Doxycycline (Lexi-Drugs)

Drug Shortages

One or more forms of this drug may be in short supply or unavailable. Refer to the following for additional information:

ASHP: http://www.ashp.org/menu/DrugShortages

Pronunciation

(doks i SYE kleen)

Brand Names: US

Acticlate; Adoxa Pak 1/100 [DSC]; Adoxa Pak 1/150 [DSC]; Adoxa Pak 2/100 [DSC]; Adoxa [DSC]; Alodox Convenience [DSC]; Avidoxy; Doryx; Doryx MPC; Doxy 100; Mondoxyne NL; Monodox [DSC]; Morgidox; Ocudox [DSC]; Okebo; Oracea; Soloxide; TargaDOX; Vibramycin

Brand Names: Canada

APO-Doxy; Apprilon; DOM-Doxycycline [DSC]; Doxycin; Doxytab; NTP-Doxycycline [DSC]; Periostat; PHL-Doxycycline [DSC]; PMS-Doxycycline; TEVA-Doxycycline; Vibramycin [DSC]

Pharmacologic Category

Antibiotic, Tetracycline Derivative

Dosing: Adult

Note: Doxycycline is available as hyclate, monohydrate, and calcium salts. All doses are expressed as doxycycline base.

Usual dosage range:

Oral: Immediate-release and most extended-release formulations: 100 to 200 mg/day in 1 to 2 divided doses. Note: 120 mg of modified polymer coated tablet (Doryx MPC) is equivalent to 100 mg conventional delayed-release tablet.

IV: 100 mg every 12 hours. Note: IV form may cause phlebitis.

Acne vulgaris (moderate to severe, inflammatory) (off-label dose): Oral: Note: Use as an adjunct to topical acne therapy (AAD [Zaenglein 2016]).

Immediate release: 50 to 100 mg twice daily or 100 mg once daily (AAD [Zaenglein 2016]; Graber 2017)

Extended release: 100 mg twice daily on day 1, then 100 mg once daily (AAD [Zaenglein 2016]; Graber 2017)

Subantimicrobial dosing: 20 mg twice daily (immediate release) or 40 mg once daily (delayed release) (Moore 2015; Skidmore 2003)

Duration: Use the shortest possible duration to minimize risk of adverse effects and development of bacterial resistance; re-evaluate at 3 to 4 months (AAD [Zaenglein 2016]).

Anaplasmosis and ehrlichiosis (off-label use): Oral, IV: 100 mg twice daily for 10 days (IDSA [Wormser 2006]) or at least 3 days after resolution of fever (CDC [Biggs 2016])

Anthrax: Note: Consult public health officials for event-specific recommendations.

Inhalational exposure (postexposure prophylaxis): Oral: 100 mg every 12 hours for 60 days (CDC [Hendricks 2014])

Cutaneous (without systemic involvement), treatment: Oral: 100 mg every 12 hours for 7 to 10 days after naturally acquired infection; treat for 60 days for bioterrorism-related cases (CDC [Hendricks 2014]). Note: Patients with cutaneous lesions of the head or neck or extensive edema should be treated for systemic involvement.

Systemic (meningitis excluded; alternative agent), treatment: IV: Initial: 200 mg as a single dose, then 100 mg every 12 hours, in combination with a bactericidal agent; treat for 2 weeks or until clinically stable, whichever is longer. Note: Following a course of IV combination therapy, patients exposed to aerosolized spores require oral doxycycline monotherapy to complete an antimicrobial course of 60 days (CDC [Hendricks 2014]).

Bartonella spp. infection:

HIV-infected (off-label use): Note: Duration of therapy is at least 3 months; continuation of therapy depends on relapse occurrence and clinical condition (HHS [OI adult 2017]).

Bacillary angiomatosis, peliosis hepatis, bacteremia, and osteomyelitis: Oral, IV: 100 mg every 12 hours

CNS infections: Oral, IV: 100 mg every 12 hours; may add rifampin therapy

Endocarditis, confirmed: Oral, IV: 100 mg IV every 12 hours in combination with gentamicin for 2 weeks, then continue with doxycycline 100 mg IV or orally every 12 hours

Other severe infections: Oral, IV: 100 mg every 12 hours in combination with rifampin

HIV-uninfected:

Bacteremia without endocarditis: Oral: 200 mg once daily or 100 mg twice daily for 4 weeks with gentamicin once daily for first 2 weeks (Foucault 2003; Rolain 2004)

Cat-scratch disease, CNS infection, and neuroretinitis: Oral, IV: 100 mg twice daily in combination with rifampin (Rolain 2004)

Endocarditis, confirmed: Oral: 100 mg every 12 hours for 6 to 12 weeks with gentamicin for first 2 weeks (Rolain 2004; Spach 2017)

Bite-wound infection, prophylaxis or treatment (animal and human bites; alternative agent) (off-label use): Oral, IV: 100 mg twice daily. Duration is 3 to 5 days for prophylaxis; duration of treatment for established infection varies based on patient-specific factors (IDSA [Stevens 2014]). Note: Some experts use in combination with an appropriate agent for anaerobes (Harper 2017).

Brucellosis:

Treatment:

Endocarditis or neurobrucellosis: Limited data available: IV, Oral: 100 mg twice daily as part of a combination regimen (Bosilkovski 2017; Jia 2017; Zheng 2017)

Uncomplicated (nonfocal): Oral: 100 mg twice daily plus rifampin for 6 weeks or 100 mg twice daily for 6 weeks plus gentamicin for the first 5 to 14 days (Ariza 2007; Hasanjani Roushan 2006; Skalsky 2008)

Spondylitis: Oral: 100 mg twice daily for at least 12 weeks plus streptomycin for the first 14 to 21 days (Skalsky 2008)

Postexposure prophylaxis (high-risk laboratory exposure): Oral: 100 mg twice daily with rifampin for 3 weeks (CDC 2012); for exposure to B. abortus RB51 strains, some experts give doxycycline plus trimethoprim-sulfamethoxazole (Bosilkovski 2017)

Cellulitis, mild to moderate (outpatient treatment; empiric coverage of MRSA) (off-label use): Oral: 100 mg twice daily for 5 to 14 days (IDSA [Liu 2011; Stevens 2014]). Note: For empiric therapy of nonpurulent cellulitis, an additional agent (eg, amoxicillin, cephalexin) for coverage of beta-hemolytic streptococci is needed.

Cholera (Vibrio cholerae), treatment (adjunctive therapy for severely ill patients): Oral: 300 mg as a single dose. Note: Due to resistance concerns, antimicrobial therapy during an outbreak or epidemic should be guided by isolate susceptibility (CDC 2015; WHO 2010).

Lyme disease (Borrelia spp. infection) (off-label use): Oral:

Prophylaxis: 200 mg as a single dose. Note: Prophylaxis is used only in patients who meet all of the following criteria: Deer tick attached for ≥36 hours, prophylaxis can be given within 72 hours of tick removal, local rate of deer tick infection with Borrelia burgdorferi is ≥20%, and there are no contraindications to doxycycline (Hu 2017; IDSA [Wormser 2006]).

Treatment, early localized (eg, erythema migrans): 100 mg twice daily for 10 to 21 days (IDSA [Wormser 2006])

Treatment, arthritis without neurologic involvement (early or late disease): 100 mg twice daily for 28 days (Hu 2017; IDSA [Wormser 2006])

Treatment, early disseminated, mild neurologic involvement (isolated facial nerve palsy): 100 mg twice daily for 14 to 28 days (Hu 2017; IDSA [Wormser 2006]). Note: Not recommended for serious neurologic disease (Hu 2017; IDSA [Wormser 2006]).

Malaria:

Chemoprophylaxis in travelers: Oral (immediate release and delayed release): 100 mg daily; initiate 1 to 2 days prior to travel to endemic area; continue daily during travel and for 4 weeks after leaving endemic area.

Uncomplicated malaria, treatment (chloroquine resistant or unknown resistance; alternative agent) (off-label use): Oral: 100 mg twice daily for 7 days in combination with quinine sulfate (plus primaquine for Plasmodium vivax). Note: Quinine sulfate duration is region specific; consult CDC for current recommendations (CDC 2013).

Severe malaria, treatment (alternative agent) (off-label use): IV, Oral: 100 mg every 12 hours for 7 days in combination with quinidine gluconate. Note: IV therapy should be administered for at least 24 hours or until oral medication tolerated; quinidine gluconate duration is region specific; consult CDC for current recommendations (CDC 2013).

Periodontitis, chronic: Subantimicrobial dosing: Oral: 20 mg twice daily (immediate release) for 3 to 9 months as an adjunct to scaling and root planing (Smiley 2015)

Plague (Yersinia pestis) (alternative agent): Oral, IV: 200 mg initially then 100 mg twice daily or 200 mg once daily for 10 to 14 days and at least until 2 days after patient has defervesced (CDC 2015; IDSA [Stevens 2014]; Inglesby 2000; Sexton 2017a)

Pleurodesis, chemical (sclerosing agent for pleural effusion) (off-label use): Intrapleural: 500 mg as a single dose in 30 to 100 mL NS (Porcel 2006; Robinson 1993); may require a repeat dose (Kvale 2007); some experts combine with or administer following instillation of a local anesthetic (eg, lidocaine, 10 mL [100 mg] of 1% solution [Robinson 1993] or mepivacaine 20 mL [400 mg] of 2% solution [Porcel 2006])

Pneumonia, community-acquired (alternative agent): Outpatients or inpatients (non-ICU): Oral, IV: 100 mg twice daily for 5 to 7 days. For empiric therapy of inpatients, use in combination with another appropriate agent (eg, antipneumococcal beta-lactam) (IDSA/ATS [Mandell 2007]).

Prosthetic joint infection (off-label use): Treatment (following pathogen-specific IV therapy in patients undergoing 1-stage exchange or debridement with retention of prosthesis): Oral:

Note: Duration ranges from a minimum of 3 months to indefinitely, depending on patient-specific factors (Berbari 2018).

Staphylococci: 100 mg twice daily. For the first 3 to 6 months of therapy, combine with rifampin (Berbari 2018; IDSA [Osmon 2013]).

Cutibacterium acnes (alternative agent): 100 mg twice daily (IDSA [Osmon 2013]; Kanafani 2018).

Q fever: Oral:

Acute: 100 mg every 12 hours for 14 days (CDC [Anderson 2013]). Note: In patients with valvulopathy/cardiomyopathy, some experts recommend extending treatment to 12 months in combination with hydroxychloroquine to prevent progression to persistent infection (Million 2013; Raoult 2017).

Persistent localized infection (endocarditis, vascular infection): Oral: 100 mg every 12 hours in combination with hydroxychloroquine for ≥18 months depending on site of infection and serologic response (CDC [Anderson 2013])

Rhinosinusitis, acute bacterial (alternative agent for beta-lactam intolerance) (off-label use): Oral: 200 mg/day in 1 to 2 divided doses for 5 to 7 days (IDSA [Chow 2012]). Note: In uncomplicated acute bacterial rhinosinusitis, initial observation and symptom management without antibiotic therapy is appropriate in most patients (ACP/CDC [Harris 2016]).

Rocky Mountain spotted fever: Oral, IV: 100 mg twice daily for 5 to 7 days or for at least 3 days after fever subsides, whichever is longer; initiate treatment as soon as possible. Severe or complicated disease may require longer treatment (CDC [Biggs 2016]). Note: A loading dose of 200 mg IV is recommended for critically ill patients (Sexton 2017b).

Rosacea, moderate to severe or unresponsive to topical therapy: Oral:

Traditional dosing (off-label dose): Initial: 50 to 100 mg twice daily for 4 to 12 weeks; may follow with a topical agent and/or subantimicrobial doxycycline dosing for long-term management. Alternatively, may initiate therapy with subantimicrobial dosing (Maier 2017)

Subantimicrobial dosing: 40 mg once daily (delayed release; Oracea) or 20 mg twice daily (immediate release) (Sanchez 2005)

Sexually transmitted infections:

Cervicitis or urethritis:

Chlamydia trachomatis: Oral: 100 mg twice daily for 7 days (CDC [Workowski 2015]) or 200 mg delayed release once daily for 7 days (Geisler 2012); consider concurrent treatment for gonorrhea with a single dose of ceftriaxone based on individual risk factors, if local prevalence is elevated (>5%), or if intracellular gram-negative diplococci on Gram stain (CDC [Workowski 2015]; Marrazzo 2017). Note: Directly observed single-dose azithromycin is preferred for the treatment of uncomplicated genital chlamydial infections by some experts (Marrazzo 2017).

Neisseria gonorrhea (alternative agent [due to resistance]; reserve for patients with azithromycin intolerance): Oral: 100 mg twice daily for 7 days in combination with a single dose of ceftriaxone (CDC [Workowski 2015])

Epididymitis, acute (off-label use): Empiric or pathogen-directed therapy for chlamydia and/or gonorrhea: Oral: 100 mg twice daily for 10 days with single dose of ceftriaxone (CDC [Workowski 2015]). Note: An alternative regimen is recommended in patients whose sexual practices increase risk of infection with enteric pathogens (Eyre 2017; Marrazzo 2017).

