Doxycycline

Doxycycline Side Effects: Trade names include Vibramycin, Monodox, Acoxa, Doryz and Periostat. Available in 50,75, 100 and 150 mg dose forms. The typical starting dose is 100 mg taken twice daily. Doxycycline is an old antibiotic that has become a much more important drug with the emergence of methicillin resistant staphylococcal aureus (MRSA). Most strains of MRSA remain sensitive to doxycycline and because of the high incidence of allergy to the sulfa drugs that are the other commonly used drug for MRSA infections. Doxycycline is a very important medication in the treatment of these difficult infections.

Common Doxycycline Side Effects: The most common doxycycline side effects are gastrointestinal problems including dyspepsia, nausea, and diarrhea. Headache, painful menses, renal toxicity primarily elevated BUN/CR, and skin or tissue discoloration are fairly common doxycycline side effects. Others include joint pain, rash, and the doxycycline side effect shared by most other antibiotics candida vaginal yeast infections. Photosensitivity, especially in southern climates or other areas with lots of sunshine, is a very common doxycycline side effect.

Serious Doxycycline Side Effects: Unfortunately serious doxycycline side effects are more common than with some other antibiotics. One of the most noticeable of these is tooth discoloration when used in children whose permanent teeth have not yet fully developed, and use of doxycycline is absolutely contraindicated in children under 8 years of age. Most physicians are reluctant to use doxycycline in children under 10 to 12 years of age. As with most antibiotics, Clostridium difficile infection and pseudomembranous colitis is well-documented as a serious doxycycline side effect. Allergic reactions including anaphylaxis, rashes of many sorts including erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis, and Stevens-Johnson Syndrome have also been reported. An unusual doxycycline side effect is sometimes very severe esophagitis, really an esophageal ulceration, that is caused by not washing the pill down with enough water and allowing the pill to start to dissolve in the esophagus that leads to erosion or ulceration of the esophagus. This can cause severe pain with swallowing that is commonly seen in emergency rooms and primary physician’s offices. Numerous other serious side effects include Systemic Lupus Erythematosis, serum-sickness, vasculitis, various blood dyscrasias, pseudotumor cerebri, pericarditis, liver and renal toxicity and others. For a complete list of possible serious doxycycline side effects see the manufacturer’s prescribing guidelines.

Doxycycline Drug Interactions: Doxycycline is contraindicated for use with acitretin (trade name Adoxa) because of an increased risk of pseudotumor cerebri or papilledema and with live BCG immunization use. Use of doxycycline with oral typhoid vaccine may result in lack of immunologic response and should be avoided. Many drugs and products can interfere with doxycycline absorption including antacids, bismuth, calcium products, iron products, magnesium products, and possibly milk. Doxycycline may increase the anticoagulation effect of warfarin (digoxin). Many other drugs may reduce the efficacy of doxycycline. The commonly used herbal supplement Black Kohash can lead to hepatotoxicity when used with doxycycline. As with many antibiotics doxycycline can reduce the effectiveness of contraception when used in women taking hormonal birth control pills. The list of potential drug interactions with doxycycline is extensive, and for a complete listing of drug interactions  please see the manufacturer’s prescriber information.

Pregnancy and Lactation: Doxycycline is contraindicated in pregnancy, and is category D in pregnancy. This category is for drugs with positive evidence of human risk. Doxycycline is felt to be possibly unsafe during lactation, and is best not used in women who are breast feeding their infants.

Unusual Side Effects: The esophageal ulceration that can occur with doxycycline, especially with the capsule formulations, is unique to only a few drugs. It is recommended that doxycycline be taken with a large glass of water and that patients not lie down for at least 20 minutes after swallowing the medication to avoid this doxycycline side effect. Photosensitivity is the other common and somewhat unusual side effect.

Special Doxycycline Considerations: Use with birth control pills, avoidance of excessive sun exposure, and avoidance of the numerous products that can inhibit doxycycline absorption are issues that deserve special consideration.

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