Doxycycline hyclate tablets 20mg
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Tablets containing doxycycline hyclate.
Drugs List
Therapeutic Indications
Uses
Periodontitis -chronic adult
Dosage
Adults
The recommended dosage is 20mg twice a day for a three month period.
No more than 3 consecutive three month periods.
Children
Children aged 12 to 18 years: No dosage adjustment required. See Dosage; Adults.
Doxycycline is contraindicated in children up to 12 years.
Patients with Hepatic Impairment
Doxycycline should be administered with caution to patients with hepatic impairment. There are no data, at the time of writing, to support the safety of doxycycline in hepatic impairment at the recommended doses.
Contraindications
Children under 12 years
Achlorhydria
Breastfeeding
Galactosaemia
Pregnancy
Precautions and Warnings
History of oral candidiasis
Alcoholism
Glucose-galactose malabsorption syndrome
Hepatic impairment
Lactose intolerance
Myasthenia gravis
Systemic lupus erythematosus
Jarisch-Herxheimer reaction possible in treatment of Spirochetes infection
May exacerbate myasthenia gravis
Advise ability to drive/operate machinery may be affected by side effects
Contains lactose
Swallow dose with plenty of fluid while sitting or standing
Monitor periodically for overgrowth of non-susceptible organisms
Consider pseudomembranous colitis if patient presents with diarrhoea
Discontinue treatment immediately if signs of phototoxicity occur
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue at first signs of skin erythema
Discontinue if benign intracranial hypertension develops
Discontinue if overgrowth of resistant organisms occurs
Discontinue if severe hypersensitivity reactions occur
Advise avoid milk/antacid/mineral supplements 2 hours before or after dose
Advise patient not to take St John's wort concurrently
Advise patient that photosensitivity possible
Advise patient to avoid exposure to sunlight and UV rays during treatment
Advise patient to avoid taking immediately before going to bed
Doxycycline should be used with care in patients with a history of or predisposition to oral candidosis. The safety and efficacy of doxycycline has not been established for the treatment of periodontitis in patients with co-existent oral candidosis. There is a possibility that the use of tetracyclines may increase the incidence of vaginal candidosis.
Doxycycline therapy may result in overgrowth of non-susceptible micro-organisms including fungi (with clinical symptoms of persistent bad breath, reddening of the gums etc.). Monitoring periodically for overgrowth of non-susceptible organisms is essential. Doxycycline has been associated with diarrhoea, colitis, vaginal moniliasis which may suggest over-growth of non-susceptible micro-organisms. Discontinue if overgrowth of resistant organisms occurs and treat appropriately.
Pregnancy and Lactation
Pregnancy
Doxycycline is contraindicated in pregnancy.
Studies in animals have not demonstrated a teratogenic effect but have shown effects on skeletal development when given in the first trimester.
Limited human studies have not revealed any specific malformation. Administration of tetracyclines during the second or third trimester may cause discolouration of the child's teeth. The risks are predominantly associated with the effects on teeth and skeletal development. Enamel hypoplasia has been reported.
Schaefer (2015) suggests that the use of tetracyclines be contraindicated beyond the fifteenth week of gestation. If used after the fifteenth week this is not an indication for termination of pregnancy or for invasive prenatal diagnostic procedures.
Lactation
Contraindicated.
Doxycycline is excreted in human breast milk.
Hale suggests prolonged use whilst breastfeeding may induce dental staining and alter gastrointestinal flora of the nursing infant.
Counselling
Advise patient the tablets should be taken with adequate fluid (at least 100ml of water) in a sitting or standing position to avoid oesophageal irritation or ulceration.
Advise patient tablets should be taken at least one hour before meals and the evening dose should be taken well before retiring to minimise the risks of oesophageal irritation and ulceration.
Advise patient to avoid milk, antacids and mineral supplements for 2 hours before or after dose.
Advise patient to avoid taking St John's wort concurrently.
Advise patient to avoid excessive sunlight or artificial ultra-violet light and to consider using sunscreen or sunblock.
Patient should be advised not to drive or operate machinery if affected by side effects such as nausea and dizziness.
Side Effects
Abdominal pain
Accidental injury
Anaphylactoid purpura
Anaphylaxis
Angioneurotic oedema
Anogenital candidiasis
Anorexia
Antibiotic-associated colitis
Arthralgia
Asthenia
Back pain
Benign intracranial hypertension
Blood urea increased
Bronchitis
Brown-black microscopic discolouration of thyroid tissue
Bulging fontanelles in infants
Common cold
Constipation
Cough
Diarrhoea
Diarrhoea - bloody
Dizziness
Dry mouth
Dyspepsia
Dysphagia
Enamel hypoplasia
Enterocolitis
Eosinophilia
Erythema
Exfoliative dermatitis
Glossitis
Haemolytic anaemia
Headache
Hepatotoxicity
Hypersensitivity reactions
Indigestion
Influenza-like symptoms
Jarisch-Herxheimer reaction
Joint pain
Maculopapular rash
Menstrual discomfort
Muscle pain
Nausea
Neutropenia
Oesophageal ulceration
Oesophagitis
Onycholysis
Opportunistic infections
Pain
Pericarditis
Periodontal abscess
Photosensitivity
Porphyria
Pruritus
Pseudomembranous colitis
Rash
Sinus headache
Sinusitis
Sore gums
Sore throat
Staining of teeth
Stevens-Johnson syndrome
Thrombocytopenia
Tooth ache
Tooth disorder
Urticaria
Vaginal candidiasis
Vomiting
Worsening of lupus erythematosus
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: April 2019
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 07 March 2019
Summary of Product Characteristics: Periostat 20mg film-coated tablets. Alliance Pharmaceuticals. Revised November 2017.
The Welsh Medicines Information Centre (WMIC) Porphyria Information Service.
Available at: https://www.wmic.wales.nhs.uk/porphyria_info.php
Last revised: April 2018
Last accessed: 07 March 2019
The Norwegian Porphyria Centre (NAPOS).
Available at: https://www.drugs-porphyria.org
Last revised: 22 September 2018
Last accessed: 07 March 2019
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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