate oral
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            150 mg capsule
            doxycycline monohydrate oral
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            75 mg capsule
            doxycycline monohydrate oral
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            25 mg/5 mL suspension
            doxycycline monohydrate oral
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            150 mg tablet
            doxycycline monohydrate oral
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            50 mg tablet
            doxycycline monohydrate oral
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            100 mg capsule
            doxycycline monohydrate oral
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            50 mg tablet
            doxycycline monohydrate oral
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            25 mg/5 mL suspension
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
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            100 mg capsule
            doxycycline monohydrate oral
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            50 mg capsule
            doxycycline monohydrate oral
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            150 mg tablet
            doxycycline monohydrate oral
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            75 mg tablet
            doxycycline monohydrate oral
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            100 mg tablet
            doxycycline monohydrate oral
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            100 mg tablet
            doxycycline monohydrate oral
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            50 mg tablet
            Vibramycin (mono) oral
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            25 mg/5 mL suspension
            Monodox oral
            -
            100 mg capsule
            Monodox oral
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            50 mg capsule
            Monodox oral
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            75 mg capsule
            Avidoxy oral
            -
            100 mg tablet
            Oracea oral
            -
            40 mg capsule

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            Patient Handout

            Patient Education
            doxycycline monohydrate oral

            DOXYCYCLINE - ORAL

            (dox-ee-SYE-kleen)

            COMMON BRAND NAME(S): Acticlate, Monodox, Vibra-Tabs, Vibramycin

            USES: This medication is used to treat a wide variety of bacterial infections, including those that cause acne. This medication is also used to prevent malaria. This medication is known as a tetracycline antibiotic. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

            HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking doxycycline and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is best taken by mouth on an empty stomach, at least 1 hour before or 2 hours after a meal, usually 1 or 2 times daily or as directed by your doctor. Take this medication with a full glass of water (8 ounces/240 milliliters) unless directed otherwise. If stomach upset occurs, taking it with food or milk may help. However, doxycycline may not work as well if you take it with food or milk (or anything high in calcium - more details below ), so ask your doctor or pharmacist if you may take it that way. Do not lie down for at least 10 minutes after taking this medication.Take this medication 2 to 3 hours before or after taking any products containing aluminum, calcium, iron, magnesium, zinc, or bismuth subsalicylate. Some examples include antacids, didanosine solution, quinapril, vitamins/minerals, dairy products (such as milk, yogurt), and calcium-enriched juice. These products bind with doxycycline, preventing your body from fully absorbing the drug.When using to prevent malaria, this medication is usually taken once daily. Take the first dose of this medication 1 to 2 days before travel or as directed by your doctor. Continue to take this medication daily while in the malarious area. Upon returning home, you should keep taking this medication for 4 more weeks. If you are unable to finish this course of doxycycline, contact your doctor.If you are using the liquid form of this medication, shake the bottle well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition and response to treatment. For children, the dosage may also be based on weight.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition lasts or gets worse.

            SIDE EFFECTS: Stomach upset, diarrhea, nausea, or vomiting may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: painful/difficult swallowing, signs of kidney problems (such as change in the amount of urine).Tetracycline drugs such as doxycycline may rarely cause increased pressure around the brain (intracranial hypertension-IH). The risk of this side effect is greater for women of childbearing age who are overweight or who have had IH in the past. If IH develops, it usually goes away after doxycycline is stopped; however, there is a chance of permanent vision loss or blindness. Get medical help right away if you have: headache that is severe or doesn't go away, nausea/vomiting that doesn't stop, vision changes (such as blurred/double vision, decreased vision, sudden blindness).This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever that doesn't go away, new or worsening lymph node swelling, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or 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: See also Side Effects section.Before taking doxycycline, tell your doctor or pharmacist if you are allergic to it; or to other tetracyclines (such as minocycline); or if you have any other allergies. This product may contain inactive ingredients (such as sulfites, soy found in some brands), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: trouble swallowing, esophagus problems (such as hiatal hernia or reflux/heartburn).Doxycycline may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using doxycycline before having any immunizations/vaccinations.Before having surgery, tell your doctor or dentist that you are taking this medication.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Children younger than 8 years may be more sensitive to the side effects of doxycycline, especially tooth discoloration. Tooth discoloration has also occurred in older children and young adults. Discuss the risks and benefits of this medication with the doctor.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using doxycycline. Doxycycline may harm an unborn baby. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.This medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: retinoid medications taken by mouth (such as acitretin, isotretinoin), barbiturates (such as phenobarbital), "blood thinners" (such as warfarin), digoxin, anti-seizure medications (such as phenytoin), strontium.This medication may interfere with certain laboratory tests (including urine catecholamine levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            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: Do not share this medication with others.If this medication is being used to prevent malaria, it is important to understand that it is still possible to get the disease even if you have used this medication. Avoid being bitten by mosquitoes when trying to prevent malaria. Avoid contact with mosquitoes, especially from dusk to dawn, by staying in well-screened areas, wearing protective clothing, and using insect repellent and bed nets.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Lab and/or medical tests (such as complete blood count, liver/kidney function) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Do not store in the bathroom. Keep all medications away from children and pets.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. Taking outdated tetracycline-related drugs can result in serious illness. Consult your pharmacist or local waste disposal company.

            Information last revised December 2022. Copyright(c) 2022 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.
            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.