Granuloma inguinale (donovanosis) (alternative agent): Oral: 100 mg twice daily for at least 3 weeks and until all lesions have healed. Note: If symptoms do not improve within the first few days of therapy, another agent (eg, aminoglycoside) can be added (CDC [Workowski 2015]).

Lymphogranuloma venereum (LGV): Oral: 100 mg twice daily for 21 days (CDC [Workowski 2015])

Pelvic inflammatory disease (off-label use):

Inpatient (severe PID): IV, Oral: 100 mg every 12 hours in combination with cefoxitin or cefotetan; transition to oral therapy after >24 hours improvement to complete a 14-day total course. If pelvic abscess, anaerobic coverage is warranted (CDC [Workowski 2015]).

Outpatient (mild to moderate PID): Oral: 100 mg every 12 hours for 14 days in combination with a single dose of ceftriaxone (preferred) (Wiesenfeld 2017) or single dose of cefoxitin plus oral probenecid or other third generation cephalosporin; if Trichomonas vaginalis or recent uterine instrumentation, add metronidazole (CDC [Workowski 2015]).

Proctitis, acute or proctocolitis (off-label use): Empiric or pathogen-directed therapy for chlamydia and/or gonorrhea: Oral: 100 mg twice daily for 7 days plus a single dose of ceftriaxone. Note: Provide 21 days of doxycycline if polymerase chain reaction (PCR) for LGV confirmed or as presumptive therapy for LGV if patient has severe rectal symptoms (eg, bloody discharge, perianal ulcers, or mucosal ulcers), and either a positive rectal chlamydia NAAT or HIV infection. Additional coverage for herpes simplex virus is warranted in patients with perianal or mucosal ulcers (CDC [Workowski 2015], Zenilman 2017).

Syphilis, penicillin-allergic patients: Note: Limited data support use of alternatives to penicillin and close serologic and clinical follow up is warranted (CDC [Workowski 2015]; Hicks 2017).

Early syphilis (primary, secondary, and early latent): Oral: 100 mg twice daily for 14 days

Late syphilis (late latent): Oral: 100 mg twice daily for 28 days

Surgical prophylaxis, uterine evacuation (induced abortion or pregnancy loss) (off-label use): Oral: 200 mg as a single dose 1 hour prior to uterine aspiration (ACOG 2018)

Tularemia (Francisella tularensis):

Treatment (mild infection): Oral: 100 mg twice daily for ≥14 days (IDSA [Stevens 2014])

Postexposure prophylaxis (nonbioterrorism event, high-risk exposure): Oral: 100 mg twice daily for 14 days (Penn 2017)

Bioterrorism event: Note: Consult public health officials for event-specific recommendations.

Mass casualty management or postexposure prophylaxis (when used as a biological weapon): Oral: 100 mg twice daily for 14 days (Dennis 2001)

Contained casualty management (when used as a biological weapon): IV (may transition to oral if clinically appropriate): 100 mg every 12 hours for 14 to 21 days (Dennis 2001)

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

No dosage adjustment necessary.

Dialysis: Poorly dialyzed (0% to 5%); no supplemental dose or dosage adjustment necessary, including patients on intermittent hemodialysis, peritoneal dialysis, or continuous renal replacement therapy (eg, CVVHD).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

General dosing: Children ≥8 years and Adolescents: Oral, IV: 2.2 mg/kg/dose every 12 hours, maximum daily dose: 200 mg/day

Anthrax (AAP [Bradley 2014]):

Prophylaxis; post-exposure (inhalation or cutaneous); prior to susceptibility testing or penicillin-resistant strains: Note: Doxycycline is a preferred option or ciprofloxacin: Infants, Children, and Adolescents: Treatment duration: 60 days

Patient weight <45 kg: Oral: 2.2 mg/kg/dose every 12 hours

Patient weight ≥45 kg: Oral: 100 mg every 12 hours

Treatment; susceptible strains:

Cutaneous infection without systemic involvement: Note: Doxycycline is an option if first-line therapy (ie, ciprofloxacin) is unavailable or patient unable to tolerate; for naturally-occurring infection, usual treatment duration is 7 to 10 days; in the event of biological weapon exposure, additional therapy (as prophylaxis for inhaled spores) is necessary for a total course of 60 days from onset of illness.

Infants, Children, and Adolescents:

Patient weight <45 kg: Oral: 2.2 mg/kg/dose every 12 hours

Patient weight ≥45 kg: Oral: 100 mg every 12 hours

Systemic anthrax, excluding meningitis: Note: Not recommended for meningitis or disseminated infection when meningitis cannot be ruled out. Doxycycline is an alternative to clindamycin as protein synthesis inhibitor and should be used in combination with a bactericidal antimicrobial (eg, fluoroquinolone, carbapenem, or vancomycin). Duration of therapy at least 14 days or longer until patient clinically stable; additional therapy (as prophylaxis for inhaled spores) is necessary for a total course of 60 days from onset of illness.

Infants, Children, and Adolescents:

Patient weight <45 kg:

Initial: IV: Loading dose: 4.4 mg/kg once, then 2.2 mg/kg/dose every 12 hours; may transition to oral therapy for patients without signs of active infection who are able to tolerate oral therapy and patient/caregiver adherent to therapy.

Step-down: Oral: 2.2 mg/kg/dose every 12 hours

Patient weight ≥45 kg:

Initial: IV: Loading dose: 200 mg once, then 100 mg every 12 hours; may transition to oral therapy for patients without signs of active infection who are able to tolerate oral therapy and patient/caregiver adherent to therapy.

Step-down: Oral: 100 mg every 12 hours

Brucellosis: Limited data available: Children ≥8 years and Adolescents: Oral: 1 to 2 mg/kg/dose twice daily for 6 weeks; maximum dose: 100 mg/dose; use in combination with rifampin or an aminoglycoside (Red Book [AAP 2015])

Chlamydial infections, uncomplicated (sexually transmitted C. trachomatis): Adolescents: Oral: 100 mg twice daily for 7 days (CDC [Workowski 2015])

Lyme disease: Limited data available (IDSA [Wormser 2006]): Children ≥8 years and Adolescents:

Prophylaxis, postexposure: Oral: 4 mg/kg/dose once as a single dose; maximum dose: 200 mg/dose; initiate within 72 hours of tick removal

Treatment:

Early Lyme disease: Oral: 2 mg/kg/dose twice daily for 10 to 21 days (usual duration: 14 days); maximum dose: 100 mg/dose

Lyme arthritis (no neurologic involvement): Oral: 2 mg/kg/dose twice daily for 28 days; maximum dose: 100 mg/dose

Meningitis, neurologic Lyme disease: Oral: 2 to 4 mg/kg/dose twice daily for 10 to 28 days; maximum dose: 200 mg/dose

Malaria: Children ≥8 years and Adolescents:

Prophylaxis: Oral: 2.2 mg/kg/dose once daily starting 1 to 2 days before travel to the area with endemic infection, continuing daily during travel and for 4 weeks after leaving endemic area; maximum daily dose: 100 mg/day

Treatment: Oral, IV: 2.2 mg/kg/dose twice daily for 7 days; maximum dose: 100 mg/dose (CDC 2013); for uncomplicated cases, combination therapy with quinine sulfate is recommended; in severe cases, combination therapy with quinidine gluconate should be used; Note: Duration of either quinine sulfate or quinidine gluconate is region-specific; consult CDC for current recommendations.

Pneumoniacommunity-acquired; presumed or proven atypical infection (Mycoplasma pneumoniae, Chlamydophila pneumoniae)Children ≥8 years and Adolescents: Oral: 1 to 2 mg/kg/dose twice daily for 10 days (IDSA [Bradley 2011])

Q fever (Coxiella burnetii) (preferred therapy): Children and Adolescents: Oral: 2.2 mg/kg/dose twice daily for 14 days; maximum dose: 100 mg/dose; in children <8 years with mild or uncomplicated disease, may consider treatment duration of 5 days, and if longer treatment required, may consider alternate therapy (trimethoprim/sulfamethoxazole) (CDC [Anderson 2013])

Skin/soft tissue infections; MRSA or community-acquired cellulitis (purulent) (IDSA [Liu 2011]): Children ≥8 years and Adolescents:

≤45 kg: Oral: 2 mg/kg/dose every 12 hours for 5 to 10 days

>45 kg: Oral: 100 mg twice daily for 5 to 10 days

Tickborne rickettsial disease (Rocky Mountain spotted fever), ehrlichiosis, or anaplasmosis: Children and Adolescents: Oral, IV: 2.2 mg/kg/dose every 12 hours; maximum dose: 100 mg/dose; treat for minimum of 5 to 7 days; continue for at least 3 days after defervescence and clinical improvement observed. Severe or complicated disease may require longer treatment; anaplasmosis should be treated for 10 days (CDC [Biggs 2016]).

Dosing: Renal Impairment: Pediatric

No adjustment necessary; poorly dialyzed (0% to 5%).

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer’s labeling.

Use: Labeled Indications

Acne: Adjunctive therapy in severe acne.

Actinomycosis: Treatment of actinomycosis caused by Actinomyces israelii when penicillin is contraindicated.

Acute intestinal amebiasis: Adjunct to amebicides in acute intestinal amebiasis.

Anthrax, including inhalational anthrax (postexposure): Treatment of anthrax caused by Bacillus anthracis, including inhalational (postexposure) prophylaxis; to reduce the incidence or progression of disease following exposure to aerosolized B. anthracis.

Cholera: Treatment of cholera infections caused by Vibrio cholerae.

Clostridium: Treatment of infections caused by Clostridium spp. when penicillin is contraindicated.

Gram-negative infections: Treatment of infections caused by Escherichia coliEnterobacter aerogenesShigella spp., Acinetobacter spp., Klebsiella spp. (respiratory and urinary infections), and Bacteroides spp.; Neisseria meningitidis (when penicillin is contraindicated).

Gram-positive infections: Treatment of infections caused by Streptococcus spp., when susceptible.

Listeriosis: Treatment of listeriosis due to Listeria monocytogenes when penicillin is contraindicated.

Malaria prophylaxis: Prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (under 4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine-resistant strains.

Mycoplasma pneumoniae: Treatment of infections caused by Mycoplasma pneumoniae.

Ophthalmic infections: Treatment of inclusion conjunctivitis or trachoma caused by Chlamydia trachomatis.

Periodontitis (20 mg tablet and capsule [Periostat (Canadian product)] only): Adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in patients with adult periodontitis.

Relapsing fever: Treatment of relapsing fever caused by Borrelia recurrentis.

Respiratory tract infections: Treatment of respiratory infections caused by Haemophilus influenzaeKlebsiella spp., or Mycoplasma pneumoniae; treatment of upper respiratory tract infections caused by Streptococcus pneumoniae; respiratory infections caused by Staphylococcus aureus (doxycycline is not the drug of choice in the treatment of any type of staphylococcal infection).

Rickettsial infections: Treatment of Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae.

Rosacea (Oracea, Apprilon [Canadian product] only): Treatment of only inflammatory lesions (papules and pustules) of rosacea in adults.

Sexually transmitted infections: Treatment of lymphogranuloma venereum and uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis; granuloma inguinale (donovanosis) caused by Klebsiella granulomatis; chancroid caused by Haemophilus ducreyi; nongonococcal urethritis caused by Ureaplasma urealyticum; when penicillin is contraindicated, uncomplicated gonorrhea caused by Neisseria gonorrhea and syphilis caused by Treponema pallidum.

Note: The CDC sexually transmitted disease guidelines recommend dual antimicrobial therapy be used for uncomplicated gonorrhea due to N. gonorrhea resistance concerns; ceftriaxone is the preferred cephalosporin and doxycycline is an alternative option for the second antimicrobial only in cases of azithromycin allergy (CDC [Workowski 2015]).

Skin and skin structure infections (Avidoxy only): Treatment of skin and skin structure infections caused by Staphylococcus aureus (doxycycline is not the drug of choice in the treatment of any type of staphylococcal infection).

Vincent infection: Treatment of Vincent infection caused by Fusobacterium fusiforme when penicillin is contraindicated.

Yaws: Treatment of yaws caused by Treponema pallidum subspecies pertenue when penicillin is contraindicated.

Zoonotic infections: Treatment of psittacosis (ornithosis) caused by Chlamydophila psittaci; plague due to Yersinia pestis; tularemia caused by Francisella tularensis; brucellosis caused by Brucella spp. (in conjunction with streptomycin); bartonellosis caused by Bartonella bacilliformis; infections caused by Campylobacter fetus.

Use: Off-Label: Adult

  Anaplasmosis and ehrlichiosisLevel of Evidence [G]

Based on the IDSA guidelines for the clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis (HGA) and babesiosis and the Centers for Disease Control and Prevention (CDC) guideline for the diagnosis and management of tickborne rickettsial diseases, doxycycline is effective and recommended for the treatment of human anaplasmosis (also known as human granulocytic anaplasmosis [HGA]) and human ehrlichiosis.

