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Indications

Acne vulgaris : Start at 100 mg once daily or twice daily and decrease the dosage once control is obtained.
Papulopustular rosacea : 40 mg daily for 4–8 weeks(FDA approved) or 50–100 mg once or twice daily.
Steroid rosacea : 100 mg once or twice a day.
Ocular Rosacea :100 mg once or twice daily.
Perioral dermatitis : 40 mg once daily.
Hidradenitis suppurativa :100 mg twice daily may prevent disease activation.
Bullous pemphigoid :100 mg twice daily.
Hailey-Hailey disease :100 mg daily may be continued for at least 3 months to gain control.
Cutaneous sarcoidosis: 200 mg daily.
Conﬂuent and reticulated papillomatosis: 100 mg twice a day.
Prurigo pigmentosa : 200 mg daily.
α1‐antitrypsin deficiency panniculitis: 200 mg twice daily for 3 months
Cold urticaria: 200 mg per day for 3 weeks.
Acute febrile neutrophilic dermatosis: 200 mg daily.
Erythema migrans :100 mg po BID for 14 days.
Mild bowel associated dermatosis arthritis syndrome : 100 mg once to twice daily,
Suspected MRSA infection :100 mg PO 2 times a day.
Rickettsial infections: 100 mg po or iv twice daily.
Early syphilis for penicillin-allergic patients :100 mg po BID for 14 days.
Late latent for penicillin-allergic patients :100 mg po BID for 28 days.
Lymphogranuloma venereum :100 mg po twice daily.
Granuloma inguinale : 100 mg po BID until all lesions completely healed (at least 3 weeks).
Anthrax.
Atypical mycobacterial infections.
Granuloma annulare: 100 mg daily.
Perforating dermatoses: 100 mg daily.

Dosage

Bacterial infection: 100 mg PO/IV bid.
Sub-antimicrobial dose : 20 mg PO bid.

Mechanism of action

Bacteriostatic agents that inhibit bacterial protein synthesis by targeting the 30S ribosomal subunit of both gram‐positive and gram‐negative bacteria.
Anti‐inflammatory : inhibition of MMPs function.

Side effects

COMMON: dyspepsia, nausea, vomiting, anorexia, diarrhea, stomatitis, candidiasis, discolored teeth (<8 years old), esophagitis,
phlebitis (IV), lightheadedness, dizziness, vertigo, ataxia, headache, tinnitus, drowsiness, photosensitivity.

RARE: pseudotumor cerebri (with isotretinoin), neutropenia, thrombocytopenia, hepatotoxicity, Jarisch-Herxheimer reaction (when treating Treponema pallidum), superinfection, pseudomembranous colitis, increased intracranial pressure (infants), skeletal retardation (infants).

Contraindications

Hypersensitivity to drug/class.
Pregnancy, children, impaired liver or renal function.

Interactions

Absorption is impaired by polyvalent cations such as calcium, aluminum, magnesium, iron, zinc, and bismuth.
Antacids, some laxatives, medications containing magnesium (e.g. quinapril), dietary supplements, and dairy products can inhibit absorption.
Antacids, H2 blockers, and proton pump inhibitors increase stomach pH and thereby decrease absorption.
Potential toxicity of digoxin, lithium and warfarin.
Barbiturates, phenytoin, and carbamazepine decrease the half-life of doxycycline.

Pregnancy &Lactation

Pregnancy category D.
Doxycycline is excreted in breast milk, potentially leading to staining of the deciduous teeth, enamel hypoplasia, and impaired skeletal growth in developing fetuses and nursing infant.

Precautions

Caution is warranted when prescribing doxycycline for patients with severe liver disease.
Not recommended for persons aged, 8 years to avoid tooth discoloration.
To decrease the likelihood of esophagitis, the pills should not be “dry swallowed” and should be taken at least half an hour prior to bedtime

Drug Info

Doxycycline, which is excreted primarily by the GI tract in bile and can be used in patients with renal failure.
The incidence of photosensitivity is low but increases with increasing dose levels.
Doxycycline may be taken with or without food, but it is preferred to be taken with food to avoid gastrointestinal upset.
Modifed‐release (subantimicrobial) preparations of doxycycline appear to minimize the development of antibiotic resistance without loss of anti‐inﬂammatory effect.

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