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What is doxycycline?

Doxycycline is a tetracycline antibiotic. It fights bacteria in the body.

Doxycycline is used to treat many different bacterial infections, such as urinary tract infections, acne, gonorrhea, and chlamydia, periodontitis (gum disease), and others.

Doxycycline is also used to treat blemishes, bumps, and acne-like lesions caused by rosacea. Doxycycline will not treat facial redness caused by rosacea.

Doxycycline may also be used for purposes not listed in this medication guide.

Important information about doxycycline

Do not use doxycycline if you are pregnant. It could harm the unborn baby or cause permanent tooth discoloration later in life.

Doxycycline can make birth control pills less effective. Ask your doctor about using a non hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while using doxycycline.

You should not take this medicine if you are allergic to doxycycline or to other tetracycline antibiotics such as demeclocycline (Declomycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

Before taking doxycycline, tell your doctor if you have liver disease, kidney disease, asthma, or if you are allergic to sulfites.

Drink plenty of liquids while you are taking doxycycline.

Children should not use this medicine. Doxycycline can cause permanent yellowing or graying of the teeth in children younger than 8 years old.

Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics.

Before taking doxycycline

You should not take this medicine if you are allergic to doxycycline or to other tetracycline antibiotics such as demeclocycline (Declomycin), minocycline (Dynacin, Minocin, Solodyn, Vectrin), or tetracycline (Brodspec, Panmycin, Sumycin, Tetracap).

To make sure you can safely take doxycycline, tell your doctor if you have any of these other conditions:

  • liver disease;

  • kidney disease; or

  • asthma or sulfite allergy.

If you are using doxycycline to treat gonorrhea, your doctor may test you to make sure you do not also have syphilis, another sexually transmitted disease.

FDA pregnancy category D. Do not use doxycycline if you are pregnant. It could harm the unborn baby or cause permanent tooth discoloration later in life. Tell your doctor right away if you become pregnant during treatment.

Doxycycline can make birth control pills less effective. Ask your doctor about using a non hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while using doxycycline.

Doxycycline passes into breast milk and may affect bone and tooth development in a nursing baby. You should not breast-feed while you are taking this medicine. Children should not use this medicine. Doxycycline can cause permanent yellowing or graying of the teeth in children younger than 8 years old.

How should I take doxycycline?

Take doxycycline exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take doxycycline with a full glass of water. Drink plenty of liquids while you are taking doxycycline.

Different brands of doxycycline may have different instructions about taking them with or without food.

Most brands of doxycyline may be taken with food or milk if the medicine upsets your stomach.

Take Oracea or Periostat on an empty stomach, at least 1 hour before or 2 hours after a meal.

You may open a Doryx capsule or break up a Doryx tablet and sprinkle the medicine into a spoonful of applesauce to make swallowing easier. Swallow right away without chewing. Do not save the mixture for later use. Drink a full glass (8 ounces) of cool water right away.

Do not crush, break, or open a delayed-release capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time. The enteric coated pill has a special coating to protect your stomach. Breaking the pill will damage this coating.

Measure liquid medicine with a special dose measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose measuring device, ask your pharmacist for one.

Take doxycycline for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Doxycycline will not treat a viral infection such as the common cold or flu.

If you need surgery, tell the surgeon ahead of time that you are using doxycycline. You may need to stop using the medicine for a short time.

Store doxycycline at room temperature away from moisture and heat. Throw away any unused medicine after the expiration date on the label has passed. Using expired doxycycline can cause damage to your kidneys.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, and diarrhea.

What should I avoid while taking doxycycline?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking doxycycline and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Avoid exposure to sunlight or tanning beds. Doxycycline can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Do not take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking doxycycline.

Doxycycline side effects

Get emergency medical help if you have any of these signs of an allergic reaction to doxycycline: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

  • severe headache, dizziness, blurred vision;

  • fever, chills, body aches, flu symptoms, swollen glands, rash or itching, joint pain, or general ill feeling;

  • urinating less than usual or not at all;

  • diarrhea that is watery or bloody

  • pale or yellowed skin, dark colored urine, fever, confusion or weakness;

  • severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate;

  • loss of appetite, jaundice (yellowing of the skin or eyes); or

  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious doxycycline side effects may include:

  • mild nausea, mild diarrhea;

  • upset stomach;

  • mild skin rash or itching; or

  • vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect doxycycline?

Tell your doctor about all other medicines you use, especially:

  • cholesterol-lowering medications such as cholestyramine (Prevalite, Questran) or colestipol (Colestid);

  • isotretinoin (Accutane);

  • tretinoin (Renova, Retin-A, Vesanoid);

  • an antacid such as Tums, Rolaids, Milk of Magnesia, Maalox, and others;

  • a product that contains bismuth subsalicylate such as Pepto-Bismol;

  • minerals such as iron, zinc, calcium, magnesium, and over-the-counter vitamin and mineral supplements;

  • a blood thinner such as warfarin (Coumadin, Jantoven); or

  • a penicillin antibiotic such as amoxicillin (Amoxil, Augmentin, Dispermox, Moxatag), ampicillin (Principen, Unasyn), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), or penicillin (Bicillin L-A, PC Pen VK, Pfizerpen).