  Bartonella infections in HIV-infected patientsLevel of Evidence [G]

Based on the US Department of Health and Human Services (HHS) guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents, doxycycline is a recommended and effective agent for treatment of bacillary angiomatosis, peliosis hepatis, bacteremia, osteomyelitis, CNS infections, infective endocarditis, and other severe infections due to Bartonella in adolescent and adult HIV-infected patients.

  Bite-wound infection (animal and human bites)Level of Evidence [G]

Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTIs), doxycycline is an acceptable alternative agent for the prophylaxis and treatment of bite wounds (animal or human).

  Cellulitis, mild to moderateLevel of Evidence [G]

Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTIs) and the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, doxycycline is an effective and recommended treatment option for SSTIs caused by MRSA, particularly purulent cellulitis due to community-acquired MRSA (CA-MRSA).

  Epididymitis, acuteLevel of Evidence [G]

Based on the Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, doxycycline in combination with ceftriaxone is an effective and recommended agent in the treatment acute epididymitis likely caused by sexually transmitted chlamydia and gonorrhea.

  Lyme disease (Borrelia spp. infection)Level of Evidence [B, G]

Controlled trials support the use of doxycycline in the prevention of development of Lyme disease when administered within 72 hours of the Ixodes scapularis tick bite and also in the management of multiple manifestations of Lyme disease.

Guidelines from the Infectious Diseases Society of America (IDSA) and American Academy of Neurology (AAN) recommend the use of oral doxycycline as an effective treatment for multiple manifestations of Lyme disease, including more severe neurological manifestations and late Lyme arthritis. Access Full Off-Label Monograph

  Malaria, treatmentLevel of Evidence [G]

Based on the Centers for Disease Control and Prevention (CDC) guidelines for the treatment of malaria in the United States, doxycycline is an effective and recommended treatment option for uncomplicated Plasmodium falciparum or unidentified species in areas with chloroquine-resistance or unknown resistance (in combination with quinine sulfate); Plasmodium vivax in chloroquine-resistant areas (in combination with quinine sulfate and primaquine); and severe malaria (in combination with quinidine gluconate).

  Pelvic inflammatory diseaseLevel of Evidence [G]

Based on the Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, doxycycline, in combination with other appropriate agents, is effective and recommended in the treatment of pelvic inflammatory disease.

  Pleurodesis, chemical (sclerosing agent for pleural effusion)Level of Evidence [C, G]

Data from a limited number of patients studied suggest that intrapleural doxycycline may be beneficial in the management of malignant pleural effusions Ref.

Based on the American College of Chest Physicians diagnosis and management of lung cancer clinical practice guidelines, intrapleural doxycycline is effective and recommended in the management of recurrent, symptomatic, malignant pleural effusions.

  Proctitis, acute or proctocolitisLevel of Evidence [G]

Based on the Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, doxycycline in combination with ceftriaxone is an effective and recommended agent in the treatment of acute proctitis or proctocolitis.

  Prosthetic joint infectionLevel of Evidence [G]

Based on the Infectious Diseases Society of America (IDSA) guidelines for the management of prosthetic joint infection, doxycycline is an effective and recommended agent for treatment (oral phase) of prosthetic joint infection and for chronic oral antimicrobial suppression of prosthetic joint infection due to staphylococci or Cutibacterium acnes.

  Rhinosinusitis, acute bacterial (ABRS)Level of Evidence [G]

Based on the Infectious Diseases Society of America (IDSA) guidelines for acute bacterial rhinosinusitis (ABRS) in children and adults, doxycycline is an effective and recommended alternative option for the treatment of ABRS in adults.

  Surgical prophylaxis, uterine evacuation (induced abortion or pregnancy loss)Level of Evidence [G]

Based on the American College of Obstetricians and Gynecologists (ACOG) guidelines for prevention of infection after gynecologic procedures, doxycycline is effective and recommended as antimicrobial prophylaxis for uterine evacuation procedures for induced abortion or pregnancy loss.

Level of Evidence Definitions
  Level of Evidence Scale
Clinical Practice Guidelines

Acne:

American Academy of Dermatology, “Guidelines of Care for the Management of Acne Vulgaris,” May 2016

Diabetic Foot Infection:

IDSA, “The Diagnosis and Treatment of Diabetic Foot Infections,” 2012

Infective Endocarditis:

British Society for Antimicrobial Chemotherapy (BSAC), “Guidelines for the Diagnosis and Antibiotic Treatment of Endocarditis in Adults,” 2012

Lyme Disease:

Infectious Diseases Society of America (IDSA), “Clinical Practice Guidelines for Lyme Disease,” 2006

Malaria:

CDC, “Guidelines for Treatment of Malaria in the United States,” Table – July 2013

CDC, “Health Information for National Travel, 2012 ” (The Yellow Book)

CDC, “Treatment of Malaria (Guidelines for Clinicians),” April 2011

WHO, “Guidelines for the Treatment of Malaria,” 2010

Methicillin-Resistant Staphylococcus aureus (MRSA) Infections:

IDSA, “Practice Guidelines for the Treatment of Methicillin-Resistant Staphylococcus Aureus,” February 2011

Opportunistic Infections:

HHS, Guidelines for the Prevention and Treatment of Opportunistic Infections Among HIV-Exposed and HIV-Infected Children, November 2013Note: Information contained within this monograph is pending revision based on these more recent guidelines.

HHS, Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, September 2015

Osteomyelitis, Native Vertebral:

IDSA, “Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults,” 2015

Pneumonia, Community-Acquired:

IDSA/ATS, “Consensus Guideline on Management of Community-Acquired Pneumonia in Adults,” 2007

IDSA/PIDS, “The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age,” 2011

Prosthetic Joint Infection:

IDSA, “Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guideline,” January 2013

Q Fever:

CDC, “Diagnosis and Management of Q Fever”, March 2013

Rhinosinusitis:

IDSA, “Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults,” 2012

Sexually Transmitted Disease:

CDC, “Sexually Transmitted Diseases Treatment Guidelines,” June 2015.

Public Health Agency of Canada, “Canadian Guidelines on Sexually Transmitted Infections,” January 2010

World Health Organization (WHO), “Guidelines for the Treatment of Chlamydia trachomatis,” 2016

World Health Organization (WHO), “Guidelines for the Treatment of Treponema pallidum (syphilis),” 2016

Skin and Soft-tissue Infection:

IDSA, “Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections,” June 2014.

Tickborne Rickettsial Diseases:

CDC, “Diagnosis and Management of Tickborne Rickettsial Diseases: Rocky Mountain Spotted Fever and Other Spotted Fever Rickettsioses, Ehrlichioses, and Anaplasmosis – United States,” May 2016

Other:

ACCP Clinical Practice Guidelines, “Symptom Management in Patients with Lung Cancer,” 2013

Administration: IV

Infuse slowly, usually over 1 to 4 hours. Avoid extravasation. Prolonged IV administration may cause thrombophlebitis. Oral administration is preferable unless patient has significant nausea and vomiting; IV and oral routes are bioequivalent.

Administration: Injectable Detail

pH: 1.8 to 3.3 (reconstituted solution)

Administration: Oral

Oral administration is preferable unless patient has significant nausea and vomiting; IV and oral routes are bioequivalent.

In general, administer with meals to decrease GI upset; however, some manufacturer labeling recommends administration on an empty stomach (see below). Administer capsule and tablet with at least 8 ounces (240 mL) of water and have patient sit up for at least 30 minutes or 1 to 2 hours (Canadian labeling) after taking to reduce the risk of esophageal irritation and ulceration.

Acticlate: Swallow capsule whole; do not break, open, crush, dissolve, or chew. The 150 mg tablet may be broken into 2/3 or 1/3 to provide a 100 mg and 50 mg strength, respectively.

Doxycycline 20 mg tablet, Oracea, Apprilon [Canadian product]: Administer on an empty stomach 1 hour before or 2 hours after meals.

Doryx: May be administered by carefully breaking up the tablet and sprinkling contents on a spoonful of cold applesauce. The delayed-release pellets must not be crushed or damaged when breaking up tablet. Should be administered immediately after preparation and without chewing; follow with a cool 8-ounce (240 mL) glass of water to ensure complete swallowing. If applesauce/pellet mixture is not administered immediately, discard (do not store for future use).

Doryx MPC: Do not chew or crush tablets.

Periostat [Canadian product]: Administer 1 hour before breakfast and evening meal.

Administration: Other

Intrapleural (off-label route): Instill diluted doxycycline (combined with or following instillation of a local anesthetic) into chest tube; clamp chest tube for 2 hours (Porcel 2006; Robinson 1993)

Administration: Pediatric

Oral: Administer capsules or tablets with adequate amounts of fluid (to avoid throat irritation); avoid antacids, infant formula, milk, dairy products, and iron for 1 hour before or 2 hours after administration of doxycycline (unless extemporaneously prepared in the instance of public health emergency when milk or pudding is appropriate); may be administered with food to decrease GI upset; shake suspension well before use

Doryx: May break up the tablet and sprinkle the delayed release pellets on a spoonful of applesauce. Do not crush or damage the delayed release pellets; loss or damage of pellets prevents using the dose. Swallow the Doryx/applesauce mixture immediately without chewing. Discard mixture if it cannot be used immediately.

Parenteral: For IV use only; administer over 1 to 4 hours; avoid rapid infusion

Dietary Considerations

Tetracyclines (in general): Take with food if gastric irritation occurs. While administration with food may decrease GI absorption of doxycycline by up to 20%, administration on an empty stomach is generally not recommended due to GI intolerance. Of currently available tetracyclines, doxycycline has the least affinity for calcium.

Doxycycline 20 mg tablet, Oracea, Apprilon [Canadian product]: Manufacturer states to take on an empty stomach 1 hour before or 2 hours after meals. Take with food if gastric irritation occurs.

Periostat [Canadian product]: Manufacturer states to take at least 1 hour before morning and evening meals. Take with food if gastric irritation occurs.

Some products may contain sodium.

Storage/Stability

Capsule, tablet, delayed-release tablet: Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Protect from light and moisture.

Syrup, oral suspension: Store below 30°C (86°F); protect from light.

Injection: Store intact vials at 20°C to 25°C (68°F to 77°F); protect from light. Stability of IV infusion varies based on solution; refer to manufacturer’s labeling.

Preparation for Administration: Adult

Intravenous: Reconstitute vials with 10 mL of SWFI or compatible IV solution for each 100 mg of doxycycline, to a concentration of 10 mg/mL. Each 100 mg is further diluted with 100 to 1,000 mL of a compatible IV solution (eg, D5W, NS) to a final concentration of 0.1 to 1 mg/mL.

Intrapleural (off-label route): Dilute with 30 to 100 mL NS; may also combine with or administer following a local anesthetic (Porcel 2006; Robinson 1993)

Preparation for Administration: Pediatric

Parenteral: IV: Reconstitute each 100 mg vial with 10 mL SWFI or other compatible solution, resulting in a concentration of 10 mg/mL; following reconstitution, further dilute with a compatible solution (eg, D5W, NS) to a final concentration of 0.1 to 1 mg/mL.

Compatibility

See Trissel’s IV Compatibility Database

Extemporaneously Prepared

If a public health emergency is declared and liquid doxycycline is unavailable for the treatment of anthrax, emergency doses may be prepared for children or adults who cannot swallow tablets.

Add 20 mL of water to one 100 mg tablet. Allow tablet to soak in the water for 5 minutes to soften. Crush into a fine powder and stir until well mixed. Appropriate dose should be taken from this mixture. To increase palatability, mix with food or drink. If mixing with drink, add 15 mL of milk, chocolate milk, chocolate pudding, or apple juice to the appropriate dose of mixture. If using apple juice, also add 4 teaspoons of sugar. Doxycycline and water mixture may be stored at room temperature for up to 24 hours.

US Food and Drug Administration, Center for Drug Evaluation and Research, “Public Health Emergency Home Preparation Instructions for Doxycycline.” Available athttp://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm130996.htm

Medication Patient Education with HCAHPS Considerations

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience tooth discoloration, nausea, vomiting, diarrhea, or lack of appetite. Have patient report immediately to prescriber signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), signs of pancreatitis (severe abdominal pain, severe back pain, severe nausea, or vomiting), angina, urinary retention, change in amount of urine passed, chills, pharyngitis, difficulty swallowing, bruising, bleeding, joint pain, muscle pain, tachycardia, fast breathing, flushing, severe dizziness, passing out, severe loss of strength and energy, vaginitis, headache, blurred vision, diplopia, blindness, signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools), or signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes) (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Medication Safety Issues
  Sound-alike/look-alike issues:
  International issues:
Contraindications

Hypersensitivity to doxycycline, other tetracyclines, or any component of the formulation

Periostat, Apprilon [Canadian products]: Additional contraindications: Use in infants and children <8 years of age or during second or third trimester of pregnancy; breast-feeding

Warnings/Precautions

Concerns related to adverse effects:

• GI inflammation/ulceration: Esophagitis and ulcerations (sometimes severe) may occur; patients with dysphagia and/or retrosternal pain may require assessment for esophageal lesions.

