Names and pronunciation
Atridox, Acticlate, Doryx, Doxy MPC, Monodox, Vibramycin doxycycline monohydrinate (Rx) Apprilon , Vibramycin
PDF page 431
Loading InternPractice…
Drug reference
Atridox, Acticlate, Doryx, Doxy MPC, Monodox, Vibramycin doxycycline monohydrinate (Rx) Apprilon , Vibramycin
PDF page 431
Func. class.: Antiinfective
PDF page 431
Chem. class.: Tetracycline
PDF page 431
Do not confuse: doxycycline/doxepin/dicyclomine
PDF page 431
ACTION: Inhibits protein synthesis, phosphorylation in microorganisms by binding to 30S ribosomal subunits; bacteriostatic
PDF page 431
USES: Acinetobacter sp., Actinomyces israelii, Bacillus anthracis, Bacteroides sp., Balantidium coli, Bartonella bacil- liformis, Borrelia recurrentis, Brucella sp., Campylobacter fetus, Chlamydia psittaci, Chlamydia trachomatis, Clos- tridium sp., Entamoeba histolytica, Enterobacter aerogenes, Enterococcus sp., Escherichia coli, Francisella tular- ensis, Fusobacterium fusiforme, Hae- mophilus ducreyi, Haemophilus influenzae (beta-lactamase negative), Haemophilus influenzae (beta-lacta- mase positive), Klebsiella granulomatis, Klebsiella sp., Leptospira sp., Listeria monocytogenes, Mycoplasma pneu- moniae, Neisseria gonorrhoeae, Neisse- ria meningitidis, Orientia tsutsugamu- shi, Plasmodium falciparum, Propionibacterium acnes, Rickettsia akari, Rickettsia prowazekii, Rickettsia rickettsii, Shigella sp., Staphylococcus aureus (MSSA), Streptococcus pneu- moniae, Streptococcus pyogenes (group A beta-hemolytic streptococci), Strepto- coccus sp., Treponema pallidum, Trepo- nema pertenue, Ureaplasma urealyti- cum, Vibrio cholerae, viridans streptococci, Yersinia pestis; syphilis, gonorrhea, lymphogranuloma venereum, uncommon gram-negative/gram-positive organisms, malaria prophylaxis
PDF pages 431, 432
Unlabeled uses: Enterocolitis, biliary tract, intraabdominal infections; epididy- mitis (Chlamydia trachomatis); chronic prostatitis (Ureaplasma urealyticum); traveler’s diarrhea (enterotoxigenic Escherichia coli); Legionnaire’s disease (Legionella pneumophila); Lyme dis- ease (Borrelia burgdorferi), Lyme dis- ease (erythema migrans); Lyme arthritis; Lyme carditis; pleural effusion; malaria (chloroquine-resistant Plasmodium fal- ciparum); pelvic inflammatory disease (PID), tubo-ovarian abscess in combina- tion; acute dental infection, dentoalveolar infection, endodontic infection; aggres- sive juvenile periodontitis, plaque pro- phylaxis (Yersinia pestis); tularemia prophylaxis (Francisella tularensis); Bancroft’s filariasis (elephantiasis) (Wuchereria bancrofti); melioidosis due to Burkholderia pseudomallei; lep- tospirosis (Leptospira sp); infection pro- phylaxis for gynecologic procedures/sur- gical infection prophylaxis hysterosalpingogram or chromotubation/ induced abortion/dilation and evacua- tion; methicillin-resistant Staphylococcus aureus (MRSA)–associated bone and joint infections
PDF page 432
CONTRAINDICATIONS: Preg- nancy, children <8 yr, hypersensitivity to tetracyclines, esophageal ulceration Precautions: Breastfeeding, hepatic disease, CDAD, ulcerative colitis, sulfite hypersensitivity, excessive sunlight
PDF page 432
SIDE EFFECTS CNS: Fever, headache CV: Pericarditis EENT: Dysphagia, glossitis, decreased calcification of deciduous teeth, oral can- didiasis, tooth discoloration GI: Nausea, abdominal pain, vomiting, diarrhea, anorexia, enterocolitis, hepa- totoxicity, flatulence, abdominal cramps, gastric burning, stomatitis GU: Increased BUN HEMA: Eosinophilia, neutropenia, throm- bocytopenia, hemolytic anemia INTEG: Rash, urticaria, photosensitiv- ity, increased pigmentation, exfoliative dermatitis, pruritus, phlebitis, injection site reaction MS: Bone growth retardation (<8 yr old), muscle, joint pain RESP: Cough SYST: Stevens-Johnson syndrome, angio edema, anaphylaxis, toxic epidermal necrolysis
PDF pages 433, 434
INTERACTIONS Increase: effect of—anticoagulants, digoxin, methotrexate Decrease: doxycycline effect—antacids, NaHCO3, dairy products, alkali products, iron, kaolin/pectin, barbiturates, carBA- Mazepine, phenytoin, cimetidine sucral- fate, cholestyramine, colestipol, rifAMPin, bismuth; iron, magnesium, zinc, calcium, aluminum salts, sevelamer Decrease: effects—penicillins, oral con- traceptives, digoxin Drug/Lab Test Increase: BUN, alkaline phosphatase, bili- rubin, amylase, ALT, AST, eosinophils, WBC Decrease: Hb False increase: urinary catecholamines
