doxycycline (Rx)

Brand and Other Names:Vibramycin, Monodox, more...Acticlate, Atridox, Avidoxy, Doxy, Doxycin, Doryx, Oracea, Periostat, Adoxa, Ocudox, Doryx MPC
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 50mg (Monodox, generic)
  • 75mg (Monodox)
  • 100mg (Monodox, Vibramycin, generic)
  • 150mg (Adoxa)

solution, reconstituted powder for IV

  • 100mg (Doxy, generic)

syrup

  • 50mg/5mL (Vibramycin)

oral suspension

  • 25mg/5mL (Vibramycin, generic)

tablet

  • 20mg (generic)
  • 50mg (Adoxa, generic)
  • 75mg (Acticlate, Adoxa, generic)
  • 100mg (Adoxa, generic)
  • 150mg (Acticlate, generic)

tablet, delayed-release

  • 50mg (Doryx)
  • 60mg (Doryx MPC)
  • 75mg (generic)
  • 100mg (generic)
  • 120mg (Doryx MPC)
  • 150mg (Doryx, generic)
  • 200mg (Doryx)

capsule, delayed-release

  • 40mg (Oracea, generic)

periodontal extended-release liquid

  • 10%

Rickettsial Infections

Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae

Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given qDay), THEN

Maintenance: 100-200 mg/day qDay or divided q12hr PO/IV (IV may be given qDay)

Sexually Transmitted Infections

Uncomplicated urethral, endocervical or rectal infections caused by Chlamydia trachomatis

Nongonococcal urethritis caused by Ureaplasma urealyticum

Lymphogranuloma venereum caused by Chlamydia trachomatis

Granuloma inguinale caused by Klebsiella granulomatis

Uncomplicated gonorrhea caused by Neisseria gonorrhoeae

Chancroid caused by Haemophilus ducreyi

Uncomplicated urethral, endocervical, or rectal infection caused by Chlamydia trachomatis: 100 mg PO BID for 7 days

Alternate dosing regimen for uncomplicated urethral or endocervical infection caused by Chlamydia trachomatis: 200 mg PO BID for 7 days

Uncomplicated gonococcal infections (except anorectal infections in men): 100 mg PO BID for 7 days

Alternate single visit dose: 300 mg stat followed in 1 hr by a second 300 mg dose

Nongonococcal urethritis (NGU) caused by U. urealyticum: 100 mg PO BID for 7 day

Respiratory Tract Infections

Respiratory tract infections caused by Mycoplasma pneumoniae

Psittacosis (ornithosis) caused by Chlamydophila psittaci

Indicated for respiratory tract infections caused by the following microorganisms, when bacteriological testing indicates appropriate susceptibility to drug: Haemophilus influenzae, Klebsiella species, Streptococcus pneumoniae

Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given qDay), THEN

Maintenance: 100-200 mg/day qDay or divided q12hr PO/IV (IV may be given qDay)

Specific Bacterial Infections

Relapsing fever due to Borrelia recurrentis

Plague due to Yersinia pestis

Tularemia due to Francisella tularensis

Cholera caused by Vibrio cholerae

Campylobacter fetus infections caused by Campylobacter fetus

Brucellosis due to Brucella species (in conjunction with streptomycin)

Bartonellosis due to Bartonella bacilliformis

Gram negative microorganisms (eg, Escherichia coli Enterobacter aerogenes, Shigella species, Acinetobacter species, urinary tract infections caused by Klebsiella species)

Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given qDay), THEN

Maintenance: 100-200 mg/day qDay or divided q12hr PO/IV (IV may be given qDay)

Ophthalmic infections

Trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated as judged by immunofluorescence

Inclusion conjunctivitis caused by Chlamydia trachomatis

Acute epididymo-orchitis caused by C. trachomatis: 100 mg, PO BID for at least 10 days

Anthrax

Anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure)

100 mg PO BID for 60 days

Select Infections When Penicillin is Contraindicated

When penicillin is contraindicated, doxycycline is an alternative treatment of the following infections:

  • Syphilis caused by Treponema pallidum
  • Yaws caused by Treponema pallidum subspecies pertenue
  • Vincent’s infection caused by Fusobacterium fusiforme
  • Actinomycosis caused by Actinomyces israelii. Infections caused by Clostridium species
  • Syphilis (<1 year duration): 100 mg PO BID for 2 weeks
  • Syphilis (≥1 year duration): 100 mg PO BID for 4 weeks

