Presentation and Status in Health Basket
7 X 100 mg
10 X 100 mg
14 X 100 mg
Adults: The usual dose for this drug for the treatment of acute infections in adults is 200 mg on the first day (administered as a single dose or divided into two equal doses with a 12 hour interval), followed by a maintenance dose of 100 mg/day. In the management of more severe infections (particularly chronic infections of the urinary tract) 200 mg daily should be given throughout the treatment period. This drug should be taken with adequate amounts of fluid (at least 100 ml of water). This should be done in the sitting or standing position and the patient should be advised to remain upright for at least thirty minutes after taking a dose. It should be taken well before bedtime to reduce the risk of oesophageal irritation and ulceration. If gastric irritation occurs, it is recommended that this drug will be taken with food or milk. Studies indicate that the absorption of it is not notably influenced by simultaneous ingestion of food or milk. Exceeding the recommended dosage may result in an increased incidence of side effects. Therapy should be continued for at least 24 to 48 hours after symptoms and fever have subsided. When used in streptococcal infections, therapy should be continued for 10 days to prevent the development of rheumatic fever or glomerulonephritis.
Dosage recommendations in specific infections: Sexually transmitted diseases: 100 mg twice daily for 7 days is recommended in the following infections: uncomplicated urethral, endocervical or rectal infection caused by Chlamydia trachomatis, non-gonococcal urethritis caused by Ureaplasma urealyticum.
Uncomplicated gonococcal infections (except anorectal infections in men): Doxycycline 100 mg twice daily for 7 days together with intramuscular ceftriaxone.
Acute epididymo-orchitis caused by Chlamydia trachomatis or Neisseria gonorrhea: Doxycycline 100 mg twice daily for 10 days together with intramuscular ceftriaxone.
Primary and secondary syphilis: Non-pregnant penicillin-allergic patients who have primary or secondary syphilis can be treated with the following regimen: This drug is taken orally twice daily for two weeks, as an alternative to penicillin therapy.
Louse and tick-borne relapsing fevers and louse borne typhus: A single dose of 100 to 200 mg according to severity.
Early Lyme disease (stage 1 and 2): 100 mg twice daily for 10-30 days according to clinical signs, symptoms and response.
Chloroquine-resistant falciparum malaria: 200 mg daily for at least 7 days. Due to the potential severity of the infection, a rapid-acting schizonticide such as quinine should always be given in conjunction with it; quinine dosage recommendations vary in different areas.
Anthrax due to Bacillus anthracis, including inhalational anthrax (post exposure): 100 mg twice a day for 60 days.
Prophylaxis of Malaria: 100 mg daily in adults. Prophylaxis can begin one or two days before travel to malarial areas. It should be continued daily during travel in the malarial areas and for 4 weeks after the traveler leaves the malarious area.
For the treatment and selective prophylaxis of cholera in adults: 300 mg as a single dose.
For the prevention of scrub typhus: 200 mg as a single dose, once weekly.
For the prevention of travelers’ diarrhea in adults: 200 mg on the first day of travel (administered as a single dose or as 100 mg every 12 hours) followed by 100 mg daily throughout the stay in the area. Data on the use of the drug prophylactically are not available beyond 21 days.
For the treatment of leptospirosis: 100 mg twice daily for 7 days.
For the prevention of leptospirosis: 200 mg once each week throughout the stay in the area and 200 mg at the completion of the trip. Data on the use of the drug prophylactically are not available beyond 21 days.
Use in the elderly: This drug may be prescribed in the usual dose with no special precautions. No dosage adjustment is necessary in the presence of renal impairment.
Use in patients with impaired hepatic function: This drug should be administered with caution to patients with hepatic impairment or those receiving potentially hepatotoxic drugs.
Use in patients with renal impairment: Studies to date have indicated that administration of it at the usual recommended doses does not lead to accumulation of the antibiotic in patients with renal impairment.
Treatment of a variety of infections caused by susceptible strains of Gram-positive and Gram-negative bacteria and certain other microorganisms.
Respiratory tract infections: Pneumonia and other lower respiratory tract infections due to susceptible strains of Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis and other organisms. Mycoplasma pneumonia pneumonia. Treatment of chronic bronchitis, sinusitis.
Urinary tract infections: Infections caused by susceptible strains of Klebsiella species, Enterobacter species, Escherichia coli, Streptococcus faecalis and other organisms.
Sexually transmitted diseases: Infections due to Chlamydia trachomatis including uncomplicated urethral, endocervical or rectal infections. Non-gonococcal urethritis caused by Ureaplasma urealiticum (T-mycoplasma). It is also indicated in infections due to Calymmatobacterium granulomatis. This drug is an alternative drug in the treatment of gonorrhoea and syphilis. Since this drug is a member of the tetracycline series of antibiotics, it may be expected to be useful in the treatment of infections which respond to other tetracyclines, such as:
Ophthalmic infections: Treatment of trachoma, although the infectious agent is not always eliminated, as judged by immunofluorescence. Inclusion conjunctivitis may be treated with oral Doxylin alone or in combination with topical agents.
