II. Indications
- Skin disorders
- Gastrointestinal disorders
- Helicobacter Pylori (part of quadruple therapy protocol)
- Tick-borne illness
- Miscellaneous disorders
- Sexually Transmitted Disease
III. Contraindications
- Pregnancy
- Pregnancy category D
- Children under age 8 years old
- AAP now approves Doxycycline for ANY age up to 21 day duration
- Unlike Tetracycline, Doxycycline is unlikely to cause visible tooth staining
- For severe infections (e.g. Lyme Disease, Rocky Mountain Spotted Fever), Doxycycline is a first-line agent
IV. Mechanism
- Tetracyclines are protein synthesis inhibitors, binding the 30S ribosomal subunit of susceptible Bacteria
- Prevents elongated peptide chains from forming from amino acid residues
V. Preparations: Tetracycline
- Acne Vulgaris: 1 gram orally daily given in 2-4 divided doses
VI. Preparations: Doxycycline
- Typical dose: 100 mg orally twice daily
- Low doses, such as 50 mg daily, are often as effective for acne
- Avoid substituting low-dose Doxycycline (Periostat, Oracea) products for systemic infections
- May substitute other Doxycycline salts
- Doxycycline hyclate (Vibramycin, Doryx)
- Doxycycline monohydrate (Monodox)
- (2013) Presc Lett 20(5):26
- Other formulations
- Doxycyline Hyclate Delayed-Release (Doryx MPC)
- Expensive ($10/pill) formulated to by-pass the esophagus for less side effects
- Alternatively, take the doxycyline with 8 oz water and food
- (2016) Presc Lett 23(11)
- Doxycyline Hyclate Delayed-Release (Doryx MPC)
VII. Preparations: Minocycline (Minocin)
- Oral
- Acne Vulgaris: 50-200 mg/d orally in divided doses
- Topicals
- Acne Vulgaris: Minocycline 4% Foam (Amzeeq)
- Rosacea: Minocycline 1.5% Foam (Zilxi)
- Very expensive (nearly $500 for 30 grams)
- No evidence of benefit over other Rosacea topicals
- (2021) Presc Lett 28(6): 36 [PubMed]
VIII. Preparations: Intravenous
- Eravacycline (Xerava)
- Nuzyra (Omadacycline)
- Load: 200 mg IV for one dose (or divided 100 mg IV every 12 hours for 2 doses)
- Maintenance: 100 mg IV once daily (or 300 mg orally once daily)
- Once daily agent indicated for Community Acquired Pneumonia and Skin Infections
- Released in 2018 at $400 per pill, and likely less effective than standard agents for CAP
- (2019) presc lett 26(1):4
IX. Drug Interactions: Food Related
- Tetracycline
- Milk and Calcium-rich food decrease absorption
- Take 1 hour before or 2 hours after a meal
- Doxycycline and Minocycline
- Can be taken with milk or food (unlike Tetracycline)
X. Precautions
- Use Sunscreen with these agents due to Drug-induced Photosensitivity
-
Pill Esophagitis
- Take with a full glass of water
XI. Adverse Effects
- Tetracycline
- Photosensitivity
- Interferes with OCP action
- Doxycycline
- Photosensitivity
- Abdominal Pain
- Diarrhea
- Pill Esophagitis (see above)
- Minocycline
- Generally well tolerated
- Does not generally cause photosensitivity
- Minocycline-Induced Hyperpigmentation
- Blue-gray or muddy brown Hyperpigmentation resulting from Minocycline-iron complex skin deposition
- Distribution: Face, arms, legs (esp. shins)
- Highest risk in long-term dosing for chronic infection or Rheumatoid Arthritis (risk increases with longer duration)
- Uncommon with low dose Acne Vulgaris use
- Hyperpigmentation often persists even after Minocycline is discontinued (limited therapies, e.g. laser)
- Jain (2019) Am Fam Physician 100(4): 239-240 [PubMed]
- Rare adverse effects
- Lupus-Like Syndrome (1:20,000)
- Vertigo
- Oral Mucosa pigmentation (blue-black pigmentation)
- Hypersensitivity Syndrome within 1-3 months
- Delayed Arthralgias or Polyarthritis