• Hepatotoxicity: Rarely occurs; if symptomatic, assess LFTs and discontinue drug.

• Hypersensitivity syndromes: Severe skin reactions (eg, exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms [DRESS]) have been reported. Discontinue therapy for serious hypersensitivity reactions.

• Increased BUN: May be associated with increases in BUN secondary to antianabolic effects; this does not occur with use of doxycycline in patients with renal impairment.

• Intracranial hypertension: Intracranial hypertension (pseudotumor cerebri) has been reported; headache, blurred vision, diplopia, vision loss, and/or papilledema may occur. Women of childbearing age who are overweight or have a history of intracranial hypertension are at greater risk. Intracranial hypertension typically resolves after discontinuation of treatment; however, permanent visual loss is possible. If visual symptoms develop during treatment, prompt ophthalmologic evaluation is warranted. Intracranial pressure can remain elevated for weeks after drug discontinuation; monitor patient until stable.

• Photosensitivity: May cause photosensitivity; discontinue at first sign of skin erythema. Use skin protection and avoid prolonged exposure to sunlight and ultraviolet light.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

• Tissue hyperpigmentation: May induce hyperpigmentation in many organs, including nails, bone, skin (diffuse pigmentation as well as over sites of scars and injury), eyes, thyroid, visceral tissue, oral cavity (adult teeth, mucosa, alveolar bone), sclerae, and heart valves independently of time or amount of drug administration.

Disease-related concerns

• Oral candidiasis: Safety and effectiveness have not been established for treatment of periodontitis in patients with coexistent oral candidiasis; use with caution in patients with a history or predisposition to oral candidiasis.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Special populations:

• Pediatric: May cause tissue hyperpigmentation, tooth enamel hypoplasia, or permanent tooth discoloration (more common with long-term use, but observed with repeated, short courses) when used during tooth development (last half of pregnancy, infancy, and childhood ≤8 years of age); manufacturer states to use in children ≤8 years of age only when the potential benefits outweigh the risks in severe or life threatening conditions (eg, anthrax, Rocky Mountain spotted fever), particularly when there are no alternative therapies. Limited use between 6 to 7 years of age has minimal effect on the color of permanent incisors (CDC [Biggs 2016]). Recommended in prevention and treatment of anthrax (AAP [Bradley 2014]), treatment of tickborne rickettsial diseases (CDC [Biggs 2016]), and Q fever (CDC 2013).

Dosage form specific issues:

• Oracea, Apprilon [Canadian product]: Should not be used for the treatment or prophylaxis of bacterial infections because the lower dose of drug per capsule may be subefficacious and promote resistance.

• Sulfite sensitivity: Syrup may contain sodium metabisulfite, which may cause allergic reactions in certain individuals (eg, asthmatic patients).

Other warnings/precautions:

• Appropriate use: Acne: The American Academy of Dermatology acne guidelines recommend doxycycline as adjunctive treatment for moderate and severe acne and forms of inflammatory acne that are resistant to topical treatments. Concomitant topical therapy with benzoyl peroxide or a retinoid should be administered with systemic antibiotic therapy (eg, doxycycline) and continued for maintenance after the antibiotic course is completed (AAD [Zaenglein 2016]).

• Limitations of use: Malaria prophylaxis: Doxycycline does not completely suppress asexual blood stages of Plasmodium strains; does not suppress P. falciparum’s sexual blood stage gametocytes. Patients completing a regimen may still transmit the infection to mosquitoes outside endemic areas.

Geriatric Considerations

Dose adjustment for renal function is not necessary.

Warnings: Additional Pediatric Considerations

Tooth staining or enamel hypoplasia of developing teeth is a known concern with the use of tetracycline-class of antibiotics in children <8 years of age based on experience with older tetracyclines which bind to calcium more readily than doxycycline. A cohort analysis of 58 children who were exposed to doxycycline for treatment of Rocky Mountain Spotted Fever when <8 years of age reported no visible tetracycline-like tooth staining of permanent teeth and recommended dose and duration compared to a control group of 213 children not exposed to doxycycline; the cohort received a total of 107 courses of doxycycline (multiple courses), mean duration: 7.3 days (range: 1 to 10 days), and mean dose: 2.3 mg/kg/day (Todd 2015). An analysis of 31 asthmatic children who received doxycycline also reported no evidence of tooth staining. A meta-analysis of the combined data reported a 0% prevalence rate for tooth staining (CDC [Biggs 2016]; Todd 2015). Retrospective data suggests that at standard doses, children <8 years could receive up to 5 courses of doxycycline without detectable evidence of tooth staining (AAP [Bradley 2014]).

Administration of tetracycline 25 mg/kg/day was associated with decreased fibular growth rate in premature infants (reversible with discontinuation of drug); bulging fontanels have been reported in infants.

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).

Pregnancy Risk Factor

D

Pregnancy Considerations

Tetracyclines cross the placenta (Mylonas 2011). Therapeutic doses of doxycycline during pregnancy are unlikely to produce substantial teratogenic risk, but data are insufficient to say that there is no risk. In general, reports of exposure have been limited to short durations of therapy in the first trimester. Tetracyclines accumulate in developing teeth and long tubular bones (Mylonas 2011). Permanent discoloration of teeth (yellow, gray, brown) can occur following in utero exposure and is more likely to occur following long-term or repeated exposure.

Doxycycline is the recommended agent for the treatment of Rocky Mountain spotted fever (RMSF) in pregnant women (CDC [Biggs 2016]). For other indications, many guidelines consider use of doxycycline to be contraindicated during pregnancy, or to be a relative contraindication in pregnant women if other agents are available and appropriate for use (Anderson 2013; CDC 2011; HHS [OI adult 2015]; Stevens 2014; Workowski [CDC 2015]; IDSA [Wormser 2006]). Doxycycline should not be used for the treatment of rosacea in pregnant women. When systemic antibiotics are needed for dermatologic conditions, other agents are preferred (Kong 2013; Murase 2014). As a class, tetracyclines are generally considered second-line antibiotics in pregnant women and their use should be avoided (Mylonas 2011).

Breast-Feeding Considerations

Doxycycline is present in breast milk.

The relative infant dose (RID) of doxycycline is 6.14% when calculated using the highest average breast milk concentration located and compared to an infant therapeutic dose of 4.4 mg/kg/day.

In general, breastfeeding is considered acceptable when the RID is <10%; when an RID is >25% breastfeeding should generally be avoided (Anderson 2016; Ito 2000).

Using the highest average milk concentration (1.8 mcg/mL), the estimated daily infant dose via breast milk is 0.27 mg/kg/day. This milk concentration was obtained following maternal administration of a single oral dose of doxycycline 200 mg (Tokuda 1969). Concentrations of doxycycline in breast milk may increase with duration of therapy (Anderson 1991).

Oral absorption of doxycycline is not markedly influenced by simultaneous ingestion of milk; therefore, oral absorption of doxycycline by the breastfeeding infant would not be expected to be diminished by the calcium in the maternal milk.

The therapeutic use of doxycycline should be avoided during tooth development (children <8 years) unless there are no alternative therapies due to the potential for tissue hyperpigmentation, tooth enamel hypoplasia, or permanent tooth discoloration. Theoretically, this risk is also present in breastfeeding infants exposed to doxycycline via breast milk. Although breastfeeding is not specifically contraindicated, the effects of long-term exposure via breast milk are not known. According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should take into account the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. The World Health Organization (WHO) states that maternal use of doxycycline should be avoided if possible but that a single dose or the short-term use of doxycycline is probably safe; there exists a possibility of dental staining and inhibition of bone growth in the infant, especially with prolonged use (WHO 2002). In general, antibiotics that are present in breast milk may cause nondose-related modification of bowel flora. Monitor infants for GI disturbances, such as thrush and diarrhea (WHO 2002).

Current guidelines note that the short-term use of doxycycline for the treatment of RMSF is considered compatible with breastfeeding (CDC [Biggs 2016]). However, breastfeeding is a relative contraindication for the use of doxycycline in the treatment of Lyme disease (Wormser 2006). If used for the treatment or prophylaxis of malaria, breastfeeding during doxycycline therapy is considered compatible; however, the theoretical risk of dental staining and inhibition of long bone growth in the breastfeeding infant should be considered (WHO 2002).

Long-term use of tetracyclines (eg, for the treatment of acne) should be avoided in breastfeeding women (Pugashetti 2013).

Lexicomp Pregnancy & Lactation, In-Depth
Briggs’ Drugs in Pregnancy & Lactation
Adverse Reactions

1% to 10%:

Cardiovascular: Hypertension (3%)

Central nervous system: Anxiety (2%), pain (2%)

Endocrine & metabolic: Increased lactate dehydrogenase (2%), increased serum glucose (1%)

Gastrointestinal: Diarrhea (5%), upper abdominal pain (2%), abdominal distention (1%), abdominal pain (1%), xerostomia (1%)

Hepatic: Increased serum aspartate aminotransferase (2%)

Infection: Fungal infection (2%), influenza (2%)

Neuromuscular & skeletal: Back pain (1%)

Respiratory: Nasopharyngitis (5%), sinusitis (3%), nasal congestion (2%), sinus headache (1%)

Frequency not defined:

Dermatologic: Skin hyperpigmentation

Gastrointestinal: Esophageal ulcer, esophagitis

<1%, postmarketing, and/or case reports: Anaphylactoid reaction, anaphylaxis, angioedema, anorexia, bulging fontanel, Clostridioides difficile associated diarrhea, Clostridioides difficilecolitis, dental discoloration, DRESS syndrome, dysphagia, enamel hypoplasia, enterocolitis, eosinophilia, erythema multiforme, erythematous rash, exacerbation of systemic lupus erythematosus, exfoliative dermatitis, glossitis, headache, hemolytic anemia, hepatotoxicity, hypersensitivity reaction, increased blood urea nitrogen, increased serum alanine aminotransferase, inflammatory anogenital lesion, intracranial hypertension, Jarisch-Herxheimer reaction, maculopapular rash, nausea, neutropenia, pancreatitis, pericarditis, serum sickness, skin hyperpigmentation, skin photosensitivity, Stevens-Johnson syndrome, thrombocytopenia, thyroid disease (brown/black discoloration; no dysfunction reported), toxic epidermal necrolysis, urticaria, vomiting

Allergy and Idiosyncratic Reactions
Metabolism/Transport Effects

None known.

Drug Interactions 

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Antacids: May decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Risk D: Consider therapy modification

Barbiturates: May decrease the serum concentration of Doxycycline. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Tetracyclines. Risk D: Consider therapy modification

Bismuth Subcitrate: May decrease the serum concentration of Tetracyclines. Management: Avoid administration of oral tetracyclines within 30 minutes of bismuth subcitrate administration. This is of questionable significance for at least some regimens intended to treat H. pylori infections. Risk D: Consider therapy modification

Bismuth Subsalicylate: May decrease the serum concentration of Tetracyclines. Management: Consider dosing tetracyclines 2 hours before or 6 hours after bismuth. The need to separate doses during Helicobacter pylori eradication regimens is questionable. Risk D: Consider therapy modification

Calcium Salts: May decrease the serum concentration of Tetracyclines. Management: If coadministration of oral calcium with oral tetracyclines can not be avoided, consider separating administration of each agent by several hours. Risk D: Consider therapy modification

CarBAMazepine: May decrease the serum concentration of Doxycycline. Risk D: Consider therapy modification

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Fosphenytoin: May decrease the serum concentration of Doxycycline. Risk D: Consider therapy modification

Iron Salts: Tetracyclines may decrease the absorption of Iron Salts. Iron Salts may decrease the serum concentration of Tetracyclines. Exceptions: Ferric Carboxymaltose; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Isomaltoside; Iron Sucrose. Risk D: Consider therapy modification

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Lanthanum: May decrease the serum concentration of Tetracyclines. Management: Administer oral tetracycline antibiotics at least two hours before or after lanthanum. Risk D: Consider therapy modification

Magnesium Dimecrotate: May interact via an unknown mechanism with Tetracyclines. Risk C: Monitor therapy

Magnesium Salts: May decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Risk D: Consider therapy modification

Mecamylamine: Tetracyclines may enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination

Methoxyflurane: Tetracyclines may enhance the nephrotoxic effect of Methoxyflurane. Risk X: Avoid combination

Mipomersen: Tetracyclines may enhance the hepatotoxic effect of Mipomersen. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease the serum concentration of Tetracyclines. Management: If coadministration of a polyvalent cation-containing multivitamin with oral tetracyclines can not be avoided, separate administration of each agent by several hours. Risk D: Consider therapy modification