Rickettsial infections: Rocky Mountain spotted fever, typhus group, Q fever and Coxiella endocarditis.
Other infections: Psittocosis, brucellosis (in combination with streptomycin), cholera, bubonic plague, louse and tick-borne relapsing fever including stage 1 and stage 2 Lyme disease, leptospirosis, tularaemia glanders, chloroquine-resistant falciparum malaria and acute intestinal amoebiasis (as an adjunct to amoebicides). Infections due to susceptible strains of Bacteroides species and Listeria species. This drug is an alternative drug in the treatment of leptospirosis, gas gangrene and tetanus. It is indicated for prophylaxis in the following conditions: Scrub typhus, traveller’s diarrhoea (enterotoxigenic Escherichia coli), leptospirosis, malaria and cholera.
Anthrax due to Bacillus anthracis, including inhalational anthrax (post exposure): to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis.
This drug is contraindicated in persons who have shown hypersensitivity to doxycycline, any of its inert ingredients or to any of the tetracyclines. Obstructive oesophageal disorders, such as stricture or achalasia. The use of drugs of the tetracycline class during tooth development (pregnancy, infancy and childhood to the age of 12 years) may cause permanent discoloration of the teeth (yellow-grey-brown). This adverse reaction is more common during long-term use of the drugs but has been observed following repeated short-term courses. Enamel hypoplasia has also been reported. It is therefore contraindicated in these groups of patients.
Pregnancy: This drug is contraindicated in pregnancy. It appears that the risks associated with the use of tetracyclines during pregnancy are predominantly due to effects on teeth and skeletal development.
Nursing Mothers: Tetracyclines are excreted into milk and are therefore contraindicated in nursing mothers.
Children: This drug is contraindicated in children under the age of 12 years. As with other tetracyclines, Doxylin forms a stable calcium complex in any bone-forming tissue. A decrease in the fibula growth rate has been observed in premature given oral tetracyclines in doses of 25 mg/kg every 6 hours. This reaction was shown to be reversible when the drug was discontinued.
Use in patients with renal impairment: Excretion of doxycycline by the kidney is about 40%/72 hours in individuals with normal renal function. This percentage excretion may fall to a range as low as 1-5%/72 hours in individuals with severe renal insufficiency (creatinine clearance below 10ml/min). Studies have shown no significant difference in the serum half-life of doxycycline in individuals with normal and severely impaired renal function. Haemodialysis does not alter the serum half-life of doxycycline. The anti-anabolic action of the tetracyclines may cause an increase in blood urea. Studies to date indicate that this anti-anabolic effect does not occur with the use of doxylin in patients with impaired renal function.
Use in patients with impaired hepatic function: Doxylin should be administered with caution to patients with hepatic impairment or those receiving potentially hepatotoxic drugs. Abnormal hepatic function has been reported rarely and has been caused by both the oral and parenteral administration of tetracyclines, including doxycycline.
This medicinal product contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Photosensitivity: Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines, including doxycycline. All patients taking doxycycline should be advised to avoid excessive sunlight or artificial ultraviolet light while receiving doxycycline. Patients likely to be exposed to direct sunlight or ultraviolet light should be advised that this reaction can occur with tetracycline drugs and treatment should be discontinued at the first evidence of skin erythema. Sunscreen or sunblock should be considered.
Microbiological overgrowth: The use of antibiotics may occasionally result in overgrowth of non-susceptible organisms including fungi. Constant observation of the patient is essential. If a resistant organism appears, the antibiotic should be discontinued and appropriate therapy instituted. Pseudomembranous colitis has been reported with nearly all antibacterial agents, including doxycycline, and has ranged in severity from mild to life-threatening. It is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. Clostridium difficile associated diarrhoea (CDAD) has been reported with use of nearly all antibacterial agents, including doxycycline, and may range in severity from mild diarrhoea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhoea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing use of antibacterial drugs not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
Oesophagitis: cases of oesophageal injuries (oesophagitis and ulceration), sometimes serious, have been reported. Patients should be instructed to take doxycycline capsules with plenty of water (at least 100ml), remain upright and not take their treatment before going to bed. Withdrawal of Doxycycline and investigation of oesophageal disorder should be considered if symptoms such as dyspepsia or retrosternal pain occur. Caution is required in the treatment of patients with known oesophageal reflux disorders.
Bulging fontanelles: in infants and benign intracarnial hypertension in juveniles and adults have been reported in individuals receiving full therapeutic dosages. These conditions disappeared rapidly when the drug was discontinued. Intracranial hypertension (IH, pseudotumor cerebri) has been associated with the use of tetracyclines including Doxylin. Clinical manifestations of IH include headache, blurred vision, diplopia and vision loss; papilledema can be found on fundoscopy. Women of childbearing age who are overweight or have a history of IH are at greater risk for developing tetracycline associated IH. Concomitant use of isotretinoin and Doxylin should be avoided because isotretinoin is also known to cause pseudotumor cerebri.Although IH typically resolves after discontinuation of treatment, the possibility for permanent visual lost exists. If visual disturbance occurs during treatment, prompt ophthalmologic evaluation is warranted. Since intracranial pressure can remain elevated for weeks after drug cessation patients should be monitored until they stabilize.Incision and drainage or other surgical procedures should be performed in conjunction with antibacterial therapy, when indicated.
