doxycycline (redirected from Adoxa)

doxycycline /doxy·cy·cline/ (dok″se-si´klēn) a semisynthetic broad-spectrum tetracycline antibiotic, active against a wide range of gram-positive and gram-negative organisms; used also as d. calcium and d. hyclate.

---

dox·y·cy·cline (dks-skln, -kln)

n.

An antibacterial derived from tetracycline.

---

doxycycline

[dok′sisī′klēn]

a tetracycline antibiotic.

indications It is prescribed in the treatment of infections caused by susceptible bacterial strains, especially Chlamydia, Rickettsia, and Mycoplasma.

contraindications Renal or liver dysfunction or known hypersensitivity to this drug or to other tetracycline medication prohibits its use. It is not given during pregnancy or to children less than 8 years of age.

adverse effects Among the more serious adverse reactions are GI disturbances, phototoxicity, potentially serious superinfections, and hypersensitivity reactions. Discoloration of teeth may occur in children exposed to the drug in utero or under 8 years of age.

---

doxycycline

a second-generation, lipid-soluble tetracycline derivative with greater activity against anaerobes and intracellular bacteria, and a longer half-life. Used as the monohydrate.

---

doxycycline

Adoxa, Vibramycin

Pharmacologic class: Tetracycline

Therapeutic class: Anti-infective

Pregnancy risk category D

Action

Unclear. Thought to inhibit bacterial protein synthesis at 30S and 50S ribosomal subunit and to alter cytoplasmic membrane of susceptible organisms.

Availability

Capsules: 20 mg, 50 mg, 100 mg

Capsules (coated pellets): 75 mg, 100 mg

Powder for injection: 100 mg, 200 mg

Powder for oral suspension: 25 mg/5 ml

Syrup: 50 mg

Tablets: 20 mg, 50 mg, 75 mg, 100 mg

⊘Indications and dosages

➣ Infections caused by unusual organisms, including Mycoplasma, Chlamydia, and Rickettsia organisms

Adults and children weighing more than 45 kg (99 lb): 100 mg P.O. q 12 hours on first day, followed by 100 to 200 mg P.O. once daily; or 50 to 100 mg P.O. q 12 hours; or 200 mg I.V. once daily; or 100 mg I.V. q 12 hours on first day, followed by 100 to 200 mg I.V. once daily; or 50 to 100 mg I.V. q 12 hours

Children weighing 45 kg (99 lb) or less: 2.2 mg/kg P.O. q 12 hours on first day, followed by 2.2 to 4.4 mg/kg/day P.O. once daily; or 1.1 to 2.2 mg/kg P.O. q 12 hours; or 4.4 mg/kg I.V. once daily; or 2.2 mg/kg I.V. q 12 hours on first day, followed by 2.2 to 4.4 mg/kg I.V. once daily; or 1.1 to 2.2 mg/kg I.V. q 12 hours

➣ Gonorrhea in penicillin-allergic patients

Adults and children weighing more than 45 kg (99 lb): 100 mg P.O. q 12 hours for 7 days; or 300 mg P.O. initially, followed by another 300 mg P.O. 1 hour later

➣ Lyme disease

Adults and children weighing more than 45 kg (99 lb): 100 mg P.O. b.i.d. for 10 to 30 days

➣ Periodontitis

Adults and children weighing more than 45 kg (99 lb): 20 mg P.O. b.i.d. for up to 9 months

➣ Anthrax

Adults and children weighing more than 45 kg (99 lb): 100 mg P.O. b.i.d. for 60 days; or 100 mg I.V. q 12 hours for 60 days, changing to oral route when appropriate

Children weighing 45 kg (99 lb) or less: 2.2 mg/kg P.O. b.i.d. for 60 days; or 100 mg I.V. q 12 hours for 60 days, changing to oral route when appropriate

➣ Prevention of malaria caused by Plasmodium falciparum in short-term travelers (less than 4 months)

Adults: 100 mg/day P.O. starting 1 to 2 days before travel begins and continuing during and for 4 weeks after travel

Children: 2 mg/kg/day P.O., up to adult dosage of 100 mg/day, starting 1 to 2 days before travel begins and continuing during and for 4 weeks after travel

Off-label uses

• Traveller's diarrhea
• Pleural effusion

Contraindications

• Hypersensitivity to drug, other tetracyclines, or bisulfites (with some drug products)

Precautions

Use cautiously in:
• renal disease, hepatic impairment, nephrogenic diabetes insipidus, cachexia
• pregnant or breastfeeding patients
• children younger than age 8.

