Is it safe to use Doxycycline (Doxycycline) with Remicade (Infliximab)?

Safety of Using Doxycycline with Infliximab (Remicade)

Doxycycline can be safely used with infliximab (Remicade) as there are no significant drug interactions between these medications. This combination does not appear on any major drug interaction lists in the clinical guidelines reviewed.

Evidence-Based Assessment

Drug Interaction Analysis

• The American Thoracic Society/CDC/Infectious Diseases Society of America guidelines on treatment of tuberculosis specifically list medications whose concentrations are decreased by rifamycins 1. While doxycycline is mentioned in this list, infliximab is not identified as having interactions with doxycycline.
• No specific contraindications or interactions between doxycycline and infliximab are mentioned in any of the guidelines for inflammatory bowel disease or other conditions where infliximab is commonly used 1.

Doxycycline Considerations

• Doxycycline is a tetracycline-class antibiotic commonly used for various infections and is recommended for conditions like acne vulgaris 1.
• Common side effects of doxycycline include gastrointestinal disturbances (15.7% vs 5.9% compared to placebo), photosensitivity, and rarely intracranial hypertension 1.
• Taking doxycycline with food and adequate fluids in the upright position may reduce gastrointestinal side effects 1.

Infliximab Considerations

• Infliximab is a TNF-α inhibitor used for various inflammatory conditions including Crohn's disease, ulcerative colitis, and rheumatoid arthritis 1.
• Combination therapy of infliximab with immunomodulators like azathioprine is more effective than monotherapy for induction and maintenance of remission in Crohn's disease 1.
• No specific warnings about antibiotic interactions appear in the infliximab guidelines.

Clinical Implications

When to Exercise Caution

1. Pregnancy and breastfeeding: Doxycycline should be avoided during pregnancy and in children under 8 years due to risk of teeth discoloration and bone growth inhibition 1. Infliximab can be used during pregnancy when benefits outweigh risks 1.

2. Immunosuppression: Since infliximab causes immunosuppression, patients may be at higher risk of infections. However, this doesn't contraindicate the use of antibiotics like doxycycline - in fact, they may be necessary to treat infections that develop.

3. Monitoring: When using both medications, monitor for:

   • Signs of infection
   • Gastrointestinal symptoms (which could be from either medication)
   • Photosensitivity reactions (more common with doxycycline)

Practical Recommendations

1. Timing of administration: Consider separating administration times to minimize potential for gastrointestinal side effects.

2. Hydration: Ensure adequate fluid intake when taking doxycycline to reduce risk of esophageal irritation.

3. Sun protection: Advise patients about increased risk of photosensitivity with doxycycline.

4. Monitoring: Regular follow-up to assess efficacy of both medications and monitor for any adverse effects.

Conclusion

The combination of doxycycline and infliximab does not present any significant drug-drug interactions based on current clinical guidelines. They can be safely administered together when clinically indicated, with appropriate monitoring for the individual side effect profiles of each medication.