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Doxycycline
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Medically reviewed by Kovalenko Svetlana Olegovna, PharmD. Last updated on 2020.02.26

Name of the medicinal product

Doxycyclate Hyclate

Qualitative and quantitative composition

Doxycycline

Pharmaceutical form

Powder for suspension; Capsule; For Suspension; Injection; Tablets

Therapeutic indications

The information provided in Therapeutic indications of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Therapeutic indications in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Doxycyclate Hyclate has been found clinically effective in the treatment of a variety of infections caused by susceptible strains of Gram-positive and Gram-negative bacteria and certain other micro-organisms.

Respiratory tract infections Pneumonia and other lower respiratory tract infections due to susceptible strains of Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and other organisms. Mycoplasma pneumoniae. Treatment of chronic bronchitis, sinusitis.

Urinary tract infections caused by susceptible strains of Klebsiella species, Enterobacter species, Escherichia coli, Streptococcus faecalis and other organisms.

Sexually transmitted diseases Infections due to Chlamydia trachomatis including uncomplicated urethral, endocervical or rectal infections. Non-gonococcal urethritis caused by Ureaplasma urealyticum (T-mycoplasma). Doxycyclate Hyclate is also indicated in chancroid, granuloma inguinale and lymphogranuloma venereum. Doxycyclate Hyclate is an alternative drug in the treatment of gonorrhoea and syphilis.

Skin infections Acne vulgaris, when antibiotic therapy is considered necessary.

Since Doxycyclate Hyclate is a member of the tetracycline series of antibiotics, it may be expected to be useful in the treatment of infections which respond to other tetracyclines, such as:

Ophthalmic infections Due to susceptible strains of gonococci, staphylococci and Haemophilus influenzae. Trachoma, although the infectious agent, as judged by immunofluorescence, is not always eliminated. Inclusion conjunctivitis may be treated with oral Doxycyclate Hyclate alone or in combination with topical agents.

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

Other infections Psittacosis, brucellosis (in combination with streptomycin), cholera, bubonic plague, louse and tick-borne relapsing fever, tularaemia glanders, melioidosis, chloroquine-resistant falciparum malaria and acute intestinal amoebiasis (as an adjunct to amoebicides).

Doxycyclate Hyclate is an alternative drug in the treatment of leptospirosis, gas gangrene and tetanus.

Doxycyclate Hyclate is indicated for prophylaxis in the following conditions: Scrub typhus, travellers' diarrhoea (enterotoxigenic Escherichia coli), leptospirosis and malaria. Prophylaxis of malaria should be used in accordance to current guidelines, as resistance is an ever changing problem.

Dosage (Posology) and method of administration

The information provided in Dosage (Posology) and method of administration of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Dosage (Posology) and method of administration in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Posology

Adults

The usual dosage of Doxycyclate Hyclate for the treatment of acute infections in adults is 200 mg on the first day (as a single dose or in divided doses) followed by a maintenance dose of 100 mg/day. In the management of more severe infections, 200 mg daily should be given throughout treatment.

Dosage recommendations in specific infections:

Acne vulgaris 50 mg daily with food or fluid for 6 to 12 weeks.

Sexually transmitted diseases 100 mg twice daily for 7 days is recommended in the following infections: uncomplicated gonococcal infections (except anorectal infections in men); uncomplicated urethral, endocervical or rectal infection caused by Chlamydia trachomatis; non-gonococcal urethritis caused by Ureaplasma urealyticum. Acute epididymo-orchitis caused by Chlamydia trachomatis or Neisseria gonorrhoea 100 mg twice daily for 10 days. Primary and secondary syphilis: Non-pregnant penicillin-allergic patients who have primary or secondary syphilis can be treated with the following regimen: doxycycline 200 mg orally twice daily for two weeks, as an alternative to penicillin therapy.

Louse and tick-borne relapsing fevers A single dose of 100 or 200 mg according to severity.

Treatment of chloroquine-resistant falciparum malaria 200 mg daily for at least 7 days. Due to the potential severity of the infection, a rapid-acting schizonticide such as quinine should always be given in conjunction with Doxycyclate Hyclate; quinine dosage recommendations vary in different areas.