PDF page 434
DOSAGE AND ROUTES Most infections • Adult: PO/IV 100 mg q12hr on day 1, then 100 mg/day; IV 200 mg in 1-2 infu- sions on day 1, then 100-200 mg/day • Child >8 yr, ≥45 kg: PO 100 mg q12hr on day 1, then 100 mg daily; se- vere infections 100 mg q12hr; IV 200 mg on day 1, then 100-200 mg daily, give 200 mg dose as 1 or 2 infusions • Child >8 yr, ≤45 kg: PO 2.2 mg/kg q12hr on day 1, then 2.2 mg/kg daily, severe infections 2.2 mg/kg q12hr; IV 4.4 mg/kg divided on day 1, then 2.2-4.4 mg/kg daily in 1 to 2 divided doses Gonorrhea in patients allergic to penicillin • Adult: PO 100 mg q12hr × 7 days or 300 mg followed 1 hr later by another 300 mg Malaria prophylaxis • Adult: PO 100 mg/day 1-2 days prior to travel, daily during travel, and for 4 wk after return • Adolescent/child ≥8 yr, <45 kg: PO 2 mg/kg/day (up to 100 mg/day) begin 1-2 days prior to travel, continue for 4 wk after return C. trachomatis • Adult: PO 100 mg bid × 7 days Syphilis (early) • Adult: PO 100 mg bid × 14 days Anthrax, postexposure • Adult and child >8 yr and ≥45 kg: IV 100 mg q12hr; change to PO when able × 60 days • Adolescent/child ≥8 yr and <45 kg: PO 2.2 mg/kg q12hr × 60 days; IV 100 mg q12hr, change to PO when able × 60 days Lyme disease • Adult/adolescent/child ≥8 yr: PO 100 mg bid × 10-21 days Periodontitis • Adult: 20 mg bid after scaling and root planing for ≤9 mo; give close to meal- time AM or PM Pleural effusion (unlabeled) • Adult: INTRACAVITARY 500 mg di- luted with 250 mL 0.9% NaCl given by chest tube lavage and drainage
PDF pages 432, 433
Available forms: Capsule 40 mg; suspen- sion 50 mg/5 mL; capsule 20, 50, 100 mg; delayed-release tablets 75, 100, 150 mg; delayed-release capsule 75, 100 mg; injec- tion 42.5, 100, 200 mg; tablets 20, 100 mg; capsules 50, 100, 150 mg; tablets 50, 75, 100 mg; oral suspension 25 mg/5 mL
PDF page 433
Administer: PO route • Do not break, crush, or chew capsules; may crush tablets and mix with food • On empty stomach or with full glass of water 2 hr prior to or after meals; avoid dairy products, antacids, laxatives, iron- containing products; if these must be taken, give 2 hr prior to or after product; avoid giving oral products within 1 hr of bedtime, esophageal ulceration may occur • Delayed-release capsule: Swallow whole or open and sprinkle on applesauce • Suspension: Shake well, use cali- brated device, may give with food/milk for GI irritation, store at room tempera- ture, discard after 14 days Intermittent IV INFUSION route • After diluting 100 mg or less/10 mL or 200 mg/20 mL of sterile water or NS for injection, each 100 mg must be further diluted with 100-1000 mL of NaCl, D5W, Ringer’s, LR, D5LR, Normosol-M, Normo- sol-R in D5W; run 100 mg or less over 1-4 hr; infusion must be completed in 6 hr when diluted in LR solution or 12 hr with other solution; protect from light, heat • Avoid rapid use, extravasation • Store in tight, light-resistant container at room temperature; IV stable for 12 hr at room temperature, 72 hr refrigerated; discard if precipitate forms Y-site compatibilities: Acyclovir, alem- tuzumab, alfentanil, amifostine, amikacin, aminophylline, amiodarone, anidulafun- gin, ascorbic acid, atracurium, atropine, aztreonam, bivalirudin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspo- fungin, cefonicid, cefotaxime, cefTRI- AXone, chlorproMAZINE, cimetidine, cisatracurium, CISplatin, clindamycin, codeine, cyanocobalamin, cyclophos- D phamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexme- detomidine, digoxin, diltiazem, diphen- hydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, etopo- side phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, IDArubicin, ifos- famide, imipenem/cilastatin, insulin, iso- proterenol, labetalol, levofloxacin, lido- caine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, methyldopate, metoclopramide, metoprolol, metro