Hospital Formulary Status Yes (PO solid)
In-Hospital Cost will be updated
PharmaCare Formulary Status Yes (PO solid)
Special Authority None
PharmaCare Coverage 100mg PO - $0.6329/tab or cap
Outpatient Cost 100mg PO - $0.69-1.10/tab or cap
Skin and soft tissue infection
Community acquired pneumonia
Malaria prophylaxis
Zoonoses
Susceptible MRSA infections
Gastritis (PO)
sx: abdominal discomfort, epigastric pain, nausea, vomiting, anorexia, esophageal ulcerations and strictures
may alter gut flora to cause large bulky stools and diarrhea, which usually subsides after discontinuation
patient with continued diarrhea, fever, and rising WBC count should be evaluated for antibiotic-associated diarrhea caused by C. Difficile
less risk than tigecycline
advise patient to take with food, plenty of water and not before bedtime
Allergic skin reactions (PO)
uncommon: hypersensitivity and photosensitivity reactions (red rash or blistering on areas exposed to the sun)
if patient is allergic to one tetracycline, they should be considered allergic to all
advise patient to avoid direct sunlight or wearing protective clothing and sunscreen
Teeth and bone toxicity (PO)
can cause brown to yellow teeth discoloration in children < 8 years old, which is associated with hypoplasia of enamel
discoloration on permanent teeth is dose-related and does not occur in adults
may deposit in bone due to chelate formation with calcium
avoid in children < 8 years old, but if tetracyclines must be used, doxycycline may be preferred
Hepatotoxicity (PO)
rare but can be fatal
more common with tetracycline and minocycline
less common with doxycycline
cholestatic liver injury is rare with a long latency of over 1 year but most recover after discontinuation
Renal failure exacerbation (PO)
tetracyclines inhibit protein synthesis
may exacerbate preexisting renal failure by increasing azotemia from amino acid metabolism
Jarisch-Herxheimer type reaction (PO)
can occur in patients with spirochetal infections (syphilis, tick-borne relapsing fever and louse-borne relapsing fever)
sx: fever, chills, headache, malaise, muscle aches, leukocytosis and exacerbation of cutaneous lesions
prevention: use of tumor necrosis factor antibodies and steroids
pretreatment: acetaminophen or meptazinol may reduce the symptoms and duration
Other uncommon ADRs
hemolytic anemia
thrombocytopenia
neutropenia
eosinophilia
pericardial effusions
Divalent cations - decreased absorption
Increased digoxin levels
Increased INR with warfarin
Some anticonvulsants can decrease doxycycline levels
Average serum half life: 18.0 hr
Urine penetration: Therapeutic
Lung penetration: Therapeutic
CSF penetration: Poor
Biliary penetration: Therapeutic