Prophylaxis of malaria 100 mg daily in adults and children over the age of 12 years. Prophylaxis can begin 1-2 days before travel to malarial areas. It should be continued daily during travel in the malarial areas and for 4 weeks after the traveller leaves the malarial area. For current advice on geographical resistance patterns and appropriate chemoprophylaxis, current guidelines or the Malaria Reference Laboratory should be consulted, details of which can be found in the British National Formulary (BNF).

For the prevention of scrub typhus 200 mg as a single dose.

For the prevention of travellers' diarrhoea in adults 200 mg on the first day of travel (administered as a single dose or as 100 mg every 12 hours) followed by 100 mg daily throughout the stay in the area. Data on the use of the drug prophylactically are not available beyond 21 days.

For the prevention of leptospirosis 200 mg once each week throughout the stay in the area and 200 mg at the completion of the trip. Data on the use of the drug prophylactically are not available beyond 21 days.

Paediatric population Doxycyclate Hyclate is contraindicated in children under the age of 12 years..

Use in the elderly Doxycyclate Hyclate may be prescribed in the elderly in the usual dosages with no special precautions. No dosage adjustment is necessary in the presence of renal impairment. The Doxycyclate Hyclate-D dispersible tablet may be preferred for the elderly since it is less likely to be associated with oesophageal irritation and ulceration.

Use in patients with impaired hepatic function

Use in patients with renal impairment

Method of administration

Dispersible Tablets are for oral administration only.

Doxycyclate Hyclate-D tablets are administered by drinking a suspension of the tablets in a small amount of water. This should be done in the sitting or standing position and well before retiring at night to reduce the risk of oesophageal irritation and ulceration. If gastric irritation occurs, it is recommended that Doxycyclate Hyclate be given with food or milk. Studies indicate that the absorption of Doxycyclate Hyclate is not notably influenced by simultaneous ingestion of food or milk.

Exceeding the recommended dosage may result in an increased incidence of side effects. Therapy should be continued for at least 24 to 48 hours after symptoms and fever have subsided.

When used in streptococcal infections, therapy should be continued for 10 days to prevent the development of rheumatic fever or glomerulonephritis.

Contraindications

The information provided in Contraindications of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Contraindications in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Pregnancy Doxycyclate Hyclate is contraindicated in pregnancy. It appears that the risks associated with the use of tetracyclines during pregnancy are predominantly due to effects on teeth and skeletal development..

Nursing mothers Tetracyclines are excreted into milk and are therefore contraindicated in nursing mothers..

Paediatric population Doxycyclate Hyclate is contraindicated in children under the age of 12 years. As with other tetracyclines, Doxycyclate Hyclate forms a stable calcium complex in any bone-forming tissue. A decrease in the fibula growth rate has been observed in prematures given oral tetracyclines in doses of 25 mg/kg every 6 hours. This reaction was shown to be reversible when the drug was discontinued..

Special warnings and precautions for use

The information provided in Special warnings and precautions for use of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Special warnings and precautions for use in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Use in children The use of drugs of the tetracycline class during tooth development (pregnancy, infancy and childhood to the age of 12 years) may cause permanent discolouration of the teeth (yellow-grey-brown). This adverse reaction is more common during long-term use of the drugs but has been observed following repeated short-term courses. Enamel hypoplasia has also been reported. Use of doxycycline is contraindicated in pediatric patients under the age of 12 years..

Use in patients with impaired hepatic function Doxycyclate Hyclate should be administered with caution to patients with hepatic impairment or those receiving potentially hepatotoxic drugs.

Abnormal hepatic function has been reported rarely and has been caused by both the oral and parenteral administration of tetracyclines, including doxycycline.

Use in patients with renal impairment Excretion of doxycycline by the kidney is about 40%/72 hours in individuals with normal renal function. This percentage excretion may fall to a range as low as 1-5%/72 hours in individuals with severe renal insufficiency (creatinine clearance below 10ml/min). Studies have shown no significant difference in the serum half-life of doxycycline in individuals with normal and severely impaired renal function. Haemodialysis does not alter the serum half-life of doxycycline. The anti-anabolic action of the tetracyclines may cause an increase in blood urea. Studies to date indicate that this anti-anabolic effect does not occur with the use of Doxycyclate Hyclate in patients with impaired renal function.

