Doxycycline


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Susceptible infections 200 mg on the first day, then 100 mg/day. Severe infections: 200 mg/day. Sexually transmitted diseases; Uncomplicated gonorrhoea 100 mg bid for 7 days. Epididymo-orchitis due to Chlamydia trachomatis or Neisseria gonorrhoeae 100 mg bid for 10 days. Syphilis 300 mg/day for at least 10 days. Relapsing fever and louse-borne typhus 100 or 200 mg as a single dose. Prophylaxis of scrub typhus 200 mg as a single dose. Chloroquine resistant falciparum malaria acute attack In combination with quinine: 200 mg/day for at least 7 days. Prophylaxis of malaria 100 mg/day. Treatment and postexposure prophylaxis of inhalation anthrax 100 mg bid for 60 days. Prophylaxis of traveller’s diarrhoea 200 mg on the first day of travel, then 100 mg/day. Prophylaxis of leptospirosis 200 mg/week throughout the trip, then 200 mg on the last day of trip. Acne 50 mg/day for 6-12 weeks. Periodontitis 20 mg bid up to 3 months. IV Susceptible infections 200 mg on day 1 followed by 100-200 mg/day depending on the severity of infection. Topical/Cutaneous Periodontitis As 10% controlled-release subgingival preparation: Inject into the periodontal pocket, may be repeated 4 months after initial treatment.
Dosage Details
Intravenous
Susceptible infections
Adult: 200 mg on day 1 followed by 100-200 mg daily depending on the severity of infection.

Oral
Syphilis
Adult: 300 mg daily in divided doses for at least 10 days.

Oral
Susceptible infections
Adult: 200 mg as a single dose or in 2 divided doses (at 12-hour interval) on the first day, then 100 mg once daily. Severe infections: 200 mg daily.
Child: <45 kg: 4.4 mg/kg in 2 divided doses on the first day then, 2.2 mg/kg. For severe infections: 2.2 mg/kg 12 hourly; ≥45 kg: Same as adult dose.

Oral
Epididymo-orchitis
Adult: Infection caused by Chlamydia trachomatis or Neisseria gonorrhoeae 100 mg bid for at least 10 days.

Oral
Chloroquine resistant falciparum malaria acute attack
Adult: In combination with quinine: 200 mg daily for at least 7 days.

Oral
Relapsing fever and louse-borne typhus
Adult: 100 or 200 mg as a single dose.

Oral
Nongonococcal urethritis, Sexually transmitted diseases, Uncomplicated gonorrhoea
Adult: 100 mg bid for 7 days.

Oral
Prophylaxis of scrub typhus
Adult: 200 mg as a single dose.

Oral
Treatment and postexposure prophylaxis of inhalation anthrax
Adult: Postexposure prophylaxis: 100 mg bid for 60 days. Treatment: 100 mg bid for 7-10 days (cutaneous); 200 mg as a single dose then 100 mg 12 hourly, in combination with a bactericidal agent, for 2 weeks until clinically stable (systemic).
Child: <45 kg: 2.2 mg/kg bid for 60 days; ≥45 kg: Same as adult dose.

Oral
Leptospirosis
Adult: As prophylaxis: 200 mg once weekly throughout the stay in the area, then 200 mg on the last day of trip.

Oral
Traveller's diarrhoea
Adult: As prophylaxis: 200 mg as a single dose or in 2 divided doses on the first day of travel, then 100 mg once daily throughout the stay in the area.

Oral
Prophylaxis of malaria
Adult: As dispersible tab: 100 mg daily starting 1-2 days before travel to malarial areas, continued daily during the stay and for 4 weeks after leaving the malarial area.
Child: ≥12 years <45 kg: 2.2 mg/kg once daily; ≥45 kg: Same as adult dose.

Oral
Periodontitis
Adult: As film-coated tab: 20 mg bid for up to 3 months.

Oral
Acne
Adult: 40 mg or 50 mg (depending on the preparation) daily for 6-12 weeks.