This list is not complete and other drugs may interact with doxycycline. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

For the Consumer

Applies to doxycycline: oral capsule, oral capsule delayed release, oral capsule extended release, oral powder for suspension, oral syrup, oral tablet, oral tablet delayed release

Along with its needed effects, doxycycline may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking doxycycline:

Incidence not known
  • Abdominal or stomach tenderness
  • bloating
  • clay-colored stools
  • cough
  • dark urine
  • decreased appetite
  • diarrhea
  • diarrhea, watery and severe, which may also be bloody
  • difficulty with swallowing
  • dizziness
  • fast heartbeat
  • feeling of discomfort
  • fever
  • headache
  • hives, itching, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • hives or welts
  • increased thirst
  • inflammation of the joints
  • itching
  • joint or muscle pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • loss of appetite
  • nausea and vomiting
  • numbness or tingling of the face, hands, or feet
  • pain
  • rash
  • redness and soreness of the eyes
  • redness of the skin
  • shortness of breath
  • sore throat
  • sores in the mouth
  • stomach cramps
  • stomach pain or tenderness
  • swelling of the feet or lower legs
  • swollen lymph glands
  • tightness in the chest
  • unusual tiredness or weakness
  • unusual weight loss
  • wheezing
  • yellow eyes or skin

Some side effects of doxycycline may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known
  • Back, leg, or stomach pains
  • black, tarry stools
  • bleeding gums
  • blood in the urine or stools
  • blurred vision
  • bulging soft spot on the head of an infant
  • change in the ability to see colors, especially blue or yellow
  • chest pain, discomfort, or burning
  • chills
  • cracks in the skin
  • decrease in vision
  • difficulty breathing
  • discoloration of the thyroid glands
  • double vision
  • general body swelling
  • heartburn
  • increased sensitivity of the skin to sunlight
  • loss of heat from the body
  • lower back or side pain
  • nosebleeds
  • pain or burning in the throat
  • pain with swallowing
  • painful or difficult urination
  • pale skin
  • pinpoint red spots on the skin
  • rash with flat lesions or small raised lesions on the skin
  • red, swollen skin
  • redness or other discoloration of the skin
  • redness, swelling, or soreness of the tongue
  • scaly skin
  • severe nausea
  • severe stomach pain
  • severe sunburn
  • sores, ulcers, or white spots on the lips or tongue or inside the mouth
  • unusual bleeding or bruising
  • vomiting blood

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Applies to doxycycline: injectable powder for injection, oral capsule, oral delayed release capsule, oral delayed release tablet, oral kit, oral powder for reconstitution, oral syrup, oral tablet, oral and topical kit

Nervous system

Very common (10% or more): Headache (up to 26%)
Frequency not reported: Sinus headache, dizziness, drowsiness, amnesia, paresthesias of body areas exposed to sunlight, phrenic nerve paralysis after sclerotherapy
Postmarketing reports: Pseudotumor cerebri (benign intracranial hypertension), headache

Tetracyclines:
Frequency not reported: Bulging fontanels in infants, benign intracranial hypertension (pseudotumor cerebri) in adults

Benign intracranial hypertension resulting in significant loss of vision has been reported.

A 70-year-old female patient with no significant medical history suddenly developed a severe headache followed by vomiting about 15 minutes after the initial dose of doxycycline. The patient also experienced memory dysfunction; she could not remember the events of the afternoon prior to the doxycycline dose and could not retain the information after she was reminded. The incident lasted about 30 minutes and she was transported to the hospital for further evaluation. No further cause, such as intoxication or trauma, could be elicited. Once at the hospital, the patient was able to remember the events of the afternoon and could retain new information, but amnesia regarding the events of the 30 minutes following the onset of the headache persisted. The patient's laboratory results, CT scan, MRI scan, cerebrospinal fluid, and EEG showed no pathology. When the patient was discharged 2 days later, the amnesia for the 30 minutes continued. After elimination of other symptomatic causes, the amnesia was concluded to be due to the doxycycline because of the close relation of the doxycycline dose and the onset of symptoms.

