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Tablets containing 250mg tetracycline hydrochloride

Drugs List

  • tetracycline 250mg tablets
  • Therapeutic Indications


    Treatment of infections caused by susceptible strains of Gram-positive and Gram-negative bacteria.

    Types of infections include:

    Respiratory tract infections
    Pneumonia and other lower respiratory tract infections due to susceptible strains of Streptococcuspneumoniae , Haemophilus influenzae , Klebsiella pneumoniae and other organisms, Mycoplasma pneumoniae , treatment of chronic bronchitis, and prophylaxis of acute exacerbations of chronic bronchitis, treatment of whooping cough.

    Urinary tract infections
    Due to susceptible strains of Klebsiella species, Enterobacter species, Escherichia coli, Streptococcus faecalis and other organisms

    Sexually transmitted infections
    Due to Chlamydia trachomatis including uncomplicated urethral, endocervical or rectal infections. Non-gonococcal urethritis caused by Ureaplasma urealyticum . Chancroid granuloma inguinale and lymphogranuloma venereum and as an alternative drug in the treatment of penicillin resistant gonorrhoea and syphilis.

    Skin infections
    Acne vulgaris when antibiotic therapy is considered necessary, and severe rosacea

    Ophthalmic infections
    Trachoma (although the infectious agent is not eliminated). Inclusion conjunctivitis.

    Rickettsial infections
    Rocky mountain spotted fever, typhus, Q fever, Coxiella endocarditis and tick fevers.

    Other infections
    Stagnant loop syndrome, Psittacosis, brucellosis (in combination with streptomycin), cholera, bubonic plague, louse and tick-borne relapsing fever, tularaemia, glanders, melioidosis, acute intestinal amoebiasis (as an adjunct to amoebicides), leptospirosis, gas gangrene and tetanus.

    Unlicensed Uses

    Management of diabetic diarrhoea in autonomic neuropathy.


    Therapy should be continued for up to three days after symptoms have resolved.


    Treatment of acute infections
    Minimum dose is 250mg every 6 hours.
    Therapeutic levels are achieved more rapidly by the initial administration of 500mg, followed by 250mg every 6 hours.
    For severe infections, the dose may be increased to 500mg every 6 hours.

    Skin infection
    250mg to 500mg daily in single or divided doses.
    Treatment should continue for at least three months in the treatment of acne vulgaris and severe rosacea.

    Streptococcal infections
    A therapeutic dose should be administered for at least ten days.

    500mg four times daily, in combination with streptomycin.

    Sexually transmitted disease
    Uncomplicated gonococcal infection, uncomplicated urethral, endocervical, or rectal infection, and non-gonococcal urethritis: 500mg four times daily for seven days.
    Acute epididymo-orchitis or Neisseria gonorrhoea: 500mg four times daily for ten days.
    Primary or secondary syphilis: 500mg four times daily for fifteen days. Syphilis of more than one year's duration (latent syphilis of uncertain or more than one year's duration, cardiovascular or late benign syphilis), except neurosyphilis should be treated with 500mg four times daily for thirty days. Optimal compliance should be encouraged and close follow up, including laboratory tests, is recommended.

    Management of diabetic diarrhoea in autonomic neuropathy (unlicensed)
    250mg to be taken two or three times.


    Use with caution in elderly patients as renal impairment in these patients may cause drug accumulation.


    Children aged 12 years and over
    (See Dosage; Adults).

    Children aged under 12 years
    Contraindicated in these patients.

    Patients with Renal Impairment

    Contraindicated in these patients.

    If tetracycline administration is considered absolutely essential in these patients, dosages should be reduced and/or the interval between doses should be extended.

    Tetracycline may cause an increase in blood urea nitrogen. In patients with severe renal impairment, higher serum levels of tetracycline may lead to azotaemia, hyperphosphataemia and acidosis.

    Patients with Hepatic Impairment

    Contraindicated in chronic hepatic impairment.

    Use with caution and avoid high doses in patients with acute hepatic impairment.


    For oral administration.

    Tablets should be swallowed whole with plenty of fluid while sitting or standing.

    Tetracycline should be administered 1 hour before or 2 hours after meals. Food and some dairy products may impair absorption.
    If gastric irritation occurs, the tablets should be taken with food.

    Absorption of tetracyclines is impaired by antacids containing calcium, magnesium, aluminium, and products containing iron or zinc. Advise patient to avoid milk, antacids and mineral supplements 2 hours before or after dose.


    Children under 12 years
    Renal impairment
    Chronic hepatic impairment
    Systemic lupus erythematosus
    Pregnancy - see Pregnancy section
    Breastfeeding - see Lactation section

    Precautions and Warnings

    In the treatment of syphilis, optimal compliance should be encouraged and close follow up, including laboratory tests, is recommended.

    Patients should be advised not to self medicate due to the potential of some drugs to interact with tetracycline. This includes anti-diarrhoeal products and vitamin A supplements. Concurrent administration of tetracycline and vitamin A may cause benign intracranial hypertension.

    Tetracyclines may cause permanent tooth discolouration if administered during tooth development in children under 12 or during the last half of pregnancy. Enamel hypoplasia has also been reported. This reaction is more common during prolonged use of tetracycline but has also been observed following repeated short term courses.

