From the Guidelines
Doxycycline is associated with several side effects, including gastrointestinal disturbances, photosensitivity, and esophageal irritation, which can be minimized by taking the medication with food and a full glass of water, and avoiding dairy products and lying down after taking it. The most common side effects of doxycycline include:
- Gastrointestinal side effects such as nausea, vomiting, diarrhea, and stomach pain
- Photosensitivity, making skin more vulnerable to sunburn
- Esophageal irritation or ulceration if the medication doesn't reach the stomach quickly enough Less common side effects include:
- Headache
- Vision changes
- Rash
- Yeast infections Serious but rare reactions include:
- Severe allergic responses
- Liver problems
- Increased intracranial pressure
- Severe skin reactions It is also important to note that doxycycline can affect tooth development in children under 8 years old and should be avoided during pregnancy, as stated in the guidelines by the Infectious Diseases Society of America 1. Additionally, doxycycline may cause pseudotumor cerebri, and its metabolism may alter the effectiveness of certain medications, such as oral contraceptives and warfarin, as mentioned in the guidelines for the management of blepharitis 1. To minimize the risk of side effects, patients should take doxycycline exactly as prescribed, with food and a full glass of water, and avoid lying down for at least an hour after taking the medication, as recommended in the CDC clinical guidelines for the use of doxycycline postexposure prophylaxis for bacterial sexually transmitted infection prevention 1.
From the FDA Drug Label
Adverse Reactions Due to oral doxycycline’s virtually complete absorption, side effects of the lower bowel, particularly diarrhea, have been infrequent The following adverse reactions have been observed in patients receiving tetracyclines: Gastrointestinal: anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, and inflammatory lesions (with monilial overgrowth) in the anogenital region. Hepatotoxicity has been reported rarely. Skin: toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, maculopapular and erythematous rashes. Renal toxicity: Rise in BUN has been reported and is apparently dose related. Hypersensitivity reactions: urticaria, angioneurotic edema, anaphylaxis, anaphylactoid purpura, serum sickness, pericarditis, and exacerbation of systemic lupus erythematosus. Blood: Hemolytic anemia, thrombocytopenia, neutropenia, and eosinophilia have been reported. Other: bulging fontanels in infants and intracranial hypertension in adults.
The common side effects of doxycycline include:
- Gastrointestinal issues such as diarrhea, nausea, and vomiting
- Skin reactions like rashes and photosensitivity
- Renal toxicity and hypersensitivity reactions
- Blood disorders like anemia and thrombocytopenia
- Other issues like bulging fontanels in infants and intracranial hypertension in adults 2. The less common side effects of doxycycline include:
- Hepatotoxicity
- Toxic epidermal necrolysis
- Stevens-Johnson syndrome
- Erythema multiforme
- Hemolytic anemia
- Neutropenia
- Eosinophilia
- Anaphylaxis
- Anaphylactoid purpura
- Serum sickness
- Pericarditis
- Exacerbation of systemic lupus erythematosus 2.
From the Research
Doxycycline Side Effects
- Gastrointestinal adverse effects, including esophagitis, are common with long-term use of doxycycline, particularly in older adults and those receiving a higher dose of 200 mg/day 3
- The incidence of gastrointestinal adverse effects was significantly higher in patients who were ≥ 50 years than < 50 years old and in those who received a daily dose of 200 mg than 100 mg 3
- Photosensitivity is a significant dermatologic side effect of doxycycline, with clinical symptoms ranging from light sunburn-like sensation to large-area photodermatitis 4
- Onycholysis is also a possible side effect of doxycycline-induced photosensitivity 4
- Skin hypersensitivity to sunlight due to doxycycline ingestion can cause severe reactions, including partial-thickness burns 5
- Doxycycline has been associated with a higher frequency of nausea, vomiting, and skin rash compared to other antibiotics 6
Specific Side Effects
- Esophagitis: 1.6% of patients reported esophagitis in a study of adults who received doxycycline for at least one month 3
- Photosensitivity: the triggering UV spectrum consists mainly of UVA1 (340-400 nm), and travelers to tropical countries taking doxycycline for malaria prophylaxis need thorough medical counseling to avoid severe phototoxic reactions 4
- Gastrointestinal adverse effects: 6.3% of patients reported gastrointestinal adverse effects, resulting in doxycycline discontinuation in 2.6% of patients 3
- Nausea and vomiting: at least 3-fold higher frequency with doxycycline compared to other antibiotics 6
- Skin rash: at least 4 times more frequent with doxycycline compared to other antibiotics 6