Acute Intestinal Amebiasis and Severe Acne

Adjunctive therapy for acute intestinal amebiasis and severe acne

Initial: 200 mg/day divided twice daily PO/IV on first day (IV may be given qDay), THEN

Maintenance: 100-200 mg/day qDay or divided q12hr PO/IV (IV may be given qDay)

Malaria

Indicated for prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (<4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

Prophylaxis: 100 mg PO qDay; begin taking 1-2 days before travel and continue daily during travel and for 4 weeks after traveler leaves malaria infested area

Severe infection (off-label): 100 mg PO/IV q12hr x 7 days with 3-7 days quinidine gluconate

Uncomplicated infection (off-label): 100 mg PO q12hr x 7 days with 3-7 days quinine sulfate depending on region

Equivalent dose of Doryx MPC is 120 mg

Periodontal Disease

Atridox: Apply subgingivally; dose depends on size, shape, and number of pockets treated

Dosing Considerations

Susceptible organisms

  • Propionibacterium acnes, Actinomyces israelii, Acinetobacter spp, Bacillus anthracis, Bacteroides spp., Bartonella bacilliformis, Bartonella henselae, Bartonella quintana, Borrelia recurrentis, Brucella spp, Campylobacter jejuni, Chlamydia psittaci, Chlamydia trachomatis, Capnocytophaga canimorsus, Citrobacter diversus, Citrobacter freundii, Escherichia coli, Eikenella corrodens, Francisella tularensis, Haemophilus ducreyi, Helicobacter pylori, Klebsiella granulomatis, Klebsiella pneumoniae, Listeria monocytogenes, Mycoplasma hominis, Mycoplasma pneumoniae, Neisseria gonorrhoeae, Propionibacterium acnes, Rickettsiae, Shigella spp., MRSA, Staphylococcus saprophyticus, Streptococcus spp, Treponema pallidum, Ureaplasma urealyticum, Vibrio cholerae, Yersinia enterocolitica, Yersinia pestis, VRE, mycobacteria other than tuberculosis

Dosage Forms & Strengths

capsule

  • 50mg (Monodox, generic)
  • 75mg (Monodox)
  • 100mg (Monodox, Vibramycin, generic)
  • 150mg (Adoxa)

solution, reconstituted powder for IV

  • 100mg (Doxy, generic)

syrup

  • 50mg/5mL (Vibramycin)

oral suspension

  • 25mg/5mL (Vibramycin, generic)

tablet

  • 20mg (generic)
  • 50mg (Adoxa, generic)
  • 75mg (Acticlate, Adoxa, generic)
  • 100mg (Adoxa, generic)
  • 150mg (Acticlate, generic)

tablet, delayed-release

  • 50mg (Doryx)
  • 60mg (Doryx MPC)
  • 75mg (generic)
  • 100mg (generic)
  • 120mg (Doryx MPC)
  • 150mg (Doryx, generic)
  • 200mg (Doryx)

capsule, delayed-release

  • 40mg (Oracea, generic)

General Dosing Guidelines

≤8 years: Not recommended for mild-to-moderate infections; may cause tooth discoloration and enamel hypoplasia during tooth development

>8 years, <45 Kg

  • Load: 4.4 mg/kg/day PO/IV divided q12hr day 1  
  • Maintenance: 2.2-4.4 mg/kg/day IV/PO qDay (may divide BID for higher doses)
  • Doryx MPC
    • Severe or life-threatening infections (eg, anthrax, Rocky Mountain spotted fever): 2.6 mg/kg PO BID
    • Less severe infections: 5.3 mg/kg PO divided into 2 doses on day 1, then a maintenance dose of 2.6 mg/kg PO qDay

>8 years, ≥45 kg

  • 100 mg PO q12hr or 50 mg PO q6hr on day 1, followed by maintenance dose of 100 mg/day as single dose or as 50 mg q12hr
  • Doryx MPC: 120 mg PO q12hr on day 1, followed by maintenance dose of 120 mg/day; may increase frequency to q12hr for more severe infections, particularly chronic UTI

Anthrax

Anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure)

≤8 years: 2.2 mg/kg PO/IV q12hr for 60 days (change to amoxicillin as soon as penicillin susceptibility confirmed)  