Veneral disease: When treating venereal disease where co-existent syphilis is suspected, proper diagnostic procedures, including dark-field examinations, should be utilized. Monthly serological tests should be made for at least 4 months.
Beta-haemolytic streptococci infections: infections due to a group A beta-haemolytic streptococci should be treated for at least 10 days.
Plasmodium strains: Doxycycline offers substantial but not complete suppression of the asexual blood stages of Plasmodium strains. Doxycycline does not suppress P. falciparum’s sexual blood stage gametocytes. Subjects completing this prophylactic regimen may still transmit the infection to mosquitoes outside endemic areas. Prescribing Doxylin in the absence of proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
Laboratory Tests: In venereal disease, when co-existent syphilis is suspected, dark field examinations should be done before treatment is started and the blood serology repeated monthly for at least 4 months. In long-term therapy, periodic laboratory evaluation of organ systems, including hematopoietic, renal, and hepatic studies, should be performed.
Very Common: Photosensitivity skin reactions.
Common: Hypersensitivity reactions, including anaphylactic shock, anaphylaxis, anaphylactoid reaction, anaphylactoid purpura, hypotension, pericarditis, angioneurotic oedema, exacerbation of systemic lupus erythematosus, dyspnoea, serum sickness, peripheral oedema, tachycardia and urticaria, headache, nausea, vomiting, rashes including maculopapular and erythematous rashes.
There have been reports of prolonged prothrombin time in patients taking warfarin and Doxycycline. Because the tetracyclines have been shown to depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage. Since bacteriostatic drugs may interfere with the bactericidal action of penicillin, it is advisable to avoid giving Doxylin in conjunction with penicillin. The absorption of doxycycline is impaired by concurrently administered antacids containing aluminium, calcium, magnesium or other drugs containing these cations; oral zinc, iron salts or bismuth preparations. The serum half-life of doxycycline is shortened when patients are concurrently receiving alcohol, barbiturates, carbamazepine, or phenytoin. The concurrent use of tetracyclines and methoxyflurane has been reported to result in fatal renal toxicity. A few cases of pregnancy or breakthrough bleeding have been attributed to the concurrent use of tetracyclines with oral contraceptives. Concurrent use of tetracycline may render oral contraceptives less effective.
Pregnancy and Lactation
Pregnancy: This drug should not be used in pregnancy unless, in the judgement of the physician, it is essential for the welfare of the patient. Results of animal studies indicate that tetracyclines cross the placenta, are found in foetal tissues and can have toxic effects on the developing foetus (often related to retardation of skeletal development). Evidence of embryotoxicity has also been noted in animals treated early in pregnancy. If any tetracycline is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. There are no adequate and well-controlled studies on the use of doxycycline in pregnant women. The vast majority of reported experience with doxycycline during human pregnancy is short term, first trimester exposure. There are no human data available to assess the effects of long term therapy of doxycycline in pregnant women, such as that proposed for treatment of anthrax exposure. An expert review of published data on experiences with doxycycline use during pregnancy by TERIS – the Teratogen Information System – concluded that therapeutic doses during pregnancy are unlikely to pose a substantial teratogenic risk (the quantity and quality of data were assessed as limited to fair), but the data are insufficient to state that there is no risk. A case-control study (18,515 mothers of infants with congenital anomalies and 32,804 mothers of infants with no congenital anomalies) shows a weak but marginally statistically significant association with total malformations and use of doxycycline anytime during pregnancy. Sixty three (0.19%) of the controls and fifty-six (0.30%) of the cases were treated with doxycycline. This association was not seen when the analysis was confined to maternal treatment during the period of organogenesis (i.e., in the second and third months of gestation) with the exception of a marginal relationship with neural tube defect based on only two exposed cases.A small prospective study of 81 pregnancies describes 43 pregnant women treated for 10 days with doxycycline during early first trimester. All mothers reported their exposed infants were normal at 1 year of age.
Labor & Delivery: The effect of tetracyclines on labor and delivery is unknown.
Lactation: Tetracyclines are present in the milk of lactating women who are taking a drug of this kind and should therefore not be used in nursing mothers.
Fertility: Doxycycline administered orally at dosage levels as high as 250 mg/kg/day had no apparent effect on the fertility of female rats. Effect on male fertility has not been studied.
Acute overdose with antibiotics is rare. In the event of overdose discontinue medication. Gastric lavage plus appropriate supportive treatment is indicated. Dialysis does not alter serum half-life and thus would not be of benefit in treating cases of overdose.