From the Guidelines
Doxycycline should be used with caution in patients with certain medical conditions, and precautions should be taken to minimize the risk of adverse effects, as recommended by the Infectious Diseases Society of America 1.
Precautions and Contraindications
- Doxycycline is relatively contraindicated in pregnant women and children under 8 years old, as it can cause permanent discoloration of developing teeth and affect bone growth 1.
- Patients with known hypersensitivity to tetracyclines should not take doxycycline 1.
- Doxycycline should be taken with a full glass of water and patients should remain upright for at least 30 minutes after taking it to prevent esophageal irritation 1.
Drug Interactions and Side Effects
- Doxycycline can interact with antacids, iron supplements, calcium, and certain medications like warfarin and seizure medications, so these should be taken at least 2 hours before or after doxycycline 1.
- Patients with liver or kidney disease may require dosage adjustments 1.
- Common side effects include nausea, diarrhea, and vaginal yeast infections, which should be reported to a healthcare provider if severe or persistent 1.
Special Considerations
- Doxycycline increases photosensitivity, so patients should use sunscreen and protective clothing when outdoors 1.
- It may reduce the effectiveness of hormonal contraceptives, so additional contraception methods are recommended during treatment 1.
- Patients with a history of tick bites should be monitored closely for signs and symptoms of tickborne diseases, and doxycycline may be used as prophylaxis in certain cases 1.
From the FDA Drug Label
Precautions General As with other antibiotic preparations, use of this drug may result in overgrowth of nonsusceptible organisms, including fungi. If superinfection occurs, the antibiotic should be discontinued and appropriate therapy instituted. Bulging fontanels in infants and benign intracranial hypertension in adults have been reported in individuals receiving tetracyclines These conditions disappeared when the drug was discontinued. Incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy, when indicated.
The precautions to doxycycline include:
- Superinfection: may result in overgrowth of nonsusceptible organisms, including fungi
- Bulging fontanels: in infants
- Benign intracranial hypertension: in adults
- Surgical procedures: incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy, when indicated
- Phototoxicity: patients should avoid excessive sunlight or artificial ultraviolet light while receiving doxycycline
- Esophageal irritation: patients should drink fluids liberally along with doxycycline to reduce the risk of esophageal irritation and ulceration
- Vaginal candidiasis: the use of doxycycline might increase the incidence of vaginal candidiasis
- Antibiotic resistance: skipping doses or not completing the full course of therapy may increase the likelihood that bacteria will develop resistance and will not be treatable by doxycycline or other antibacterial drugs in the future 2
From the Research
Precautions to Doxycycline
- Photosensitivity is a common cutaneous adverse reaction to doxycycline, which can range from mild erythema to severe photodermatitis 3, 4, 5.
- Patients taking doxycycline should be advised to avoid sun exposure and use UV-protective products that cover the UVA1 spectrum (340-400 nm) to prevent photosensitivity reactions 5.
- Women are more often affected by photosensitivity reactions than men, and the risk of photosensitivity is higher in patients treated with doxycycline for longer durations (14-15 days) 4.
- Doxycycline can also cause esophagitis, especially if the capsule is swallowed with a small amount of water or in a recumbent position 6.
- Patients should be instructed to take doxycycline capsules with enough liquid and in an upright position to minimize the risk of esophagitis 6.
- Other less common skin side effects of doxycycline include bullous eruptions, lupus-like eruptions, pigmentary disorders, and vasculitis 3.