>8 years

  • ≤45 kg: 2.2 mg/kg PO/IV q12hr for 60 days (Doryx MPC: 2.6 mg/kg PO q12hr for 60 days)
  • >45 kg: 100 mg PO/IV q12hr for 60 days (Doryx MPC: 120 mg PO q12hr for 60 days)

Malaria

Prophylaxis

  • Indicated for prophylaxis of malaria due to Plasmodium falciparum in short-termtravelers (<4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxineresistant strains
  • 2 mg/kg PO qDay; not to exceed 100 mg /day
  • Doryx MPC: 2.4 mg/kg PO qDay
  • Initiate treatment 1-2 days prior to travel to endemic area and continue for 4 weeks after leaving the area

Severe infection

  • <45 kg: 2.2 mg/kg q12hr for 7 days with quinidine gluconate
  • ≥45 kg (Off label): 100 mg PO/IV q12hr for 7 days with quinidine gluconate

Uncomplicated

  • >8 years: 2.2 mg/kg; not to exceed 100 mg dose PO q12hr for 7 days with quinine sulfate

Next:

Interactions

Interaction Checker

and doxycycline

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            Contraindicated (6)

            • acitretin

              doxycycline, acitretin. Other (see comment). Contraindicated. Comment: Both acitretin and tetracyclines can cause increased intracranial pressure.

            • allogeneic cultured keratinocytes/fibroblasts in bovine collagen

              doxycycline decreases effects of allogeneic cultured keratinocytes/fibroblasts in bovine collagen by Other (see comment). Contraindicated. Comment: Exposure to topical antibiotics has been shown to degrade Gintuit; if exposed, irrigate the wound thoroughly with saline and allow a suitable wash-out period to elapse before applying Gintuit.

            • flibanserin

              doxycycline will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.

            • lomitapide

              doxycycline increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

            • lonafarnib

              doxycycline will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.

            • tretinoin

              doxycycline, tretinoin. Either increases toxicity of the other by unspecified interaction mechanism. Contraindicated. Both tretinoin and tetracyclines can cause increased intracranial pressure.

            Serious - Use Alternative (81)

            • aluminum hydroxide

              aluminum hydroxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • aminolevulinic acid oral

              aminolevulinic acid oral, doxycycline. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

            • aminolevulinic acid topical

              doxycycline increases toxicity of aminolevulinic acid topical by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of photosensitizing drugs may enhance the phototoxic reaction to photodynamic therapy with aminolevulinic acid.

            • amoxicillin

              doxycycline decreases effects of amoxicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

            • ampicillin

              doxycycline decreases effects of ampicillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Tetracyclines may interfere with the bactericidal action of penicillins. Monitor for decreased therapeutic effects of penicillins if concomitantly used with a tetracycline.

            • atracurium

              doxycycline increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • avapritinib

              doxycycline will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications.

            • axitinib

              doxycycline increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

            • BCG vaccine live

              doxycycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • bismuth subsalicylate

              bismuth subsalicylate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • bosutinib

              doxycycline increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • calcium acetate

              calcium acetate, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium carbonate

              calcium carbonate, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium chloride

              calcium chloride, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium citrate

              calcium citrate, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • calcium gluconate

              calcium gluconate, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • carbonyl iron

              carbonyl iron decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • cholera vaccine

              doxycycline, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

            • cisatracurium

              doxycycline increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • cobimetinib

              doxycycline will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).

            • dicloxacillin

              doxycycline decreases effects of dicloxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • eliglustat

              doxycycline increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .

            • entrectinib

              doxycycline will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of moderate CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce dose to 200 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing moderate CYP3A inhibitor for 3-5 elimination half-lives.

            • fentanyl

              doxycycline will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • fentanyl intranasal

              doxycycline will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • fentanyl transdermal

              doxycycline will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • fentanyl transmucosal

              doxycycline will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

            • ferric maltol

              ferric maltol decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ferrous fumarate

              ferrous fumarate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ferrous gluconate

              ferrous gluconate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ferrous sulfate

              ferrous sulfate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • flucloxacillin

              doxycycline decreases effects of flucloxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • infigratinib

              doxycycline will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • iron dextran complex

              iron dextran complex decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • iron sucrose

              iron sucrose decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • isotretinoin

              isotretinoin, doxycycline. Mechanism: unknown. Contraindicated. Risk of pseudotumor cerebri.