Multivitamins/Minerals (with AE, No Iron): May decrease the serum concentration of Tetracyclines. Management: If coadministration of a polyvalent cation-containing multivitamin with oral tetracyclines can not be avoided, separate administration of each agent by several hours. Risk D: Consider therapy modification

Neuromuscular-Blocking Agents: Tetracyclines may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Penicillins: Tetracyclines may diminish the therapeutic effect of Penicillins. Risk D: Consider therapy modification

Phenytoin: May decrease the serum concentration of Doxycycline. Risk D: Consider therapy modification

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Proton Pump Inhibitors: May decrease the bioavailability of Doxycycline. Risk C: Monitor therapy

Quinapril: May decrease the serum concentration of Tetracyclines. Management: Separate doses of quinapril and oral tetracycline derivatives by at least 2 hours in order to reduce the risk of interaction. Monitor for reduced efficacy of the tetracycline if these products are used concomitantly. Risk D: Consider therapy modification

Retinoic Acid Derivatives: Tetracyclines may enhance the adverse/toxic effect of Retinoic Acid Derivatives. The development of pseudotumor cerebri is of particular concern.Exceptions: Adapalene; Bexarotene (Topical); Tretinoin (Topical). Risk X: Avoid combination

RifAMPin: May decrease the serum concentration of Doxycycline. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Strontium Ranelate: May decrease the serum concentration of Tetracyclines. Management: In order to minimize any potential impact of strontium ranelate on tetracycline antibiotic concentrations, it is recommended that strontium ranelate treatment be interrupted during tetracycline therapy. Risk X: Avoid combination

Sucralfate: May decrease the absorption of Tetracyclines. Management: Administer the tetracycline derivative at least 2 hours prior to sucralfate in order to minimize the impact of this interaction. Risk D: Consider therapy modification

Sucroferric Oxyhydroxide: May decrease the serum concentration of Tetracyclines. Management: Administer oral/enteral doxycycline at least 1 hour before sucroferric oxyhydroxide. Specific dose separation guidelines for other tetracyclines are not presently available. No interaction is anticipated with parenteral administration of tetracyclines. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Risk D: Consider therapy modification

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Tetracyclines may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Food Interactions

Ethanol: Chronic ethanol ingestion may reduce the serum concentration of doxycycline.

Food: Doxycycline serum levels may be slightly decreased if taken with high-fat meal or milk. Administration with iron or calcium may decrease doxycycline absorption. May decrease absorption of calcium, iron, magnesium, zinc, and amino acids. Management: Administer Doryx and Doryx MPC without regard to meals. Administer Oracea and doxycycline 20 mg tablet on an empty stomach 1 hour before or 2 hours after meals.

Test Interactions

Injectable tetracycline formulations (if they contain large amounts of ascorbic acid) may result in a false-negative urine glucose using glucose oxidase tests (eg, Clinistix, Diastix, Tes-Tape); false elevations of urinary catecholamines with fluorescence

Monitoring Parameters

CBC, renal and liver function tests periodically with prolonged therapy. When used as part of alternative treatment for gonococcal infection, test of cure 7 days after dose (CDC [Workowski 2015]).

Patients with no risk factors for chronic Q fever should undergo clinical and serological evaluation 6 months after diagnosis of acute Q fever to identify possible progression to chronic disease. Postpartum women treated during pregnancy for acute Q fever, others who are at high risk for progression to chronic disease or when used as part of treatment for chronic Q fever infection unrelated to endocarditis or vascular infection (eg, osteoarticular infections or chronic hepatitis), assess serologic response at 3, 6, 12, 18, and 24 months after diagnosis of acute Q fever (or after delivery in pregnant women) (CDC 2013).

Advanced Practitioners Physical Assessment/Monitoring

Assess results of culture and sensitivity test and patient’s allergy history prior to beginning therapy. Obtain CBC, renal function tests, and liver function tests periodically with prolonged therapy. IV: Infusion site must be closely monitored; extravasation can be very irritating to veins (use of central line is preferable). Test for C. difficile if patient develops diarrhea. If used for gonococcal infection, test for cure 7 days after dose. Follow up patients with Q fever per CDC guidelines: with no risk factors, evaluate 6 months after acute Q fever to identify possible progression to chronic disease. Others who are at high risk for progression to chronic disease, or when used as part of treatment for chronic Q fever, assess serologic response at 3, 5, 12, 18, and 24 months after diagnosis of acute Q fever, or after delivery in pregnant women.

Nursing Physical Assessment/Monitoring

Check ordered labs and report abnormalities. Monitor for hypersensitivity reactions. Closely monitor IV infusion site for signs of irritation and thrombophlebitis; use of a central venous access device is preferred. Monitor for severe or bloody diarrhea and send a specimen to the lab for C. difficile. Teach patient importance of adequate hydration and photosensitivity precautions. Instruct patient to have regular dental checkups.

Product Availability

LymePak (doxycycline tablets): FDA approved June 2018; anticipated availability is currently unknown. Information pertaining to this product within the monograph is pending revision. LymePak is indicated for the treatment of early Lyme disease due to Borrelia burgdorferi in adults and pediatric patients ≥8 years of age weighing ≥45 kg. Consult the prescribing information for additional information.

Dosage Forms Considerations

Alodox Convenience kits contain doxycycline tablets 20 mg, plus eyelid cleanser

Morgidox kits contain doxycycline capsules 100 mg, plus AcuWash moisturizing Daily Cleanser

NizAzel Doxy kits contain doxycycline tablets 100 mg, plus NicAzel FORTE dietary supplement tablets

Ocudox kits contain doxycycline capsules 50 mg, plus eyelid cleanser and Tears Again Advanced eyelid spray

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral, as hyclate [strength expressed as base]:

Morgidox: 50 mg, 100 mg [contains brilliant blue fcf (fd&c blue #1)]

Vibramycin: 100 mg [contains brilliant blue fcf (fd&c blue #1)]

Generic: 50 mg, 100 mg

Capsule, Oral, as monohydrate [strength expressed as base]:

Adoxa: 150 mg [DSC] [contains fd&c red #40, fd&c yellow #6 (sunset yellow)]

Mondoxyne NL: 50 mg [contains fd&c yellow #10 (quinoline yellow)]

Mondoxyne NL: 75 mg [DSC]

Mondoxyne NL: 75 mg, 100 mg [contains fd&c yellow #10 (quinoline yellow)]

Monodox: 75 mg [DSC], 100 mg [DSC]

Okebo: 75 mg, 100 mg [DSC]

Generic: 50 mg, 75 mg, 100 mg, 150 mg

Capsule Delayed Release, Oral, as monohydrate [strength expressed as base]:

Oracea: 40 mg

Generic: 40 mg

Kit, Combination, as hyclate [strength expressed as base]:

Alodox Convenience: 20 mg [DSC]

Morgidox: 1 x 50 mg, 2 x 100 mg, 1 x 100 mg [contains brilliant blue fcf (fd&c blue #1), cetyl alcohol, edetate disodium]

Ocudox: 50 mg [DSC] [contains brilliant blue fcf (fd&c blue #1)]

Solution Reconstituted, Intravenous, as hyclate [strength expressed as base, preservative free]:

Doxy 100: 100 mg (1 ea)

Generic: 100 mg (1 ea)

Suspension Reconstituted, Oral, as monohydrate:

Generic: 25 mg/5 mL (60 mL)

Suspension Reconstituted, Oral, as monohydrate [strength expressed as base]:

Vibramycin: 25 mg/5 mL (60 mL) [contains brilliant blue fcf (fd&c blue #1), methylparaben, propylparaben; raspberry flavor]

Generic: 25 mg/5 mL (60 mL)

Syrup, Oral, as calcium [strength expressed as base]:

Vibramycin: 50 mg/5 mL (473 mL) [contains butylparaben, propylene glycol, propylparaben, sodium metabisulfite; raspberry-apple flavor]

Tablet, Oral, as hyclate [strength expressed as base]:

Acticlate: 75 mg [contains brilliant blue fcf (fd&c blue #1), fd&c yellow #6 (sunset yellow)]

Acticlate: 150 mg [scored; contains fd&c blue #2 (indigotine)]

TargaDOX: 50 mg [contains fd&c blue #2 (indigotine), fd&c yellow #6 (sunset yellow)]

Generic: 20 mg, 50 mg, 75 mg, 100 mg, 150 mg

Tablet, Oral, as monohydrate [strength expressed as base]:

Adoxa: 50 mg [DSC]

Adoxa: 75 mg [DSC] [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 (sunset yellow)]

Adoxa: 100 mg [DSC]

Adoxa Pak 1/100: 100 mg [DSC] [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 (sunset yellow)]

Adoxa Pak 2/100: 100 mg [DSC] [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 (sunset yellow)]

Adoxa Pak 1/150: 150 mg [DSC] [scored; contains fd&c yellow #6 (sunset yellow)]

Avidoxy: 100 mg [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Generic: 50 mg, 75 mg, 100 mg, 150 mg

Tablet Delayed Release, Oral, as hyclate [strength expressed as base]:

Doryx: 50 mg, 200 mg [DSC]

Doryx: 200 mg [scored]

Doryx MPC: 120 mg [contains corn starch]

Soloxide: 150 mg [scored]

Generic: 50 mg, 75 mg, 100 mg, 150 mg, 200 mg

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Periostat: 20 mg

Capsule, Oral, as hyclate [strength expressed as base]:

Vibramycin: 100 mg [DSC]

Generic: 100 mg

Capsule Delayed Release, Oral, as monohydrate [strength expressed as base]:

Apprilon: 40 mg

Tablet, Oral, as hyclate [strength expressed as base]:

Generic: 100 mg

Anatomic Therapeutic Chemical (ATC) Classification
  • A01AB22
  • J01AA02
Generic Available (US)

May be product dependent

Pricing: US

Capsule, delayed release (Doxycycline Oral)

40 mg (per each): $21.77 – $24.94

Capsule, delayed release (Oracea Oral)

40 mg (per each): $28.18

Capsules (Doxycycline Hyclate Oral)

50 mg (per each): $2.16 – $2.25

100 mg (per each): $3.28 – $9.62

Capsules (Doxycycline Monohydrate Oral)

50 mg (per each): $1.45 – $1.55

75 mg (per each): $16.40 – $16.92

100 mg (per each): $2.13 – $2.56

150 mg (per each): $24.65

Capsules (Mondoxyne NL Oral)

50 mg (per each): $9.60

75 mg (per each): $15.20

100 mg (per each): $10.52

Capsules (Morgidox Oral)

50 mg (per each): $13.33

100 mg (per each): $21.84

Capsules (Okebo Oral)

75 mg (per each): $4.40

Capsules (Vibramycin Oral)

100 mg (per each): $14.35

Kit (Morgidox Combination)

1 x 50 mg (per each): $400.03

1 x 100 mg (per each): $655.32

2 x 100 mg (per each): $1,046.90

Solution (reconstituted) (Doxy 100 Intravenous)

100 mg (per each): $22.43

Solution (reconstituted) (Doxycycline Hyclate Intravenous)

100 mg (per each): $30.20

Suspension (reconstituted) (Doxycycline Monohydrate Oral)

25 mg/5 mL (per mL): $0.38 – $0.44

Suspension (reconstituted) (Vibramycin Oral)

25 mg/5 mL (per mL): $0.82

Syrup (Vibramycin Oral)

50 mg/5 mL (per mL): $1.27

Tablet, EC (Doryx MPC Oral)

120 mg (per each): $15.00

Tablet, EC (Doryx Oral)

50 mg (per each): $14.22

200 mg (per each): $52.64

Tablet, EC (Doxycycline Hyclate Oral)

50 mg (per each): $11.73

75 mg (per each): $10.22

100 mg (per each): $13.12 – $13.15

150 mg (per each): $17.60

200 mg (per each): $43.42

Tablet, EC (Soloxide Oral)

150 mg (per each): $13.00

Tablets (Acticlate Oral)

75 mg (per each): $41.85

150 mg (per each): $41.85

Tablets (Doxycycline Hyclate Oral)

20 mg (per each): $0.77 – $1.30

50 mg (per each): $13.20

75 mg (per each): $31.15 – $31.19

100 mg (per each): $2.62 – $6.15

150 mg (per each): $31.15 – $31.19

Tablets (Doxycycline Monohydrate Oral)

50 mg (per each): $2.89 – $3.72

75 mg (per each): $4.93 – $4.99

100 mg (per each): $4.23 – $5.46

150 mg (per each): $9.13 – $9.14

Tablets (TargaDOX Oral)

50 mg (per each): $16.48

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer’s AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Inhibits protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit(s) of susceptible bacteria; may also cause alterations in the cytoplasmic membrane

20 mg tablets and capsules (Periostat [Canadian product]): Proposed mechanism: Has been shown to inhibit collagenase activity in vitro. Also has been noted to reduce elevated collagenase activity in the gingival crevicular fluid of patients with periodontal disease. Systemic levels do not reach inhibitory concentrations against bacteria.

