Doxycycline

Oral Antibiotic

Doxycycline is available only as a prescription oral treatment. It is available in capsule, tablet, suspension (liquid), and syrup forms.

  • Available forms:

    • Oral treatment: 

      • Capsule / Delayed-release capsule:
        Available as prescription
        Generic available (US)
      • Tablet / Delayed-release tablet:
        Available as prescription
        Generic available (US)
      • Suspension (liquid) / Powder for suspension:
        Available as prescription
        Generic available (US)
      • Syrup:
        Available as prescription
        Generic available (US)
    • Brand names:

      • Acticlate®
      • Adoxa®
      • AdoxaCK®
      • Adoxa Pak®
      • Adoxa TT®
      • Acticlate CAP®
      • Doryx®
      • Doryx MPC®
      • Doxychel®*
      • Monodox®
      • Oracea®
      • Periostat®*
      • Vibra-Tabs®*
      • Vibramycin®

* This brand name is no longer available. 

  • Available in these doses:

    • Capsule: 50 mg, 75 mg, 100 mg, 150 mg
    • Delayed-release capsule: 40 mg, 75 mg, 100 mg
    • Tablet: 20 mg, 50 mg, 75 mg, 100 mg, 120 mg, 150 mg, 200 mg
    • Delayed-release tablet: 50 mg, 75 mg, 100 mg, 150 mg, 200 mg
    • Suspension: 25 mg per 5 ml
    • Syrup: 50 mg per 5 ml 

Dosing information:

The dose is normally 50 to 100 mg once or twice per day, or 100 mg once per day. Your physician may decide to prescribe a subantimicrobial dose (a dose less than that needed to kill bacteria but enough to reduce bacteria growth) of 20 mg twice per day (immediate release) or 40 mg once per day (delayed release). 

The duration of doxycycline use should be as short as possible to minimize the risk of side-effects and bacterial resistance. However, make sure to complete the prescribed course in its entirety even if your skin has cleared up before the end of your prescribed course. 

It is recommended that you take doxycycline in addition to your topical acne treatment.

The effect of doxycycline on your acne should be re-evaluated after 3 to 4 months of use. 

  • Who is it for? 

    • Gender:
      • Males and females
    • Severity of acne:
      • Moderate-to-severe
    • Age:
      • Children of 8 years and older, adolescents, and adults 

How to use it:

Doxycycline is an oral treatment and is available in capsule, tablet, and liquid forms and is usually taken once or twice a day.

When taking doxycycline, drink a full glass of water to avoid irritation of the throat. You may take doxycycline with milk or food if your stomach gets upset despite this, however, talk to your physician if you do this as food may interfere with the absorption of doxycycline. 

Follow the instructions on your prescription carefully and use doxycycline exactly as prescribed by your physician. Do not change the dose or the frequency of your medication. Only use the brand of doxycycline prescribed by your physician because different brands may work differently. Talk to your physician when switching between brands. If you have any questions about the medication or the prescription, ask your physician or pharmacist. 

Capsule / Delayed-release capsule

In general, capsules should be swallowed whole. Do not break, crush, chew, or open the capsules. 

Doryx® delayed-release capsules may be opened and the pellets sprinkled onto cold or room temperature applesauce, without losing or crushing any of the pellets. The mixture should be swallowed immediately without chewing, and should then be followed by a glass of cool water to make sure all the pellets are consumed. Do not save the mixture for a later time. 

Oracea® delayed-release capsules should be taken on an empty stomach, preferably an hour before or two hours after a meal. In order to avoid throat irritation, take the capsules with a full glass of water while standing or sitting and do not lie down right after taking the medication. 

Tablet / Delayed-release tablet 

Tablets may be swallowed whole or may be broken. Break the tablet by holding it between your thumb and fingers close to the separation line and applying pressure to the two segments. If the tablet doesn’t break on the scored lines, do not use it. 

You may also sprinkle the equally broken tablets onto cold, soft food such as applesauce. The mixture should then be swallowed without chewing followed by a glass of cool water to make sure all the pieces are swallowed. Do not save the mixture for a later time. 

Suspension (liquid) / Powder for suspension

Before use, the suspension should be shaken well in order to mix the medication evenly. Measure the prescribed amount of suspension using the medicine cup (as provided), a marked measuring spoon, or an oral syringe.

Be aware of: 

  • Before using doxycycline, let your physician or pharmacist know if you are allergic to doxycycline, minocycline, tetracycline, demeclocycline, any other medications, sulfites, or any of the other ingredients in the capsules, tablets, or suspension. 
  • Before using doxycycline, inform your physician about the prescription and non-prescription medications, vitamins, nutritional supplements, and herbal products you are using/taking. You will find a complete list of drug interactions below.
  • The following medications interfere with doxycycline, making it less effective: antacids containing magnesium, aluminium, or calcium, calcium supplements, products containing iron such as multi-vitamin or mineral supplements, and laxatives containing magnesium. Doxycycline should be taken 2 hours before or 6 hours after taking these medications. 
  • Before using doxycycline, inform your physician if you currently suffer from  or have ever suffered from lupus (an inflammatory disease in which the immune system attacks certain tissues such as skin, joints, blood, and kidneys), intracranial hypertension (increased pressure in the skull), oral / vaginal candidiasis (a yeast infection in your mouth or vagina), asthma, diarrhea, kidney or liver disease, or have ever undergone stomach surgery.
  • Doxycycline may reduce the effectiveness of hormonal contraceptives such as birth control pills, patches, rings, or injections. To ensure adequate contraception while on doxycycline ask your physician about other forms of birth control, including condoms, diaphragms, or contraceptive foams or jellies. 
  • Doxycycline may make your skin more sensitive to sunlight so avoid unnecessary direct or prolonged exposure to sunlight, especially between 10am and 3pm, and wear protective clothing, sunglasses, and sunscreen (with an SPF of at least 15) while taking doxycycline. Do not use a sunlamp or tanning bed. Inform your physician if you develop a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn after exposure to the sun. 
  • If you are using doxycycline and are pregnant or are planning on becoming pregnant, talk to your physician about using doxycycline during pregnancy. Doxycycline can harm the fetus.
  • If you are using doxycycline and are breastfeeding, talk to your physician about using doxycycline during this period.
  • If you are about to undergo surgery (which includes dental surgery), inform your physician or dentist that you use doxycycline, prior to the procedure.
  • If doxycycline was prescribed for acne, you can continue your regular diet unless your physician advises otherwise.
  • Do not share your medication with anyone else. 
  • Keep your regular appointments with your physician to track your response to doxycycline.