Serious skin reactions Serious skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) have been reported in patients receiving doxycycline. If serious skin reactions occur, doxycycline should be discontinued immediately and appropriate therapy should be instituted.

Photosensitivity Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines, including doxycycline. Patients likely to be exposed to direct sunlight or ultraviolet light should be advised that this reaction can occur with tetracycline drugs and treatment should be discontinued at the first evidence of skin erythema.

Photoonycholysis has also been reported in patients receiving doxycycline.

Benign intracranial hypertension Bulging fontanelles in infants have been reported in individuals receiving tetracyclines. Benign intracranial hypertension (pseudotumor cerebri) has been associated with the use of tetracyclines including doxycycline. Benign intracranial hypertension (pseudotumor cerebri) is usually transient, however cases of permanent visual loss secondary to benign intracranial hypertension (pseudotumor cerebri) have been reported with tetracyclines including doxycycline. If visual disturbance occurs during treatment, prompt ophthalmologic evaluation is warranted. Since intracranial pressure can remain elevated for weeks after drug cessation patients should be monitored until they stabilize. Concomitant use of isotretinoin or other systemic retinoids and doxycycline should be avoided because isotretinoin is also known to cause benign intracranial hypertension (pseudotumor cerebri)..

Microbiological overgrowth The use of antibiotics may occasionally result in the overgrowth of non-susceptible organisms including Candida. If a resistant organism appears, the antibiotic should be discontinued and appropriate therapy instituted.

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including doxycycline, and has ranged in severity from mild to life-threatening. It is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents.

Clostridium difficile associated diarrhoea (CDAD) has been reported with use of nearly all antibacterial agents, including doxycycline, and may range in severity from mild diarrhoea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

C. difficile produces toxins A and B which contribute to the development of CDAD.

Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhoea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

Oesophagitis Instances of oesophagitis and oesophageal ulcerations have been reported in patients receiving capsule and tablet forms of drugs in the tetracycline class, including doxycycline. Most of these patients took medications immediately before going to bed or with inadequate amounts of fluid.

Porphyria There have been rare reports of porphyria in patients receiving tetracyclines.

Venereal disease When treating venereal disease, where co-existent syphilis is suspected, proper diagnostic procedures including dark-field examinations should be utilised. In all such cases monthly serological tests should be made for at least four months.

Beta-haemolytic streptococci infections Infections due to group A beta-haemolytic streptococci should be treated for at least 10 days.

Myasthenia gravis Due to a potential for weak neuromuscular blockade, care should be taken in administering tetracyclines to patients with myasthenia gravis.

Systemic lupus erythematosus Tetracyclines can cause exacerbation of SLE.

Methoxyflurane Caution is advised in administering tetracyclines with methoxyflurane.

Jarisch-Herxheimer reaction Some patients with spirochete infections may experience a Jarisch-Herxheimer reaction shortly after doxycycline treatment is started. Patients should be reassured that this is a usually self-limiting consequence of antibiotic treatment of spirochete infections.

Effects on ability to drive and use machines

The information provided in Effects on ability to drive and use machines of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Effects on ability to drive and use machines in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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The effect of doxycycline on the ability to drive or operate heavy machinery has not been studied. There is no evidence to suggest that doxycycline may affect these abilities.

Undesirable effects

The information provided in Undesirable effects of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Undesirable effects in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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The following adverse reactions have been observed in patients receiving tetracyclines, including doxycycline.

System Organ Class

Common

>1/100 to <1/10

Uncommon

>1/1000 to <1/100

Rare

>1/10,000 to <1/1000

Not known

Cannot be estimated from the available data.