Administration

• Obtain specimens for culture and sensitivity testing, as ordered, before first dose.
☞ Don't give in conjunction with methoxyflurane anesthetic. Severe or fatal kidney damage may result.
• Reconstitute powder for injection with dextrose 5% in water, normal saline solution, lactated Ringer's solution, or dextrose 5% in lactated Ringer's solution.
• Don't infuse solutions with concentrations above 1 mg/ml.
• Infuse 100-mg dose over at least 1 hour.
• Complete infusion within 12 hours of dilution, unless diluted with lactated Ringer's solution or dextrose 5% in lactated Ringer's solution; in this case, complete infusion within 6 hours.
☞ Don't give during last half of pregnancy or to children under age 8 unless other drugs are likely to be ineffective or are contraindicated. Drug may retard bone growth and cause tooth discoloration and malformation.

Route	Onset	Peak	Duration
P.O.	1-2 hr	1.5-4 hr	12 hr
I.V.	Rapid	End of infusion	12 hr

Adverse reactions

CNS: paresthesia, pseudotumor cerebri

CV: phlebitis, thrombophlebitis, pericarditis

EENT: vestibular reactions, hoarseness, pharyngitis

GI: nausea, vomiting, diarrhea, esophagitis, epigastric distress, enterocolitis, anogenital lesions or inflammation, glossitis, oral candidiasis, black hairy tongue, pancreatitis

GU: dark yellow or brown urine, vaginal candidiasis

Hematologic: hemolytic anemia, neutropenia, thrombocytopenia

Hepatic: hepatotoxicity

Musculoskeletal: bone growth retardation (in children younger than age 8)

Skin: photosensitivity, maculopapular or erythematous rash, hyperpigmentation, urticaria

Other: tooth enamel defects, increased appetite, phlebitis at I.V. site, superinfection, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Adsorbent antidiarrheals; antacids; calcium, iron, and magnesium preparations: decreased doxycycline absorption

Barbiturates, carbamazepine, hormonal contraceptives containing estrogen, phenytoin, rifamycin: decreased doxycycline efficacy

Cholestyramine, colestipol: decreased oral absorption of doxycycline

Methoxyflurane: increased nephrotoxicity

Penicillin: decreased penicillin activity

Sucralfate: prevention of doxycycline absorption from GI tract

Warfarin: enhanced warfarin effects

Drug-diagnostic tests. Alkaline phosphatase, alanine aminotransferase, amylase, aspartate aminotransferase, bilirubin, blood urea nitrogen (BUN), eosinophils: increased levels

Hemoglobin, neutrophils, platelets, white blood cells: decreased levels

Urine catecholamines: false elevations

Drug-food. Calcium-containing foods: decreased drug absorption

Drug-behaviors. Alcohol use: decreased anti-infective effect of doxycycline

Sun exposure: increased risk of photosensitivity

Patient monitoring

• Evaluate I.V. site regularly. Apply cool compresses as needed.
☞ Monitor for hypersensitivity reactions, including anaphylaxis.
• Monitor hepatic profile, CBC, BUN, and creatinine levels.
• Assess for hypercoagulability in patients taking warfarin concurrently.
• Monitor for digoxin toxicity in patients taking digoxin concurrently.

Patient teaching

• Advise patient to take with 8 oz of water to ensure passage into stomach.
• Tell patient to take on empty stomach at least 1 hour before meals or 2 hours afterwards.
• Instruct patient to take at least 1 hour before bedtime to prevent esophagitis.
☞ Tell patient to immediately report painful swallowing, abdominal pain, easy bruising or bleeding, or signs of hypersensitivity (such as rash).
• Advise female patient to tell prescriber if she is pregnant.
• Instruct patient to avoid alcohol use and large amounts of calcium-containing foods (such as dairy products and some green leafy vegetables, such as spinach).
• Stress importance of good oral hygiene.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and behaviors mentioned above.

---

doxycycline

Infectious disease A broad-spectrum antibiotic used for rickettsiosis–eg, Rocky mountain spotted fever, typhus fever, Q fever, rickettsialpox, tick fevers, RTIs from Mycoplasma pneumoniae, lymphogranuloma venereum, trachoma, inclusion conjunctivitis, etc, due to Chlamydia trachomatis, psittacosis–C psittaci, nongonococcal urethritis–Ureaplasma urealyticum, relapsing fever–Borrelia recurrentis, gram-negative microorganisms: Chancroid–Haemophilus ducreyi, plague–Yersinia pestis, tularemia–Francisella tularensis, cholera–Vibrio cholerae, Campylobacter fetus, Brucella spp, Bartonella bacilliformis, Calymmatobacterium granulomatis, malaria prophylaxis–Plasmodium falciparum in travelers to chloroquine and/or pyrimethamine-sulfadoxine resistant areas Adverse effects GI tract disturbances, anorexia, N&V, diarrhea, glossitis, dysphagia, enterocolitis, anogenital Candida overgrowth, photophobia