            • ivabradine

              doxycycline will increase the level or effect of ivabradine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of ivabradine with moderate CYP3A4 inhibitors.

            • lemborexant

              doxycycline will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.

            • lurbinectedin

              doxycycline will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • magnesium chloride

              magnesium chloride decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium citrate

              magnesium citrate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium hydroxide

              magnesium hydroxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium oxide

              magnesium oxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • magnesium sulfate

              magnesium sulfate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • methoxyflurane

              doxycycline, methoxyflurane. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of nephrotoxicity.

            • methyl aminolevulinate

              doxycycline, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.

            • midazolam intranasal

              doxycycline will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of moderate CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.

            • mobocertinib

              doxycycline will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use of moderate CYP3A4 inhibitor unavoidable, reduce mobocertinib dose by ~50% (eg, 160 to 80 mg); closely monitor QTc interval.

            • nafcillin

              doxycycline decreases effects of nafcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic antibiotics may interfere with the bactericidal actions of penicillins.

            • naloxegol

              doxycycline will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministation of naloxegol with moderate CYP3A4 inhibitors is unavoidable, reduce naloxegol dose to 12.5 mg qDay

            • neratinib

              doxycycline will increase the level or effect of neratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of neratinib with strong/moderate CYP3A4 inhibitors.

            • olaparib

              doxycycline will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.

            • onabotulinumtoxinA

              doxycycline increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • oxacillin

              doxycycline decreases effects of oxacillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • pancuronium

              doxycycline increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • pemigatinib

              doxycycline will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.

            • penicillin G aqueous

              doxycycline decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • penicillin VK

              doxycycline decreases effects of penicillin VK by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • pexidartinib

              doxycycline will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.

            • pivmecillinam

              doxycycline decreases effects of pivmecillinam by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • polysaccharide iron

              polysaccharide iron decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • rapacuronium

              doxycycline increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • rocuronium

              doxycycline increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • rose hips

              rose hips decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • selumetinib

              doxycycline will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.

            • siponimod

              doxycycline will increase the level or effect of siponimod by affecting hepatic enzyme CYP2E1 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.

            • sodium bicarbonate

              sodium bicarbonate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Administer tetracyclines at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Administer tetracyclines at least 2 hr before and no less than 6 hr after each dose to avoid chelation with magnesium. .

            • strontium ranelate

              strontium ranelate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Suspend strontium ranelate during antibiotic therapy.

            • succinylcholine

              doxycycline increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • tazemetostat

              doxycycline will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with moderate CYP3A4 inhibitors. If coadministration is unavoidable, reduce tazemetostat current dose (see drug monograph Dosage Modifications).

            • temocillin

              doxycycline decreases effects of temocillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • ticarcillin

              doxycycline decreases effects of ticarcillin by pharmacodynamic antagonism. Avoid or Use Alternate Drug.

            • tretinoin

              doxycycline, tretinoin. Either increases levels of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

            • tretinoin topical

              doxycycline, tretinoin topical. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased phototoxicity.

            • tripotassium dicitratobismuthate

              tripotassium dicitratobismuthate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • typhoid vaccine live

              doxycycline decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

            • vecuronium

              doxycycline increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.

            • venetoclax

              doxycycline will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a moderate CYP3A inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

            Monitor Closely (69)

            • acalabrutinib

              doxycycline will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease acalabrutinib dose to 100 mg once daily if coadministered with a moderate CYP3A inhibitor.

            • amobarbital

              amobarbital decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • bazedoxifene/conjugated estrogens

              doxycycline will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • brexpiprazole

              doxycycline will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor.

            • buprenorphine subdermal implant

              doxycycline will increase the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inhibitors for signs and symptoms of overmedication. If the dose of the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, implant removal may be necessary and the patient should then be treated with a buprenorphine dosage form that permits dose adjustments. If a CYP3A4 inhibitor is discontinued in a patient who has been stabilized on buprenorphine, monitor the patient for withdrawal.

            • buprenorphine, long-acting injection

              doxycycline will increase the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who transfer to buprenorphine long-acting injection from transmucosal buprenorphine coadministered with CYP3A4 inhibitors should be monitored to ensure buprenorphine plasma levels are adequate. Within 2 weeks, if signs and symptoms of buprenorphine toxicity or overdose occur and the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, transition the patient back to a buprenorphine formulation that permits dose adjustments.