Infections and infestations

Vaginal infection

Candida Infection

Blood and lymphatic system disorders

Haemolytic anaemia, neutropenia, thrombocytopenia, eosinophilia

Immune system disorders

Hypersensitivity (including anaphylactic shock, anaphylactic reaction, anaphylactoid reaction, angioedema, exacerbation of systemic lupus erythematosus, pericarditis, serum sickness, Henoch-Schonlein purpura, hypotension, dyspnoea, tachycardia, peripheral oedema and urticaria)

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

Jarisch-Herxheimer reaction

Endocrine disorders

Brown-black microscopic discoloration of thyroid glands

Metabolism and nutrition disorders

Porphyria, decreased appetite

Nervous system disorders

Headache

Anxiety, benign intracranial hypertension (pseudotumor cerebri)*, fontanelle bulging

Ear and labyrinth disorders

Tinnitus

Vascular disorders

Flushing

Gastrointestinal disorders

Nausea/vomiting

Dyspepsia (Heartburn/gastritis)

Pancreatitis, pseudomembranous colitis, Clostridium difficile colitis, oesophageal ulcer, oesophagitis, enterocolitis, inflammatory lesions (with monilial overgrowth) in the anogenital region, dysphagia, abdominal pain, diarrhoea, glossitis, stomatitis, tooth discolourationa

Hepatobiliary disorders

Hepatic failure, hepatitis, hepatotoxicity, jaundice, hepatic function abnormal

Skin and subcutaneous tissue disorders

Photosensitivity reaction, rash including maculopapular and erythematous rashes

Toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, dermatitis exfoliative, photoonycholysis

Musculoskeletal, connective tissue and bone disorders

Arthralgia, myalgia

Renal and urinary disorders

Blood urea increased

* Symptoms included blurring of vision, scotomata and diplopia. Permanent visual loss has been reported.

a Reversible and superficial discolouration of permanent teeth has been reported with the use of doxycycline.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Overdose

The information provided in Overdose of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Overdose in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Acute overdosage with antibiotics is rare. In the event of overdosage discontinue medication. Gastric lavage plus appropriate supportive treatment is indicated.

Dialysis does not alter serum half-life and thus would not be of benefit in treating cases of overdosage.

Pharmacodynamic properties

The information provided in Pharmacodynamic properties of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Pharmacodynamic properties in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Pharmacotherapeutic group: Tetracyclines, ATC code: J01 AA02.

Doxycyclate Hyclate is primarily bacteriostatic and is believed to exert its antimicrobial effect by the inhibition of protein synthesis. Doxycyclate Hyclate is active against a wide range of Gram-positive and Gram-negative bacteria and certain other micro-organisms.

Pharmacokinetic properties

The information provided in Pharmacokinetic properties of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Pharmacokinetic properties in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Tetracyclines are readily absorbed and are bound to plasma proteins in varying degrees. They are concentrated by the liver in the bile and excreted in the urine and faeces at high concentrations and in a biologically active form. Doxycycline is virtually completely absorbed after oral administration. Studies reported to date indicate that the absorption of doxycycline, unlike certain other tetracyclines, is not notably influenced by the ingestion of food or milk. Following a 200 mg dose, normal adult volunteers averaged peak serum levels of 2.6 micrograms/ml of doxycycline at 2 hours decreasing to 1.45 micrograms/ml at 24 hours. Doxycycline has a high degree of lipid solubility and a low affinity for calcium. It is highly stable in normal human serum. Doxycycline will not degrade into an epianhydro form.

Pharmacotherapeutic group

The information provided in Pharmacotherapeutic group of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Pharmacotherapeutic group in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Tetracyclines, ATC code: J01 AA02.

Preclinical safety data

The information provided in Preclinical safety data of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Preclinical safety data in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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None stated

Incompatibilities

The information provided in Incompatibilities of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Incompatibilities in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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Not applicable.

Special precautions for disposal and other handling

The information provided in Special precautions for disposal and other handling of Doxycyclate Hyclate is based on data of another medicine with exactly the same composition as the Doxycyclate Hyclate of the medicine (Doxycycline). Be careful and be sure to specify the information on the section Special precautions for disposal and other handling in the instructions to the drug Doxycyclate Hyclate directly from the package or from the pharmacist at the pharmacy.
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No special requirements.

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