NIDAZOLE, miconazole, midazolam, milrinone, mitoXANtrone, morphine, multivitamins, nalbuphine, naloxone, nesiritide, netilmicin, nitroglycerin, nitroprusside, norepinephrine, octreo- tide, ondansetron, oxaliplatin, oxytocin, PACLitaxel, pancuronium, pantoprazole, papaverine, pentamidine, pentazocine, perphenazine, phentolamine, phenyleph- rine, phytonadione, potassium chloride, procainamide, prochlorperazine, pro- methazine, propofol, propranolol, prot- amine, pyridoxime, quinupristin/dalfo- pristin, ranitidine, remifentanil, ritodrine, riTUXimab, rocuronium, sar- gramostim, sodium acetate, succinylcholine, SUFentanil, tacrolimus, telavancin, tenip oside, theophylline, thiamine, thiotepa, tirofiban, tobramycin, tolazoline, TPN (2 in 1), trastuzumab, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vori- conazole, zoledronic acid
PDF page 433
Assess: • I&O ratio • Blood studies: PT, CBC, AST, ALT, BUN, creatinine • Signs of infection • Allergic reactions: rash, itching, pru- ritus, angioedema • Nausea, vomiting, diarrhea; adminis- ter antiemetic, antacids as ordered • Overgrowth of infection: fever, mal- aise, redness, pain, swelling, drainage, perineal itching, diarrhea, changes in cough or sputum • IV site for phlebitis/thrombosis; prod- uct is highly irritating • After C&S is obtained, do not wait for results • Pregnancy/breastfeeding: no well- controlled studies; may affect skeletal development, do not use in second half of pregnancy unless benefit outweighs fetal risk; discontinue breastfeeding or product, excreted in small amounts in breast milk
PDF page 434
Evaluate: • Therapeutic response: decreased tem- perature, absence of lesions, negative C&S
PDF page 434
CLINICAL CONSIDERATIONS
PDF page 434
Patient and caregiver information: • To avoid sun because burns may oc- cur; that sunscreen does not seem to decrease photosensitivity • That all prescribed medication must be taken to prevent superinfection; not to use outdated products because Fanconi syndrome may occur (reversible nephro- toxicity) • That if children ≤8 yr old are undergo- ing tooth development, teeth may be per- manently discolored • Not to use with antacids, iron prod- ucts, H2 blockers, sevelamer, calcium (milk), magnesium, zinc • To take with full glass of water; if nausea occurs, take with food
PDF page 434
PHARMACOKINETICS PO: Well absorbed, widely distributed; peak 1½-4 hr; half-life 1 day; excreted in urine, feces, bile; 90% protein bound; crosses placenta; enters breast milk
PDF page 434
• Adult: PO/IV 100 mg q12hr on day 1, then 100 mg/day; IV 200 mg in 1-2 infu- sions on day 1, then 100-200 mg/day
PDF pages 432, 433
• Child >8 yr, ≥45 kg: PO 100 mg q12hr on day 1, then 100 mg daily; se- vere infections 100 mg q12hr; IV 200 mg on day 1, then 100-200 mg daily, give 200 mg dose as 1 or 2 infusions
PDF pages 432, 433
• Child >8 yr, ≤45 kg: PO 2.2 mg/kg q12hr on day 1, then 2.2 mg/kg daily, severe infections 2.2 mg/kg q12hr; IV 4.4 mg/kg divided on day 1, then 2.2-4.4 mg/kg daily in 1 to 2 divided doses Gonorrhea in patients allergic to penicillin
PDF pages 432, 433
• Adult: PO 100 mg q12hr × 7 days or 300 mg followed 1 hr later by another 300 mg Malaria prophylaxis
PDF pages 432, 433
• Adult: PO 100 mg/day 1-2 days prior to travel, daily during travel, and for 4 wk after return
PDF pages 432, 433
• Adolescent/child ≥8 yr, <45 kg: PO 2 mg/kg/day (up to 100 mg/day) begin 1-2 days prior to travel, continue for 4 wk after return C. trachomatis
PDF pages 432, 433
• Adult: PO 100 mg bid × 7 days Syphilis (early)
PDF pages 432, 433
• Adult: PO 100 mg bid × 14 days Anthrax, postexposure
PDF pages 432, 433
• Adult and child >8 yr and ≥45 kg: IV 100 mg q12hr; change to PO when able × 60 days
PDF pages 432, 433
• Adolescent/child ≥8 yr and <45 kg: PO 2.2 mg/kg q12hr × 60 days; IV 100 mg q12hr, change to PO when able × 60 days Lyme disease
PDF pages 432, 433
• Adult/adolescent/child ≥8 yr: PO 100 mg bid × 10-21 days Periodontitis
PDF pages 432, 433
• Adult: 20 mg bid after scaling and root planing for ≤9 mo; give close to meal- time AM or PM Pleural effusion (unlabeled)
PDF pages 432, 433
• Adult: INTRACAVITARY 500 mg di- luted with 250 mL 0.9% NaCl given by chest tube lavage and drainage
PDF pages 432, 433