(DOX-ee-SIGH-kleen)
Bio-Tab, Doryx, Doxy 100, Doxy 200, Doxy Caps, Doxychel Hyclate, Monodox, Periostat, Vibramycin, Vibramycin IV, Vibra-Tabs, Alti-Doxycycline, Apo-Doxy, Apo-Doxy Tabs, Doryx, Doxy-Tec, Doxycin, Novo-Doxylin, Nu-Doxycycline, Rho-Doxycycline, Vibra-Tabs C-Pak
Class: Antibiotic/Tetracycline

 Action Inhibits bacterial protein synthesis.

 Indications Treatment of infections due to susceptible strains of gram-positive and gram-negative bacteria, Rickettsia, Mycoplasma pneumoniae; treatment of trachoma and susceptible infections when penicillins are contraindicated; treatment of acute intestinal amebiasis, uncomplicated gonorrhea in adults; prophylaxis of malaria due to Plasmodium falciparum Periodontitis: Adjunct treatment to scaling and root planing to promote attachment level gain and reduce pocket depth. Unlabeled use(s): Prevention of “traveler’s diarrhea.”

 Contraindications Hypersensitivity to tetracyclines; nursing mothers, infancy, and childhood (Periostat).

 Route/Dosage

Infection

ADULTS and children > 8 YR AND > 45 KG: PO/IV 200 mg day 1, then 100 to 200 mg qd in single or divided doses. CHILDREN > 8 YR AND < 45 KG: PO/IV 4.4 mg/kg day 1, then 2.2 mg/kg in single or 2 divided doses. CHILDREN > 8 YR: 2 mg/kg/day; do not exceed 100 mg/day.

Acute Gonococcal Infection

ADULTS & CHILDREN < 8 YR (AND ³ 45 KG): PO 200 mg immediately, then 100 mg at bedtime day 1, then 200 mg qd for 3 days. Single visit alternative: PO 300 mg immediately, followed by 300 mg in 1 hr.

Primary/Secondary Syphilis

ADULTS (NONPREGNANT PENICILLIN-ALLERGIC): PO/IV 100 mg bid for 2 wk.

Chlamydia

ADULTS & CHILDREN ³ 8 YR: PO 100 mg bid for 7 days.

Malaria Prophylaxis

ADULTS: PO 100 mg qd, beginning 1 to 2 days before travel and continuing for 4 wk after leaving area.

Periodontitis

ADULTS: PO 20 mg bid as an adjunct following scaling and root planing for £ 9 mo. Administer tablets ³ 1 hr before or 2 hr after meals; administer capsules ³ 1 hr before the morning and evening meals.

 Interactions

Antacids containing aluminum, zinc, calcium, magnesium, bismuth salts, divalent/trivalent cations: May decrease oral absorption of doxycycline. Barbiturates, carbamazepine, hydantoins: May increase metabolism of and decrease effect of doxycycline. Digoxin: May increase digoxin serum levels. Iron salts: May decrease absorption of doxycycline. Methoxyflurane: Increased potential for nephrotoxicity exists; do not use together. Penicillins: May interfere with bactericidal action of penicillins.

 Lab Test Interferences False elevations of urinary catecholamine levels may occur due to interference with fluorescence test.

 Adverse Reactions

CNS: Pseudotumor cerebri, manifested by headache and blurred vision. DERM: Rash; photosensitivity. GI: Diarrhea; nausea; vomiting; abdominal pain or discomfort; anorexia; bulky, loose stools; sore throat; glossitis. HEMA: Hemolytic anemia; thrombocytopenia; neutropenia. OTHER: Hypersensitivity reactions (eg, urticaria, anaphylaxis, pericarditis).

 Precautions

Pregnancy: Category D. Lactation: Excreted in breast milk. Children: Not recommended in children < 8 yrs; abnormal bone formation and tooth discoloration may result. Anticoagulants: May need to decrease dosage of anticoagulant. Hepatic effects: Doses > 2 g/day have been associated with liver failure; monitor function and avoid other hepatotoxic drugs. Outdated product: Do not use; degradation products of drug are highly nephrotoxic. Photosensitivity: May occur; avoid exposure to sunlight or ultraviolet light. Prolonged use: May result in thrombophlebitis; use oral form whenever reasonable. Renal impairment: Dosage reduction is required. Superinfection: Prolonged use may result in bacterial or fungal overgrowth.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

Oral

  • Do not administer oral form with antacids.

Parenteral

  • Do not inject via IM or SC route.
  • Reconstitute vial contents with 10 mL of Sterile Water for Injection. Dilute further with D5W or normal saline to make concentration of 0.1 to 1 mg/ml.
  • For solutions diluted with Lactated Ringer’s Injection or 5% Dextrose in Lactated Ringer’s, use within 6 hr of reconstitution. Discard any remaining solution.
  • For solutions diluted with other preparations, store up to 72 hr before infusion. Complete infusion within 12 hr to ensure stability. Keep solution refrigerated and protect from light.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Review baseline WBC and BUN and monitor throughout therapy.
  • Withhold drug and notify physician if GI disturbances develop.
  • Monitor body temperature.
  • Inform physician of signs/symptoms of superinfection.

 Patient/Family Education

  • Instruct patient not to take medication with antacids.
  • Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.
  • Explain rationale and techniques for oral hygiene.
  • Tell patient to increase fluid intake and to take medication after meals.
  • Inform patient of possible skin rash (eg, maculopapular, erythematous).
  • Instruct patient to report any visual changes and any additional infections to physician.
  • Explain missed medication procedure: < 2 hr, take medication; > 2 hr, wait until next scheduled dose. Do not double up on medication.

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