- Omadacycline (Nuzyra)
XII. References
- (2019) Tarascon Pharmacopeia, accessed 3/31/2019
- LoVecchio (2019) Crit Dec Emerg Med 33(3): 28
Images: Related links to external sites (from Bing)
Related Studies
| tetracycline (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TETRACYCLINE 250 MG CAPSULE | Generic | $5.23 each |
| TETRACYCLINE 500 MG CAPSULE | Generic | $7.81 each |
| doxycycline (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| DOXYCYCLINE 25 MG/5 ML SUSP | Generic | $0.29 per ml |
| DOXYCYCLINE HYC DR 100 MG TAB | Generic | $8.83 each |
| DOXYCYCLINE HYCLATE 100 MG CAP | Generic | $0.49 each |
| DOXYCYCLINE HYCLATE 100 MG TAB | Generic | $0.63 each |
| DOXYCYCLINE HYCLATE 20 MG TAB | Generic | $0.36 each |
| DOXYCYCLINE HYCLATE 50 MG CAP | Generic | $0.59 each |
| DOXYCYCLINE IR-DR 40 MG CAP | Generic | $15.88 each |
| DOXYCYCLINE MONO 100 MG CAP | Generic | $0.42 each |
| DOXYCYCLINE MONO 100 MG TABLET | Generic | $0.50 each |
| DOXYCYCLINE MONO 150 MG TABLET | Generic | $5.36 each |
| DOXYCYCLINE MONO 50 MG CAP | Generic | $0.31 each |
| DOXYCYCLINE MONO 50 MG TABLET | Generic | $0.44 each |
| minocycline (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MINOCYCLINE 100 MG CAPSULE | Generic | $0.35 each |
| MINOCYCLINE 50 MG CAPSULE | Generic | $0.21 each |
| MINOCYCLINE 75 MG CAPSULE | Generic | $0.44 each |
| MINOCYCLINE HCL 100 MG TABLET | Generic | $2.82 each |
| MINOCYCLINE HCL 50 MG TABLET | Generic | $1.29 each |
Ontology: Doxycycline (C0013090)
| Definition (CHV) | a kind of antibiotics |
| Definition (MSH) | A synthetic tetracycline derivative with similar antimicrobial activity. |
| Definition (NCI_NCI-GLOSS) | A drug used to treat many types of bacterial infections. It stops the growth of bacteria by keeping them from making proteins. It is a type of antibiotic. |
| Definition (NCI) | A synthetic, broad-spectrum tetracycline antibiotic exhibiting antimicrobial activity. Doxycycline binds to the 30S ribosomal subunit, possibly to the 50S ribosomal subunit as well, thereby blocking the binding of aminoacyl-tRNA to the mRNA-ribosome complex. This leads to an inhibition of protein synthesis. In addition, this agent has exhibited inhibition of collagenase activity. |
| Definition (PDQ) | A synthetic, broad-spectrum tetracycline antibiotic exhibiting antimicrobial activity. Doxycycline binds to the 30S ribosomal subunit, possibly to the 50S ribosomal subunit as well, thereby blocking the binding of aminoacyl-tRNA to the mRNA-ribosome complex. This leads to an inhibition of protein synthesis. In addition, this agent has exhibited inhibition of collagenase activity. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42494&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42494&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C457" NCI Thesaurus) |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D004318 |
| SnomedCT | 10504007, 372478003 |
| LNC | LP14992-9, MTHU002295 |
| English | Doxycycline, 2-Naphthacenecarboxamide, 4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-, (4S-(4alpha,4aalpha,5alpha,5aalpha,6alpha,12aalpha))-, doxycycline, DOXYCYCLINE, Doxycycline [Chemical/Ingredient], Alpha 6 Deoxyoxytetracycline, Alpha-6-Deoxyoxytetracycline, Doxycycline (product), Doxycycline (substance) |
| Swedish | Doxycyklin |
| Czech | doxycyklin |
| Finnish | Doksisykliini |
| Russian | VIBRAMITSIN, DOKSITSIKLIN, ВИБРАМИЦИН, ДОКСИЦИКЛИН |
| Italian | alfa-6-Deossi-ossitetraciclina, Doxiciclina |
| Croatian | DOKSICIKLIN |
| Polish | Doksycyklina, Wibramycyna |