Topical/Cutaneous
Periodontitis
Adult: As 10% controlled-release subgingival preparation: Inject into the periodontal pocket, may be repeated 4 months after initial treatment.
Administration
May be taken with or without food. Take w/ a full glass of water & remain upright for at least 30 min. Take w/ food or milk if GI irritation occurs.
Reconstitution
IV: Dilute a 100 or 200 mg vial with 10 or 20 mL of sterile water for inj or other compatible IV infusion solution, respectively, to a final concentration of 10 mg/mL. Further dilute each 100 or 200 mg with 100-1000 or 200-2000 mL, respectively, of compatible IV infusion fluid to a final concentration of approx 0.1-1 mg/mL.
Contraindications
Hypersensitivity to doxycycline and other tetracycline congeners. Known or suspected achlorhydria (film-coated tab). Children <8 years (except for anthrax). Pregnancy and lactation. Concomitant use of methoxyflurane.
Special Precautions
Patient with coexisting venereal disease, myasthenia gravis, SLE. Hepatic and renal impairment.
Adverse Reactions
Significant: Microbial overgrowth including fungi, pseudomembranous colitis, oesophagitis, oesophageal ulceration, benign intracranial hypertension, discolouration of teeth, enamel hypoplasia, photosensitivity, exfoliative dermatitis, erythema multiforme, drug reaction with eosinophilia and systemic symptoms, Jarisch-Herxheimer reaction (if with spirochete infection); rarely, transient increases in LFT, porphyria.
Blood and lymphatic system disorders: Haemolytic anaemia, neutropenia, eosinophilia, thrombocytopenia.
Cardiac disorders: Tachycardia, pericarditis.
Ear and labyrinth disorders: Tinnitus.
Eye disorders: Blurred vision, diplopia, scotomata.
Gastrointestinal disorders: Stomatitis, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, pancreatitis.
General disorders and administration site conditions: Peripheral oedema.
Hepatobiliary disorders: Jaundice.
Immune system disorders: Angioneurotic oedema, urticaria, serum sickness.
Investigations: Brown/black discolouration of thyroid tissue, increased serum AST.
Metabolism and nutrition disorders: Anorexia.
Musculoskeletal and connective tissue disorders: Arthralgia, myalgia.
Nervous system disorders: Headache.
Reproductive system and breast disorders: Vaginitis.
Respiratory, thoracic and mediastinal disorders: Dyspnoea.
Skin and subcutaneous tissue disorders: Rashes, photo-onycholysis, skin hyperpigmentation.
Vascular disorders: Hypotension.
Potentially Fatal: Anaphylactoid reactions, Stevens-Johnson syndrome, toxic epidermal necrolysis, Clostridium difficile-associated disease (CDAD), hepatotoxicity.
IV/Parenteral/PO: D
Patient Counseling Information
Avoid exposure to direct sunlight or UV light.
MonitoringParameters
Before treatment, perform sensitivity testing. Monitor CBC, LFT and renal function.
Drug Interactions
Risk of pseudotumour cerebri with isotretinoin. Risk of breakthrough bleeding with oral contraceptives. Prolonged prothrombin time with anticoagulants (e.g. warfarin). Decreased exposure with antacids containing Al, Ca or Mg, Zn, Fe salts, bismuth preparations, carbamazepine, phenobarbital, phenytoin and primidone. May increase the exposure of ciclosporin. May interfere with the bactericidal action of penicillin. Drugs that induce hepatic enzymes (e.g. rifampicin) may decrease the half-life of doxycycline.
Potentially Fatal: Concurrent use with methoxyflurane may result in renal toxicity.
Food Interaction
May decrease absorption with food including milk. Decreased half-life with alcohol.
Lab Interference
May interfere with fluorescence test for urinary catecholamines.
Action
Description: Doxycycline, a tetracycline congener, is bacteriostatic against a broad range of gram-positive and gram-negative bacteria. It inhibits protein synthesis by inhibiting the 30S ribosomal subunit of bacteria.
Pharmacokinetics:
Absorption: Readily and almost completely absorbed from the gastrointestinal tract. Bioavailability: Approx 93%. Time to peak plasma concentration: 2 hours.
Distribution: Widely distributed into body tissues (with strong affinity to lung and renal tissues) and fluids. Crosses the placenta and enters breast milk. Plasma protein binding: Approx 80-95%.
Excretion: Via urine (23%-40%); faeces (30%). Plasma elimination half-life: 12-24 hours.
Chemical Structure

Chemical Structure Image

Source: National Center for Biotechnology Information. PubChem Database. Doxycycline, CID=54671203, https://pubchem.ncbi.nlm.nih.gov/compound/Doxycycline (accessed on Jan. 21, 2020)

Storage
Store between 20-25°C. Protect reconstituted solution from light (IV).
ATC Classification
A01AB22 - doxycycline ; Belongs to the class of local antiinfective and antiseptic preparations. Used in the treatment of diseases of the mouth.
J01AA02 - doxycycline ; Belongs to the class of tetracyclines. Used in the systemic treatment of infections.
References
Acticlate Tablet, Coated (Aqua Pharmaceuticals). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 09/07/2018.

Anon. Doxycycline. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 06/07/2018.

Doryx Tablet, Delayed Release (Mayne Pharma Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 09/07/2018.

Disclaimer: This information is independently developed by MIMS based on Doxycycline from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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