    Patients with renal impairment - See Dosage; Renal impairment. Use with caution in elderly patients as renal impairment in these patients may cause drug accumulation.

    Patients with hepatic impairment - See Dosage; Hepatic impairment

    In long-term therapy, laboratory evaluation of organ systems, including haematopoietic, renal and hepatic function, should be monitored periodically.

    In patients with a venereal disease where syphilis is also suspected, proper diagnostic procedures should be followed. This includes monthly serological tests for at least 4 months.

    The use of tetracycline may result in the overgrowth of non-susceptible organisms, such as candida. The patients should be observed closely and if this effect occurs, tetracycline should be discontinued and appropriate therapy initiated.

    Use with caution and avoid high doses in patients with acute hepatic impairment.

    High doses of tetracycline have been associated with a syndrome involving fatty liver degeneration and pancreatitis.

    If patients present with severe and persistent diarrhoea after treatment with tetracycline, consider pseudomembranous colitis. If clostridium difficile is suspected or confirmed tetracycline should be discontinued and appropriate treatment initiated. Anti-peristaltic drugs are contraindicated in this situation.

    Photosensitivity reactions may occur in hypersensitive persons. Patients should be warned to avoid direct exposure to natural or artificial sunlight and to discontinue therapy at the first sign of skin discomfort.

    Bulging fontanelles in infants and benign intracranial hypertension in juveniles and adults has been reported. Symptoms include headache, visual disturbances, blurred vision, scotomata, and diplopia. Permanent loss of vision has been reported. If evidence of raised intracranial pressure develops, tetracycline should be discontinued.

    Systemic lupus erythematosus can be exacerbated by the use of tetracyclines.

    Use with caution in patients with myasthenia gravis. Tetracyclines may increase muscle weakness in these patients.

    Absorption of tetracyclines is impaired by milk, antacids containing calcium, magnesium, aluminium, and products containing iron or zinc.

    If gastric irritation occurs, the tablets should be taken with food.

    The Faculty of Sexual and Reproductive Health has issued revised guidance concerning additional contraceptive cover when antibiotics are prescribed to patients taking combined oral contraceptives in January 2011. With the exception of the enzyme-inducing antibiotics rifampicin and rifabutin, it is no longer necessary to advise the patient to take additional contraceptive precautions while also taking an antibiotic.

    Advise the patient that if vomiting occurs, she should follow the guidance for the oral contraceptive in respect of additional doses or contraceptive precautions.

    Pregnancy and Lactation


    Contraindicated. Tetracycline should not be used during pregnancy unless essential to the welfare of the patient.

    Tetracyclines cross the placenta and may have toxic effects on the foetal tissues, especially on skeletal development.

    If used during pregnancy, or if the patient becomes pregnant during treatment, the potential risks to the foetus should be discussed with the patient.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).



    Tetracycline is excreted in human breast milk. There is a theoretical risk of dental staining and inhibition of bone growth in breastfed infants.

    Hale (2010) concludes, short-term exposure (less than 3 weeks) to tetracycline is not contraindicated however long-term exposure could cause problems. The drugs and lactation database (LactMed) suggests as a theoretical precaution, avoid prolonged or repeated courses during breastfeeding. Monitor the infant for rash and for possible effects on the gastrointestinal flora, such as diarrhoea or candidiasis.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Effects on Ability to Drive and Operate Machinery

    None known


    Advise patients to take tetracycline 1 hour before or 2 hours after food.

    Advise patient to avoid milk, antacids and mineral supplements 2 hours before or after dose.

    Advise patients to avoid direct exposure to natural or artificial sunlight and to discontinue therapy at the first sign of skin discomfort.

    Side Effects

    Gastric irritation
    Abdominal discomfort
    Overgrowth by non-susceptible organisms
    Rectal irritation
    Vaginal irritation
    Perianal inflammation
    Urogenital lesions
    Altered liver function tests
    Hepatic failure
    Pseudomembranous colitis
    Haemolytic anaemia
    Benign intracranial hypertension
    Visual disturbances
    Blurred vision
    Loss of vision
    Maculopapular rash
    Erythematous rash
    Exfoliative dermatitis
    Hypersensitivity reactions
    Anaphylactoid purpura
    Exacerbation of systemic lupus erythematosus
    Brown-black microscopic discolouration of thyroid tissue
    Oesophageal ulceration
    Antibiotic-associated colitis
    Stevens-Johnson syndrome
    Acute renal failure
    Skin discolouration
    Increase in blood urea nitrogen
    Exacerbation of myasthenia gravis
    Aplastic anaemia
    Fixed drug eruption
    Bulging fontanelles in infants
    Enamel hypoplasia
    Staining of teeth
    Bullous dermatoses
    Serum urea increased
    Renal impairment


    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 ( ) or if this is unavailable at the backup site ( ).

    Shelf Life and Storage

    Store at or below 25 degrees C
    Protect from light.

    Further Information

    Last Full Review Date: November 2012

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Tetracycline Tablets BP 250mg. Actavis UK Ltd. Revised May 2011.

    Faculty of Sexual and Reproductive Healthcare
    Last accessed 31 May 2011

    NICE Evidence Services Available at: Last accessed: 04 September 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Tetracycline. Last revised: October 2, 2012
    Last accessed: November 12, 2012

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