Pharmacodynamics/Kinetics

Absorption: Oral: Almost completely absorbed from the GI tract; average peak plasma concentration may be reduced ~20% (30% for Doryx MPC) by high-fat meal or milk

Distribution: Widely into body tissues and fluids including synovial, pleural, prostatic, seminal fluids, and bronchial secretions; saliva, aqueous humor, and CSF penetration is poor

Protein binding: >90%

Metabolism: Not hepatic; partially inactivated in GI tract by chelate formation

Bioavailability: Reduced at high pH; may be clinically significant in patients with gastrectomy, gastric bypass surgery or who are otherwise deemed achlorhydric

Half-life elimination: 18 to 22 hours; End-stage renal disease: 18 to 25 hours

Time to peak, serum: Oral: Immediate release: 1.5 to 4 hours; delayed release: 2.8 to 3 hours

Excretion: Feces (30%); urine (23% to 40%)

Pharmacodynamics/Kinetics: Additional Considerations

Renal function impairment: Excretion by the kidneys may fall as low as 1% to 5% in 72 hours in patients with CrCl <10 mL/minute.

Dental Use

Treatment of periodontitis associated with presence of Actinobacillus actinomycetemcomitans (AA); adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in adult periodontitis (systemic levels are subinhibitory against bacteria)

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Glossitis and tooth discoloration (children). Opportunistic “superinfection” with Candida albicans; tetracyclines are not recommended for use during pregnancy or in children ≤8 years of age since they have been reported to cause enamel hypoplasia and permanent teeth discoloration. The use of tetracyclines should only be used in these patients if other agents are contraindicated or alternative antimicrobials will not eradicate the organism.

Effects on Bleeding

Hemolytic anemia and thrombocytopenia have been reported

Dental Usual Dosing

Adults: Oral: Treatment of periodontitis (refractory): 100-200 mg once daily for 21 days (Jolkovsky 2006). Note: A specific formulation (Periostat [available in Canada]) containing a subantimicrobial dosage is also available for use as an adjunct to scaling and root planing. In addition, doxycycline gel (Atridox) is available for subgingival application (see Doxycycline Hyclate Periodontal Extended-Release Liquid monograph).

Index Terms

Doxycycline Calcium; Doxycycline Hyclate; Doxycycline Monohydrate; LymePak

FDA Approval Date
December 05, 1967
References

Abramowicz M, “Antimicrobial Prophylaxis in Surgery,” Medical Letter on Drugs and Therapeutics, Handbook of Antimicrobial Therapy, 16th ed, New York, NY: Medical Letter, 2002.

ACOG Committee on Practice Bulletins–Gynecology. ACOG practice bulletin No. 195: prevention of infection after gynecologic procedures. Obstet Gynecol. 2018;131(6):e172-1189. doi:10.1097/AOG.0000000000002670.[PubMed 29794678]

Acticlate (doxycycline hyclate) [prescribing information]. Exton, PA: Aqua Pharmaceuticals; April 2016.

Adoxa (doxycycline) [prescribing information]. Melville, NY: PharmaDerm; February 2012.

Ailani RK, Agastya G, Ailani RK, et al, “Doxycycline is a Cost-Effective Therapy for Hospitalized Patients With Community-Acquired Pneumonia,” Arch Intern Med, 1999, 159(3):266-70.[PubMed 9989538]

American Academy of Pediatrics. Doxycycline. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, ed. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever–United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep. 2013;62(RR-03):1-30.[PubMed 23535757]

Anderson PO. Drug use during breast-feeding. Clin Pharm. 1991;10(8):594-624.[PubMed 1934918]

Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52.[PubMed 27060684]

Apprilon (doxycycline) [product monograph]. Thornhill, Ontario, Canada: Galderma Canada Inc; May 2018.

Arguin PM, Tan KR. Infectious diseases related to travel: malaria. In: CDC Health Information for International Travel 2016. Centers for Disease Control and Prevention (CDC). https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/malaria#4661. Updated July 10, 2015. Accessed March 14, 2017.

Ariza J, Bosilkovski M, Cascio A, et al; International Society of Chemotherapy; Institute of Continuing Medical Education of Ioannina. Perspectives for the treatment of brucellosis in the 21st century: the Ioannina recommendations. PLoS Med. 2007;4(12):e317.[PubMed 18162038]

Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46.[PubMed 26229122]

Berbari E, Baddour LM. Prosthetic joint infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 12, 2018.

Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis – United States. MMWR Recomm Rep. 2016;65(2):1-44. doi: 10.15585/mmwr.rr6502a1.[PubMed 27172113]

Böcker R, Mühlberg W, Platt D, et al, “Serum Level, Half-Life and Apparent Volume of Distribution of Doxycycline in Geriatric Patients,” Eur J Clin Pharmacol, 1986, 30(1):105-8.[PubMed 3709622]

Bosilkovski M. Clinical manifestations, diagnosis, and treatment of brucellosis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Bradley JS, Byington CL, Shah SS, et al. “The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America”, Clin Infect Dis, 2011, 53(7):e25-76.[PubMed 21880587]

Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics. 2014;133(5):1411-1436.[PubMed 24777226]

Bryant SG, Fisher S, and Kluge RM, “Increased Frequency of Doxycycline Side Effects,” Pharmacotherapy, 1987, 7(4):125-9.[PubMed 3684731]

Centers for Disease Control and Prevention (CDC). Brucellosis: Assessing laboratory risk level and PEP. https://www.cdc.gov/brucellosis/laboratories/risk-level.html. Updated November 12, 2012. Accessed August 10, 2017.

Centers for Disease Control and Prevention (CDC). Diagnosis and management of Q fever — United States, 2013: Recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep. 2013;62(RR03):1-23.[PubMed 23535757]

Centers for Disease Control and Prevention (CDC). Guidelines for treatment of malaria in the United States: Treatment table. http://www.cdc.gov/malaria/resources/pdf/treatmenttable.pdf Updated July 1, 2013.

Centers for Disease Control and Prevention (CDC). Q Fever – California, Georgia, Pennsylvania, and Tennessee, 2000-2001. MMWR Weekly. 2002;51(41):924-927.[PubMed 12403408]

Centers for Disease Control and Prevention (CDC). Recommended antibiotic treatment for plague. 2015. Available at https://www.cdc.gov/plague/healthcare/clinicians.html

Centers for Disease Control and Prevention (CDC). Use of anthrax vaccine in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR. 2010;59(6):1-30. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5906a1.htm?s_cid=rr5906a1_e[PubMed 20651644]

Centers for Disease Control and Prevention (CDC). Update: Investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR. 2001;50(42):909-919. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5042a1.htm[PubMed 11699843]

Chow AW, Benninger MS, Brook I, et al; Infections Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis.2012;54(8):e72-e112.[PubMed 22438350]

Chung AM, Reed MD, and Blumer JL, “Antibiotics and Breast-Feeding: A Critical Review of the Literature,” Paediatr Drugs, 2002, 4(12):817-37.[PubMed 12431134]

Daunt N, Brodribb TR, and Dickey JD, “Oesophageal Ulceration Due to Doxycycline,” Br J Radiol, 1985, 58(696):1209-11.[PubMed 3842633]

Daya M and Nakamura Y, “Pulmonary Disease From Biological Agents: Anthrax, Plague, Q Fever, and Tularemia,” Crit Care Clin, 2005, 21(4):747-63.[PubMed 16168313]

Dennis DT, Inglesby TV, Henderson DA, et al; Working Group on Civilian Biodefense. Tularemia as a biological weapon: medical and public health management. JAMA. 2001;285(21):2763-2773.[PubMed 11386933]

Doryx (doxycycline hyclate) [prescribing information]. Greenville, NC: Mayne Pharma; July 2018.

Doryx MPC (doxycycline hyclate delayed release tablets) [prescribing information]. Greenville, NC: Mayne Pharma USA; July 2018.

Doxycycline hyclate delayed-release tablets [prescribing information]. Greenville, NC: Mayne Pharma; April 2016.

Doxycycline hyclate tablets (equivalent to 20 mg doxycycline) [prescribing information]. Philadelphia, PA: Lannett Company; May 2016.

Doxy 100 injection (doxycycline) [prescribing information]. Lake Zurich, IL: Fresenius Kabi; October 2015.

Eyre RC. Evaluation of acute scrotal pain in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Fenollar F, Fournier PE, Carrieri MP, et al, “Risks Factors and Prevention of Q Fever Endocarditis,” Clin Infect Dis, 2001, 33(3):312-6.[PubMed 11438895]

Foucault C, Raoult D, Brouqui P. Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia. Antimicrob Agents Chemother. 2003;47(7):2204-2207.[PubMed 12821469]

Francke EL and Neu HC, “Chloramphenicol and Tetracyclines,” Med Clin North Am, 1987, 71(6):155-68.[PubMed 3320617]

Geisler WM, Koltun WD, Abdelsayed N, et al. Safety and efficacy of WC2031 versus vibramycin for the treatment of uncomplicated urogenital Chlamydia trachomatis infection: a randomized, double-blind, double-dummy, active-controlled, multicenter trial. Clin Infect Dis. 2012;55(1):82-88.[PubMed 22431798]

Gould FK, Denning DW, Elliott TS, et al, “Guidelines for the Diagnosis and Antibiotic Treatment of Endocarditis in Adults: A Report of the Working Party of the British Society for Antimicrobial Chemotherapy,” J Antimicrob Chemother, 2012, 67(2):269-89.[PubMed 22086858]

Graber E, ed. Treatment of acne vulgaris. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 27, 2017.

Halperin JJ, Shapiro ED, Logigian E, et al, “Practice Parameter: Treatment of Nervous System Lyme Disease (an Evidence-Based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology,” Neurology, 2007, 69(1):91-102.[PubMed 17522387]

Harper M. Clinical manifestations and initial management of animal and human bites. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Harris AM, Hicks LA, Qaseem A; High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164(6):425-434. doi: 10.7326/M15-1840.[PubMed 26785402]

Hartzell JD, Wood-Morris RN, Martinez LJ, et al, “Q Fever: Epidemiology, Diagnosis, and Treatment,” Mayo Clin Proc, 2008, 83(5):574-9.[PubMed 18452690]

Hasanjani Roushan MR, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA. Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans. Clin Infect Dis. 2006;42(8):1075-1080.[PubMed 16575723]

Health and Human Services [HHS] Panel on Opportunistic Infections [OI] in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Updated September 24, 2015. Accessed September 25, 2015

Health and Human Services [HHS] Panel on Opportunistic Infections [OI] in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Updated October 18, 2017. Accessed October 23, 2017.

Hendricks KA, Wright ME, Shadomy SV, et al; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis. 2014;20(2):e130687.[PubMed 24447897]

Hicks CB, Clement M. Syphilis: Treatment and monitoring. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Hu L. Treatment of Lyme disease. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Inglesby TV, Dennis DT, Henderson DA, et al, “Plague as a Biological Weapon: Medical and Public Health Management. Working Group on Civilian Biodefense,” JAMA, 2000, 283(17):2281-90.[PubMed 10807389]

Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126.[PubMed 10891521]

Jia B, Zhang F, Pang P, et al. Brucella endocarditis: Clinical features and treatment outcomes of 10 cases from Xinjiang, China. J Infect. 2017;74(5):512-514. doi: 10.1016/j.jinf.2017.01.011.[PubMed 28143754]

Jolkovsky DL and Ciancio S, “Chemotherapeutic Agents,” Newman MG, Takei HH, Klokkevold PR, et al, eds, Clinical Periodontology, 10th ed, St Louis, MO: Saunders/Elsevier, 2006, 802-3.

Joshi N and Miller DQ, “Doxycycline Revisited,” Arch Intern Med, 1997, 157(13):1421-8.[PubMed 9224219]

Kanafani ZA. Invasive Cutibacterium (formerly Propionibacterium) infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 12, 2018.

Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73(8):779-787.[PubMed 23657872]

Kvale PA, Selecky, Prakash BS, et al, “Palliative Care In Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition),” Chest, 2007, 132(Suppl 3):268-403.[PubMed 17873181]

Lipsky BA, Berendt AR, Cornia PB, et al, “2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infections,” Clin Infect Dis, 2012, 54(12):e132-73.[PubMed 22619242]

Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011;52(3):285-292.[PubMed 21217178]

Ljungberg B and Nilsson-Ehle I, “Pharmacokinetics of Antimicrobial Agents in the Elderly,” Rev Infect Dis, 1987, 9(2):250-64.[PubMed 3296097]

Maier LE. Management of rosacea. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Mandell LA, Wunderink RG, Anzueto A, et al, “Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines On The Management Of Community-Acquired Pneumonia In Adults,” 2007, Clin Infect Dis, 44(Suppl 2):27-72.[PubMed 17278083]

Marrazzo J. Treatment of Chlamydia trachomatis infection. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Million M, Walter G, Thuny F, Habib G, Raoult D. Evolution from acute Q fever to endocarditis is associated with underlying valvulopathy and age and can be prevented by prolonged antibiotic treatment. Clin Infect Dis. 2013;57(6):836-844. doi: 10.1093/cid/cit419.[PubMed 23794723]

Monodox (doxycycline) [prescribing information]. Exton, PA: Aqua Pharmaceuticals; April 2017.