| Japanese | ドキシサイクリン, 塩酸ドキシサイクリン |
| Norwegian | Doksycyklin |
| Spanish | doxiciclina (producto), doxiciclina (sustancia), doxiciclina, Doxiciclina |
| French | Doxycycline |
| German | Doxycyclin |
| Portuguese | Doxiciclina |
Ontology: Minocycline (C0026187)
| Definition (CHV) | a kind of antibiotics |
| Definition (MSH) | A TETRACYCLINE analog, having a 7-dimethylamino and lacking the 5 methyl and hydroxyl groups, which is effective against tetracycline-resistant STAPHYLOCOCCUS infections. |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D008911 |
| SnomedCT | 13512003, 372653009 |
| LNC | LP16031-4, MTHU008456 |
| English | Minocycline, 2-Naphthacenecarboxamide, 4,7-bis(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,10,12,12a-tetrahydroxy-1,11-dioxo-, (4S-(4alpha,4aalpha,5aalpha,12aalpha))-, Minocycline [Chemical/Ingredient], (2E,4S,4aR,5aS,12aR)- 2-(amino-hydroxy-methylidene)- 4,7-bis(dimethylamino)-10,11,12a-trihydroxy-4a,5,5a,6- tetrahydro-4H-tetracene- 1,3,12-trione, MINOCYCLINE, antibacterial minocycline, minocycline (medication), minocycline, Minocycline (product), Minocycline (substance) |
| Swedish | Minocyklin |
| Czech | minocyklin |
| Finnish | Minosykliini |
| Russian | MINOTSIKLIN, МИНОЦИКЛИН |
| Japanese | ミノサイクリン塩酸塩, 塩酸ミノサイクリン, ミノサイクリン |
| Polish | Minocyklina |
| Norwegian | Minocyklin |
| Spanish | minociclina (producto), minociclina (sustancia), minociclina, Minociclina |
| French | Minocycline |
| German | Minocyclin |
| Italian | Minociclina |
| Portuguese | Minociclina |
Ontology: Tetracycline (C0039644)
| Definition (NCI) | A broad-spectrum naphthacene antibiotic produced semisynthetically from chlortetracycline, an antibiotic isolated from the bacterium Streptomyces aureofaciens. In bacteria, tetracycline binds to the 30S ribosomal subunit, interferes with the binding of aminoacyl-tRNA to the mRNA-ribosome complex, thereby inhibiting protein synthesis. |
| Definition (NCI_NCI-GLOSS) | A drug used to treat bacterial infections. It stops the growth of bacteria by keeping them from making proteins. Tetracycline also binds to new bone tissue and is being studied as a way to detect bone growth. Tetracycline is a type of antibiotic and a type of bone-labeling agent. |
| Definition (MSH) | A naphthacene antibiotic that inhibits AMINO ACYL TRNA binding during protein synthesis. |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D013752 |
| SnomedCT | 324010007, 372809001, 66261008 |
| LNC | LP16286-4, MTHU008490 |
| English | Tetracycline, 2-Naphthacenecarboxamide, 4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,6,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-, (4S-(4alpha,4aalpha,5aalpha,6beta,12aalpha))-, Tetracycline [systemic], 4-(Dimethylamino)-1,4,4A,5,5A,6,11,12A-Octahydro-3,6,10,12,12A-Pentahydroxy-6-Methyl-1,11-Dioxo-2-Naphthacenecarboxamide, tetracycline (medication), Tetracycline [Chemical/Ingredient], TETRACYCLINE, Tetracycline [systemic] (product), tetracycline, Tetracycline (product), Tetracycline (substance), TETRA, Tetracycline, NOS, Tetracycline [systemic] (substance), TCN |
| German | Tetrazyklin, Tetracyclin |
| Swedish | Tetracyklin |
| Czech | tetracyklin |
| Finnish | Tetrasykliini |
| Russian | TETRATSIKLIN, ТЕТРАЦИКЛИН |
| Japanese | 塩酸テトラサイクリン, コサテトラシン, テトラサイクリン塩酸塩, アクロマイシン, テトラサイクリン |
| Polish | Tetracyklina |
| Norwegian | Tetracyklin |
| Spanish | tetraciclina [sistémica], tetraciclina [sistémica] (producto), tetraciclina (producto), tetraciclina (sustancia), tetraciclina, Tetraciclina |
| French | Tétracycline |
| Italian | Tetraciclina |
| Portuguese | Tetraciclina |