Drug interactions: 

Some drugs interact with doxycycline and should not be used together with doxycycline. However, your physician may prescribe other drugs together with doxycycline which may cause a slight interaction, and in this case precautions are necessary.

Inform your physician or pharmacist about all the prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take before starting doxycycline. Also inform your physician or pharmacist of the skin products you use, including soaps, cleansers, moisturizers, and cosmetics. 

Drugs that should not be used with doxycycline at all are:

  • Acitretin

Full list of drug interactions (From PubMed and Medline Plus):

  • Aluminium Carbonate
  • Aluminium Hydroxide
  • Aluminium Phosphate
  • Aminolevulinic Acid
  • Amoxicillin
  • Ampicillin
  • Ascorbic Acid
  • Bacampicillin
  • Bexarotene
  • Bismuth Subsalicylate
  • Butabarbital
  • Calcium
  • Carbamazepine
  • Cholera Vaccine, Live
  • Cloxacillin
  • Dexlansoprazole
  • Dicloxacillin
  • Dihydroxyaluminum Aminoacetate
  • Dihydroxyaluminum Sodium Carbonate
  • Esomeprazole
  • Etretinate
  • Iron
  • Isotretinoin
  • Lansoprazole
  • Magaldrate
  • Magnesium Carbonate
  • Magnesium Hydroxide
  • Magnesium Oxide
  • Magnesium Trisilicate
  • Methicillin
  • Methotrexate
  • Methoxyflurane
  • Nafcillin
  • Omeprazole
  • Oxacillin
  • Pantoprazole
  • Penicillin G
  • Penicillin G Benzathine
  • Penicillin G Procaine
  • Penicillin V
  • Phenobarbital
  • Phenytoin
  • Piperacillin
  • Pivampicillin
  • Rabeprazole
  • Rifampin
  • Rifapentine
  • Secobarbital
  • Sultamicillin
  • Temocillin
  • Tretinoin
  • Warfarin

What if I overdose? 

In case of overdose, contact an emergency facility or call the American Association of Poison Control Centers at 1 (800) 222-1222 (available 24/7).

If immediate assistance is necessary because the victim has collapsed, had a seizure, has trouble breathing, or cannot be awakened, call 911 at once.

Information can also be found online at https://www.poisonhelp.org/help

What if I miss a dose?

As soon as you recall that you have missed a dose, take the missed dose. However, skip the missed dose if it is almost time for your next dose and continue with your prescribed dosing schedule. Do not increase the quantity or frequency of dosing to make up for the missed dose. 

Storage:

Store your medication in the container that the pharmacist provided and keep it out of reach and out of sight of children. Many containers can be opened by children. Keep the container tightly closed. Always lock safety caps and immediately place the medication in a safe location that is up and away from the sight of young children, to prevent poisoning (www.upandaway.org).

Store the medication at room temperature. Keep the medication away from excessive heat and moisture – do not store in the bathroom. Do not freeze doxycycline.

Disposal:

Do not keep outdated medication and medication that you no longer use. Unneeded medications should be disposed of in a way that pets, children, and other people cannot consume them. Do not flush the medication down the toilet. Contact your pharmacist to learn about the availability of a medicine take-back program in your neighborhood, or get in touch with your local garbage/recycling department to ensure safe disposal. If you do not have access to a take-back program, you can find more information on safe disposal of medication on the FDA website: (https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm

References
  1. Medlineplus.gov. (2018). Doxycycline: MedlinePlus Drug Information. [online] Available at: https://medlineplus.gov/druginfo/meds/a682063.html [Accessed 23 Apr. 2018].
  2. Ncbi.nlm.nih.gov. (2018). Doxycycline. [online] Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0044904/. [Accessed 23 Apr. 2018].
  3. Toxnet.nlm.nih.gov. (2018). Doxycycline. [online] Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~x5GdKk:5. [Accessed 23 Apr. 2018].
  4. Uptodate.com. (2018). Doxycycline. [online] Available at: https://www-uptodate-com.eresources.mssm.edu/contents/doxycycline-drug-information?search=doxycycline&source=search_result&selectedTitle=1~149&usage_type=default&display_rank=1#F163300. [Accessed 23 Apr. 2018].
  5. Epocrates.com. (2018). Doxycycline. [online] Available at: https://online.epocrates.com/drugs/20310/doxycycline/Monograph. [Accessed 23 Apr. 2018].