Monodoxyne NL (doxycycline) [prescribing information]. Petaluma, CA: IntraDerm Pharmaceuticals; November 2015.

Moore A, Ling M, Bucko A, Manna V, Rueda MJ. Efficacy and safety of subantimicrobial dose, modified-release doxycycline 40 mg versus doxycycline 100 mg versus placebo for the treatment of inflammatory lesions in moderate and severe acne: a randomized, double-blinded, controlled study. J Drugs Dermatol. 2015;14(6):581-586.[PubMed 26091383]

Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: part I. Pregnancy. J Am Acad Dermatol. 2014;70(3):e1-14.[PubMed 24528911]

Mylonas I, “Antibiotic Chemotherapy During Pregnancy and Lactation Period: Aspects for Consideration,” Arch Gynecol Obstet, 2011, 283(1):7-18.[PubMed 20814687]

Oracea [prescribing information]. Fort Worth, TX: Galderma Laboratories LP; December 2014.

Osmon DR, Berbari EF, Berendt AR, et al, “Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guideline by the Infectious Diseases Society of America,” Clin Infect Dis, 2013, 56(1):e1-25.[PubMed 23223583]

Penn RL. Clinical manifestations, diagnosis, and treatment of tularemia. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Periostat (doxycycline hyclate capsules, USP 20 mg) [product monograph]. Montreal, Quebec, Canada: PENDOPHARM; November 2018.

Porcel JM, Salud A, Nabal M, et al, “Rapid Pleurodesis With Doxycycline Through a Small-Bore Catheter for the Treatment of Metastatic Malignant Effusions,” Support Care Cancer, 2006, 14(5):475-8.[PubMed 16404570]

Pugashetti R, Shinkai K. Treatment of acne vulgaris in pregnant patients. Dermatol Ther. 2013;26(4):302-311.[PubMed 23914887]

Rams TE and Slots J, “Antibiotics in Periodontal Therapy: An Update,” Compendium, 1992, 13(12):1130, 1132, 1134.[PubMed 1298559]

Raoult D. Treatment and prevention of Q fever. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Robinson LA, Fleming WH, Galbraith TA. Intrapleural doxycycline control of malignant pleural effusions. Ann Thorac Surg. 1993;55(5):1115-1121; discussion 1121-1122.[PubMed 8494419]

Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D. Recommendations for treatment of human infections caused by Bartonella species. Antimicrob Agents Chemother. 2004;48(6):1921-1933.[PubMed 15155180]

Ross J, Judlin P, and Nilas L, “European Guideline for the Management of Pelvic Inflammatory Disease,” Int J STD AIDS, 2007, 18(10):662-6. Available at http://std.sagepub.com/content/18/10/662.full.pdf+html. Accessed May 15, 2013.[PubMed 17945043]

Saivin S and Hovin G, “Clinical Pharmacokinetics of Doxycycline and Minocycline,” Clin Pharmacokinet, 1985, 15:355-66.[PubMed 3072140]

Sanchez J, Somolinos AL, Almodóvar PI, Webster G, Bradshaw M, Powala C. A randomized, double-blind, placebo-controlled trial of the combined effect of doxycycline hyclate 20-mg tablets and metronidazole 0.75% topical lotion in the treatment of rosacea. J Am Acad Dermatol. 2005;53(5):791-797.[PubMed 16243127]

Sexton DJ. Clinical manifestations, diagnosis, and treatment of plague (Yersinia pestis infection). Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 27, 2017. [2017a]

Sexton DJ, McClain MT. Treatment of Rocky Mountain spotted fever. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017. [2017b]

Simoff MJ, Lally B, Slade MG, et al. Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 suppl):e455S-e497S. doi: 10.1378/chest.12-2366.[PubMed 23649452]

Skalsky K, Yahav D, Bishara J, Pitlik S, Leibovici L, Paul M. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2008;336(7646):701-704. doi: 10.1136/bmj.39497.500903.25.[PubMed 18321957]

Skidmore R, Kovach R, Walker C, et al. Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne. Arch Dermatol. 2003;139(4):459-464.[PubMed 12707093]

Smilack JD, Wilson WR, and Cockerill FR 3d, “Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole,” Mayo Clin Proc, 1991, 66(12):1270-80.[PubMed 1749296]

Smiley CJ, Tracy SL, Abt E, et al. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015;146(7):525-535. doi: 10.1016/j.adaj.2015.01.026.[PubMed 26113100]

Spach DH. Endocarditis caused by Bartonella. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52.[PubMed 24947530]

Targadox (doxycycline) [prescribing information]. Scottsdale, AZ: Journey Medical Corporation; January 2019.

Tokuda G, Yuasa M, Mihara S et al. Clinical study of doxycycline in obstetrical and gynecological fields. Chemotherapy (Tokyo). 1969;17:339-344. Available at http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@[email protected]+100

Vibramycin (doxycycline oral) [prescribing information]. New York; NY: Pfizer; received August 2017.

Vibramycin (doxycycline injection) [prescribing information]. New York; NY: Pfizer; July 2017.

Vibramycin Capsules (doxycycline) [product monograph]. Kirkland, Quebec, Canada: Pfizer Canada Inc; December 2015.

Vibra-Tabs (doxycycline) [prescribing information]. New York; NY: Pfizer; December 2018.

Wiesenfeld HC. Pelvic inflammatory disease: Treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Wilson WR and Cockerill FR 3d, “Tetracyclines, Chloramphenicol, Erythromycin, and Clindamycin,” Mayo Clin Proc, 1987, 62(10):906-15.[PubMed 3657308]

Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137.[PubMed 26042815]

World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the Eleventh WHO Model List of Essential Drugs. 2002. Available at http://www.who.int/maternal_child_adolescent/documents/55732/en/

World Health Organization (WHO) Global Task Force on Cholera Control. First steps for managing an outbreak of acute diarrhoea. http://www.who.int/cholera/publications/firststeps/en/. Updated November 2010. Accessed July 25, 2013.

Wormser GP, Dattwyler RJ, Shapiro ED, et al, “The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America,” Clin Infect Dis, 2006, 43(9):1089-134.[PubMed 17029130]

Wyler DJ, “Malaria: Overview and Update,” Clin Infect Dis, 1993, 16(4):449-56.[PubMed 8513046]

Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.e33. http://www.jaad.org/article/S0190-9622(15)02614-6/pdf. Accessed May 17, 2016.[PubMed 26897386]

Zenilman JM. Lymphogranuloma venereum. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed November 9, 2017.

Zheng N, Wang W, Zhang JT, et al. Neurobrucellosis [published online ahead of print August 24, 2017]. Int J Neurosci. doi: 10.1080/00207454.2017.1363747.[PubMed 28768443]

Brand Names: International

Abraxil (CL); Adjusan (BE, NL); Agidox (LK); Alldox (ZW); Amermycin (HK); Apdox (BD); Asdoxin (ET); Azudoxat (DE); Bactidox (PH); Bassado (IT); Biodoxi (IN); Biomixin (MX); By-Mycin (IE); Ciclonal (MX); Clordox (BR); Cyclidox (ZA); Cyclindox (VN); Cytragen (PH); Dagramycine (LU); Dentacline (KR); Dentistar (KR); Deoxymykoin (CZ); Doc-100 (TZ); Docyl (TH); Doinmycin (TW); Dokat (TR); Doksiciklin (HR); Doksin (TR); Domiken (MX); Doryx (AU, NZ); Dosil (ES); Dotur (UY); Doxat (CY, IQ, IR, JO, KW, LY, MT, OM, QA, SA, SY, VN, YE); Doxicap (ZW); Doxiclat (ES); Doxicor (ID); Doxikan (EG); Doximed (FI); Doximycin (FI); Doxin (PH, TH); Doxine (NZ); Doxipil (ES); Doxiplus (PE); Doxitin (LV); Doxman (LK); Doxsig (AU); Doxxkam (PH); Doxy (LB); Doxy 200 (LU); Doxy A (BD); Doxy Komb (LU); Doxy M (EE); Doxy SMB (LU); Doxy-1 (IN); Doxy-100 (DE, NZ); Doxybene (CZ, UA); Doxycap (HK, SG); Doxycin (SA); Doxyclin (ZW); Doxycline (LU, TH); Doxycyclin AL (HU); Doxycycline (BE); Doxycycline-Ethypharm (LU); Doxycycline-Eurogenerics (LU); Doxydar (BH, JO, QA, SA); Doxydox (EG); Doxyhexal (CZ, HU, LU); Doxylag (BB, BF, BJ, BM, BS, BZ, CI, CY, ET, GH, GM, GN, GY, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, YE, ZM, ZW); Doxylan (LV); Doxylcap (TH); Doxylets (LU); Doxylin (AU, IL, NO, NZ); Doxyline (SG); Doxylis (FR); Doxymycin (TW, ZA); Doxymycine (LU); Doxypharm (HU); Dumoxin (CY, ID, IQ, IR, JO, KW, LY, OM, SA, SY, YE); Duo Di (CN); Duradox (AE, BH, KW, QA); Efracea (BE, GB, IE, NL); Empadoxine (ET); Etidoxina (CO); Genobiotic-Doxi (MX); Grandoxy (AE); Granudoxy (FR, LU); Hiramicin (HR); Impedox (BD); Interdoxin (ID); Lenteclin (ET); Madoxy (TH); Mardox (BD); Medomycin (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, MY, NE, NG, SC, SD, SG, SL, SN, TH, TN, TW, TZ, UG, ZM, ZW); Medox (PH); Microdox (LK, ZW); Miraclin (IT); Monocin (KR); Monodox (CO); Oracea (ES); Periostat (GB); Policycline (TH); Radox (BF, BJ, CI, CY, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZM, ZW); Remycin (BH, MT, TR, TW); Retadox (LB); Retens (MT); Revidox (LK); Servidoxine (EC); Siadocin (TH); Sigadoxin (PT); Supracyclin (AT, CH, PE); Supramycina (EC, PY); Tabocine (AE, QA); Tarocin (KW); Tedoxy (PH); Tenutan (BB, BM, BS, BZ, GY, JM, SR, TT); Teradox (PH); Teradoxin (ET); Tolexine (FR, HK); Tolexine Ge (FR); Torymycin (TH); Tremesal (VE); Unidox (CY, IQ, IR, JO, KW, LY, NL, OM, PL, QA, RO, SA, SY, UA, YE); Unidoxy (KR); Veemycin (TH); Verboril (AR); Vibradox (DK, PT); Vibramicina (AR, CL, CO, MX, PE, PT, UY, VE); Vibramycin (AE, AT, AU, BB, BF, BG, BH, BJ, BM, BS, BZ, CH, CI, CY, DE, EG, ET, GB, GH, GM, GN, GR, GY, HK, HU, ID, IE, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, MY, NE, NG, NL, OM, PH, PK, QA, RU, SA, SC, SD, SE, SL, SN, SR, SY, TH, TN, TT, TZ, UG, YE, ZA, ZM, ZW); Vibramycin N (KR); Vibramycine (FR); Vibratab (BE, LU); Vibraveineuse (FR); Vibravenos (AT, DE); Viclorax (PE); Vidoxy (KR); Vivradoxil (MX); Weibamycin (TW); Withamycin (TW); Yong Xi (CN); Zadorin (BB, BF, BJ, BM, BS, BZ, CI, CY, ET, GH, GM, GN, GY, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, YE, ZM, ZW)

Doxycycline (Patient Education – Adult Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(doks i SYE kleen)

Brand Names: US

Acticlate; Adoxa Pak 1/100 [DSC]; Adoxa Pak 1/150 [DSC]; Adoxa Pak 2/100 [DSC]; Adoxa [DSC]; Alodox Convenience [DSC]; Avidoxy; Doryx; Doryx MPC; Doxy 100; Mondoxyne NL; Monodox [DSC]; Morgidox; Ocudox [DSC]; Okebo; Oracea; Soloxide; TargaDOX; Vibramycin

Brand Names: Canada

Apo-Doxy; Apo-Doxy Tabs; Apprilon; Dom-Doxycycline; Doxycin; Doxytab; Periostat; PHL-Doxycycline; PMS-Doxycycline; Teva-Doxycycline; Vibramycin