Gastrointestinal

Very common (10% or more): Nausea (up to 13.4%)
Common (1% to 10%): Vomiting (8.1%), toothache (7%), tooth disorder (6%), dyspepsia (6%), diarrhea (up to 6%), periodontal abscess (4%), acid indigestion (4%), upper abdominal pain (2%), abdominal distention (1%), abdominal pain (1%), stomach discomfort (1%), dry mouth (1%)
Uncommon (0.1% to 1%): Gum pain (less than 1%)
Rare (less than 0.1%): Adult tooth staining (at least 1 case)
Frequency not reported: Clostridium difficile associated diarrhea, esophageal irritation, ulceration, epigastric burning, black hairy tongue

Tetracyclines:
Frequency not reported: Nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, inflammatory lesions (with monilial overgrowth) in the anogenital region, esophagitis, esophageal ulcerations

Numerous cases of esophageal ulceration have been reported. In most of the cases the patients had taken their medication at bedtime, usually without enough liquid. Patients often present with severe retrosternal pain and difficulty swallowing. Ulcerations generally resolve within a week after discontinuation of the medication. One case report describes severe hiccups of 4-day duration associated with esophagitis following the first dose of doxycycline.

Esophagitis and esophageal ulcerations have been reported in patients receiving capsule and tablet formulations of tetracycline-class drugs. Most took medication immediately before going to bed.

Other

Very common (10% or more): Common cold (22%), influenza symptoms (11%)
Common (1% to 10%): Injury (5%), pain (up to 4%), back pain (up to 3%), back ache (2%), infection (2%), fungal infection (2%), influenza (2%)
Frequency not reported: Possible overgrowth of nonsusceptible organisms (superinfection)

Tetracyclines:
Frequency not reported: Microscopic brown-black discoloration of the thyroid gland

The long-term use of tetracyclines has been associated with microscopic brown-black discoloration of the thyroid gland; abnormal thyroid function has not been reported.

Musculoskeletal

Common (1% to 10%): Joint pain (6%), muscle pain (1%)

Respiratory

Common (1% to 10%): Nasopharyngitis (5%), sore throat (5%), sinus congestion (5%), coughing (4%), sinus headache (up to 4%), sinusitis (3%), bronchitis (3%), nasal congestion (2%), pharyngolaryngeal pain (1%)

Dermatologic

Common (1% to 10%): Rash (4%)
Frequency not reported: Nail discoloration, phototoxicity, photoallergic reaction, photo-onycholysis

Tetracyclines:
Frequency not reported: Photosensitivity, maculopapular and erythematous rashes, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, hyperpigmentation

In a double-blinded study, doxycycline was found to be more phototoxic than minocycline and demeclocycline. Paresthesias of the body areas exposed to sunlight may be early signs of sunburn reactions.

A case report of a possible photoallergic reaction describes scaly erythema and vesicles on the face and neck associated with doxycycline administration. Upon rechallenge, a flare with erythema, itching and burning occurred in the same area.

Another case report was documented in Australian troops treated with doxycycline 100 mg daily for malaria prophylaxis while on deployment in East Timor, a group of islands within the Malaysian archipelago located close to the equator. Of the 135 troops, 22 exhibited phototoxic reactions to low dosages of doxycycline that resembled severe sunburn with erythematous plaques on the sun-exposed areas. The troops used a sunscreen containing oxybenzone.

An 11-year-old boy treated with doxycycline for brucellosis was evaluated for painless brown nail discoloration. Doxycycline was initiated for brucellosis but stopped when the boy developed photosensitivity, but 15 days after the initiation of therapy brown nail discoloration developed. Other than the brown discoloration, the boy's physical condition was normal and the discoloration disappeared within one month.

Genitourinary

Common (1% to 10%): Menstrual cramp (4%), bacterial vaginitis (3.3%), vulvovaginal mycotic infection (2%)
Frequency not reported: Vaginal itch

Tetracyclines:
Frequency not reported: Vaginal candidiasis

Cardiovascular

Common (1% to 10%): Hypertension (3%), increased blood pressure (2%)

Hepatic

Common (1% to 10%): Increased aspartate aminotransferase (2%)
Frequency not reported: Acute hepatocellular injury, cholestatic reactions

Tetracyclines:
Frequency not reported: Hepatotoxicity

Metabolic

Common (1% to 10%): Increased blood lactate dehydrogenase (2%), increased blood glucose (1%)
Frequency not reported: Hypoglycemia

Tetracyclines:
Frequency not reported: Anorexia

Hypoglycemia in a nondiabetic patient has been reported.

Psychiatric

Common (1% to 10%): Anxiety (2%)

Hypersensitivity

Tetracyclines:
Frequency not reported: Hypersensitivity reactions (including urticaria, angioneurotic edema, anaphylaxis, anaphylactoid purpura, serum sickness, pericarditis, exacerbation of systemic lupus erythematosus, drug rash with eosinophilia and systemic symptoms [DRESS])

Hematologic

Tetracyclines:
Frequency not reported: Hemolytic anemia, thrombocytopenia, neutropenia, eosinophilia

Ocular

Frequency not reported: Diplopia, papilledema, loss of vision (associated with doxycycline-induced benign intracranial hypertension)

Renal

Tetracyclines:
Frequency not reported: Dose-related rise in BUN

Immunologic

Tetracyclines:
Frequency not reported: Autoimmune syndromes