What is this drug used for?
  • It is used to treat pimples (acne).
  • It is used to treat or prevent bacterial infections.
  • It is used to prevent malaria.
  • It is used to treat swelling of the tissue around the teeth (periodontitis). It is used with scaling and root planing.
  • It is used to treat rosacea.
  • It may be given to you for other reasons. Talk with the doctor.
What do I need to tell my doctor BEFORE I take this drug?
  • If you have an allergy to doxycycline or any other part of this drug.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you are taking any of these drugs: Acitretin, isotretinoin, or a penicillin.
  • If you are breast-feeding or plan to breast-feed.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
What are some things I need to know or do while I take this drug?
  • All products:
  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Have your blood work checked if you are on this drug for a long time. Talk with your doctor.
  • This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug.
  • Do not use longer than you have been told. A second infection may happen.
  • Do not take more than what your doctor told you to take. Taking more than you are told may raise your chance of very bad side effects.
  • Do not switch between different forms of this drug without first talking with the doctor.
  • If you are taking warfarin, talk with your doctor. You may need to have your blood work checked more closely while you are taking it with this drug.
  • You may get sunburned more easily. Avoid sun, sunlamps, and tanning beds. Use sunscreen and wear clothing and eyewear that protects you from the sun.
  • A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away, and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes.
  • A very bad and sometimes deadly reaction has happened with this drug. Most of the time, this reaction has signs like fever, rash, or swollen glands with problems in body organs like the liver, kidney, blood, heart, muscles and joints, or lungs. Talk with the doctor.
  • Birth control pills and other hormone-based birth control may not work as well to prevent pregnancy. Use some other kind of birth control also like a condom when taking this drug.
  • This drug may cause a change in tooth color to yellow-gray-brown in children younger than 8 years old. If this change of tooth color happens, it will not go away. Talk with the doctor.
  • Most of the time, this drug is not for use in children younger than 8 years old. However, there may be times when these children may need to take this drug. Talk with the doctor.
  • Change in tooth color has also happened in adults. This has gone back to normal after this drug was stopped and teeth cleaning at a dentist’s office. Talk with the doctor.
  • This drug may cause harm to the unborn baby if you take it while you are pregnant. If you are pregnant or you get pregnant while taking this drug, call your doctor right away.
  • Liquid (syrup):
  • If you are allergic to sulfites, talk with your doctor. Some products have sulfites.
What are some side effects that I need to call my doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
  • Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
  • Chest pain.
  • Not able to pass urine or change in how much urine is passed.
  • Fever or chills.
  • Sore throat.
  • Throat irritation.
  • Trouble swallowing.
  • Any unexplained bruising or bleeding.
  • Muscle or joint pain.
  • A fast heartbeat.
  • Fast breathing.
  • Flushing.
  • Very bad dizziness or passing out.
  • Feeling very tired or weak.
  • Change in skin color.
  • Vaginal itching or discharge.
  • It is common to have diarrhea when taking antibiotics. Rarely, a severe form of diarrhea called C diff–associated diarrhea (CDAD) may happen. Sometimes, this has led to a deadly bowel problem (colitis). CDAD may happen while you are taking an antibiotic or within a few months after you stop taking it. Call your doctor right away if you have stomach pain or cramps, very loose or watery stools, or bloody stools. Do not try to treat diarrhea without first checking with your doctor.
  • Raised pressure in the brain has happened with this drug. Most of the time, this will go back to normal after this drug is stopped. Sometimes, loss of eyesight may happen and may not go away even after this drug is stopped. Call your doctor right away if you have a headache or eyesight problems like blurred eyesight, seeing double, or loss of eyesight.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:
  • Not hungry.
  • Upset stomach or throwing up.
  • Diarrhea.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best taken?
  • Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.
  • All oral products:
  • To gain the most benefit, do not miss doses.
  • Keep taking this drug as you have been told by your doctor or other health care provider, even if you feel well.
  • Some drugs may need to be taken with food or on an empty stomach. For some drugs it does not matter. Check with your pharmacist about how to take this drug.
  • It is best to avoid taking this drug at the same time as milk, dairy, or other products with calcium. This drug may not work as well. If you have questions, talk with the doctor or pharmacist.
  • Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor.
  • Do not take bismuth (Pepto-Bismol®), calcium, iron, magnesium, zinc, multivitamins with minerals, colestipol, cholestyramine, didanosine, or antacids within 2 hours of this drug.
  • Tablets and capsules:
  • Take with a full glass of water.
  • Do not lie down for at least 30 minutes after taking this drug.
  • All long-acting products:
  • Swallow whole. Do not chew or crush.
  • Long-acting tablets:
  • The tablet may be broken if the doctor tells you to.
  • You may sprinkle contents of tablet on applesauce. Be careful to break the tablet without crushing the pellets. Do not chew, crush, or damage the contents of the tablet.
  • Swallow the mixture right away. Do not store for use at a later time.
  • All liquid products:
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • Liquid (suspension):
  • Shake well before use.
  • Injection:
  • It is given as an infusion into a vein over a period of time.
What do I do if I miss a dose?
  • All oral products:
  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.
  • Injection:
  • Call your doctor to find out what to do.
How do I store and/or throw out this drug?
  • All oral products:
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Do not take this drug if it is outdated.
  • Do not take this drug if it has not been stored as you have been told.
  • Liquid (syrup):
  • Throw away any unused part of this drug.
  • Liquid (suspension):
  • Store liquid (suspension) at room temperature. Throw away any part not used after 2 weeks.
  • Injection:
  • If you need to store this drug at home, talk with your doctor, nurse, or pharmacist about how to store it.
  • All products:
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
  • Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.
Doxycycline (Patient Education – Pediatric Medication)
You must carefully read the “Consumer Information Use and Disclaimer” below in order to understand and correctly use this information
Pronunciation

(doks i SYE kleen)

Brand Names: US

Acticlate; Adoxa Pak 1/100 [DSC]; Adoxa Pak 1/150 [DSC]; Adoxa Pak 2/100 [DSC]; Adoxa [DSC]; Alodox Convenience [DSC]; Avidoxy; Doryx; Doryx MPC; Doxy 100; Mondoxyne NL; Monodox [DSC]; Morgidox; Ocudox [DSC]; Okebo; Oracea; Soloxide; TargaDOX; Vibramycin

Brand Names: Canada

Apo-Doxy; Apo-Doxy Tabs; Apprilon; Dom-Doxycycline; Doxycin; Doxytab; Periostat; PHL-Doxycycline; PMS-Doxycycline; Teva-Doxycycline; Vibramycin

What is this drug used for?
  • It is used to treat pimples (acne).
  • It is used to treat or prevent bacterial infections.
  • It is used to prevent malaria.
  • It is used to treat swelling of the tissue around the teeth (periodontitis). It is used with scaling and root planing.
  • It is used to treat rosacea.
  • It may be given to your child for other reasons. Talk with the doctor.
What do I need to tell the doctor BEFORE my child takes this drug?
  • If your child has an allergy to this drug or any part of this drug.
  • If your child is allergic to any drugs like this one or any other drugs, foods, or other substances. Tell the doctor about the allergy and what signs your child had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If your child is taking any of these drugs: Acitretin, isotretinoin, or a penicillin.
  • If your child is breast-feeding a baby:
  • Talk with the doctor if your child is breast-feeding a baby or plans to breast-feed a baby.
  • This is not a list of all drugs or health problems that interact with this drug.
  • Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for your child to take this drug with all of his/her drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.
What are some things I need to know or do while my child takes this drug?
  • All products:
  • Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
  • Have your child’s blood work checked if he/she is on this drug for a long time. Talk with your child’s doctor.
  • This drug may affect certain lab tests. Tell all of your child’s health care providers and lab workers that your child takes this drug.
  • Do not give to your child longer than you have been told. A second infection may happen.
  • Do not give your child more of this drug than what the doctor told you to give. Giving more of this drug than you are told may raise the chance of very bad side effects.
  • Do not switch between different forms of this drug without first talking with the doctor.
  • If your child is taking warfarin, talk with the doctor. Your child may need to have blood work checked more closely while taking it with this drug.
  • Your child may get sunburned more easily. Avoid lots of sun, sunlamps, and tanning beds. Use sunscreen and dress your child in clothing and eyewear that protects him/her from the sun.
  • A very bad and sometimes deadly reaction has happened with this drug. Most of the time, this reaction has signs like fever, rash, or swollen glands with problems in body organs like the liver, kidney, blood, heart, muscles and joints, or lungs. Talk with the doctor.
  • This drug may cause a change in tooth color to yellow-gray-brown in children younger than 8 years old. If this change of tooth color happens, it will not go away. Talk with the doctor.
  • Most of the time, this drug is not for use in children younger than 8 years old. However, there may be times when these children may need to take this drug. Talk with the doctor.
  • Change in tooth color has also happened in adults. This has gone back to normal after this drug was stopped and teeth cleaning at a dentist’s office. Talk with the doctor.
  • If your child is or may be sexually active:
  • Birth control pills and other hormone-based birth control may not work as well to prevent pregnancy. Be sure your child uses some other kind of birth control also, like a condom, when taking this drug.
  • If your child is pregnant:
  • This drug may cause harm to the unborn baby if your child takes it during pregnancy. If your child is pregnant or gets pregnant while taking this drug, call the doctor right away.
  • Liquid (syrup):
  • If your child is allergic to sulfites, talk with your child’s doctor. Some products have sulfites in them.
What are some side effects that I need to call my child’s doctor about right away?
  • WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:
  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
  • Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
  • Chest pain.
  • Not able to pass urine or change in how much urine is passed.
  • Fever or chills.
  • Sore throat.
  • Throat irritation.
  • Trouble swallowing.
  • Any unexplained bruising or bleeding.
  • Muscle or joint pain.
  • A fast heartbeat.
  • Fast breathing.
  • Flushing.
  • Very bad dizziness or passing out.
  • Feeling very tired or weak.
  • Change in skin color.
  • Vaginal itching or discharge.
  • It is common to have diarrhea when taking antibiotics. Rarely, a severe form of diarrhea called C diff-associated diarrhea (CDAD) may happen. Sometimes, this has led to a deadly bowel problem (colitis). CDAD may happen while your child is taking an antibiotic or within a few months after he/she stops taking it. Call your child’s doctor right away if your child has stomach pain or cramps, very loose or watery stools, or bloody stools. Do not try to treat diarrhea without first checking with the doctor.
  • Raised pressure in the brain has happened with this drug. Most of the time, this will go back to normal after this drug is stopped. Sometimes, loss of eyesight may happen and may not go away even after this drug is stopped. Call the doctor right away if your child has a headache or eyesight problems like blurred eyesight, seeing double, or loss of eyesight.
  • A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away, and sometimes death. Get medical help right away if your child has signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in the mouth, throat, nose, or eyes.
What are some other side effects of this drug?
  • All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:
  • Upset stomach or throwing up.
  • Diarrhea.
  • Not hungry.
  • These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.
  • You may report side effects to your national health agency.
How is this drug best given?
  • Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.
  • All oral products:
  • To gain the most benefit, do not miss giving your child doses.
  • Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well.
  • Some drugs may need to be given with food or on an empty stomach. For some drugs, it does not matter. Check with your pharmacist about how to give this drug to your child.
  • It is best to avoid taking this drug at the same time as milk, dairy, or other products with calcium. This drug may not work as well. If you have questions, talk with the doctor or pharmacist.
  • Have your child drink lots of noncaffeine liquids every day unless told to drink less liquid by your child’s doctor.
  • Do not give bismuth (Pepto-Bismol®), calcium, iron, magnesium, zinc, multivitamins with minerals, colestipol, cholestyramine, didanosine, or antacids within 2 hours of this drug.
  • Tablets and capsules:
  • Give this drug with a full glass of water.
  • Do not let your child lie down for at least 30 minutes after taking this drug. This helps to prevent irritation to the swallowing tube (esophagus).
  • All long-acting products:
  • Have your child swallow whole. Do not let your child chew or crush.
  • Long-acting tablets:
  • The tablet may be broken if the doctor tells you to.
  • You may sprinkle contents of tablet on applesauce. Be careful to break the tablet without crushing the pellets. Do not chew, crush, or damage the contents of the tablet.
  • If mixed, have your child swallow the mixed drug right away. Do not store for use at a later time.
  • All liquid products:
  • Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.
  • Liquid (suspension):
  • Shake well before use.
  • Injection:
  • It is given as an infusion into a vein over a period of time.
What do I do if my child misses a dose?
  • All oral products:
  • Give a missed dose as soon as you think about it.
  • If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
  • Do not take 2 doses at the same time or extra doses.
  • Injection:
  • Call your child’s doctor to find out what to do.
How do I store and/or throw out this drug?
  • All oral products:
  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Get rid of this drug when your child no longer needs it or if the drug is outdated.
  • Do not give this drug if it has not been stored as you have been told.
  • Liquid (syrup):
  • Throw away any unused part of this drug.
  • Liquid (suspension):
  • Store liquid (suspension) at room temperature. Throw away any part not used after 2 weeks.
  • Injection:
  • If you need to store this drug at home, talk with your child’s doctor, nurse, or pharmacist about how to store it.
  • All products:
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.
General drug facts
  • If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
  • Do not share your child’s drug with others and do not give anyone else’s drug to your child.
  • Keep a list of all your child’s drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your child’s doctor.
  • Talk with your child’s doctor before giving your child any new drug, including prescription or OTC, natural products, or vitamins.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.