            • butabarbital

              butabarbital decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • butalbital

              butalbital decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • cabozantinib

              doxycycline will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • cannabidiol

              doxycycline will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP3A4 inhibitor.

            • carbamazepine

              carbamazepine decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • cefdinir

              doxycycline decreases effects of cefdinir by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefditoren

              doxycycline decreases effects of cefditoren by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefoxitin

              doxycycline decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefpodoxime

              doxycycline decreases effects of cefpodoxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • ceftriaxone

              doxycycline decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cefuroxime

              doxycycline decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • cholestyramine

              cholestyramine decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • conjugated estrogens

              doxycycline will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • deflazacort

              doxycycline will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

            • didanosine

              didanosine will decrease the level or effect of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Applies to didanosine chewable tablets and powder for oral solution; administer 2 hr before or several hours after didanosine oral solution or chewable tablet administration

            • digoxin

              doxycycline will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

            • estradiol

              doxycycline will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estrogens conjugated synthetic

              doxycycline will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • estropipate

              doxycycline will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • ethinylestradiol

              doxycycline will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • ferric citrate

              ferric citrate will decrease the level or effect of doxycycline by drug binding in GI tract. Use Caution/Monitor. Administer doxycycline at least 1 hr before ferric citrate

            • finerenone

              doxycycline will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

            • guanfacine

              doxycycline will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Strong or moderate CYP3A4 inhibitors significantly increase guanfacine plasma concentrations. FDA-approved labeling for extended-release (ER) guanfacine recommends that, if coadministered, the guanfacine dosage should be decreased to half of the recommended dose. Specific recommendations for immediate-release (IR) guanfacine are not available.

            • ibrutinib

              doxycycline increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or 420 mg qDay (graft versus host disease). After CYP3A inhibitor discontinuation, resume previous dose of ibrutinib.

            • ifosfamide

              doxycycline will decrease the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use of a CYP3A4 inhibitor may decrease metabolism of ifosfamide, potentially reducing ifosfamide therapeutic effects.

            • ivosidenib

              doxycycline will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with moderate CYP3A4 inhibitors may increase ivosidenib plasma concentrations, thus increasing the risk of QTc prolongation. Monitor for increased risk of QTc interval prolongation.

            • lanthanum carbonate

              lanthanum carbonate decreases levels of doxycycline by cation binding in GI tract. Use Caution/Monitor. Administer oral tetracycline antibiotics at least 2 hr before or after lanthanum. Interaction applies only to oral tetracyclines.

            • lefamulin

              doxycycline will increase the level or effect of lefamulin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for adverse effects if lefamulin is coadministered with moderate CYP3A inhibitors.

            • levamlodipine

              doxycycline will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.

            • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

              doxycycline will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

            • magnesium supplement

              magnesium supplement will decrease the level or effect of doxycycline by Other (see comment). Modify Therapy/Monitor Closely. Formation of an insoluble complex reduces absorption of the drug through intestinal tract; administer magnesium 2hr before the tetracycline or 4hr after the tetracycline.

            • mefloquine

              doxycycline will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • mestranol

              doxycycline will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

            • methotrexate

              doxycycline increases levels of methotrexate by decreasing elimination. Use Caution/Monitor. Tetracyclines may decrease intestinal absorption of methotrexate or interfere with the enterohepatic circulation by inhibiting bowel flora and suppressing metabolism of the drug by bacteria.

            • methoxsalen

              methoxsalen, doxycycline. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive photosensitizing effects.

            • mipomersen

              mipomersen, doxycycline. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

            • naldemedine

              doxycycline increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.

            • oliceridine

              doxycycline will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

            • ospemifene

              doxycycline, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely.

            • palbociclib

              doxycycline will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • pentobarbital

              pentobarbital decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • phenobarbital

              phenobarbital decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • piperacillin

              doxycycline decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

            • polycarbophil

              polycarbophil decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • porfimer

              doxycycline, porfimer. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Enhanced photosensitivity.

            • primidone

              primidone decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • rimegepant

              doxycycline will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid repeating rimegepant dose within 48 hr if coadministered with a moderate CYP3A4 inhibitor.

            • ruxolitinib

              doxycycline will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • secobarbital

              secobarbital decreases levels of doxycycline by increasing metabolism. Use Caution/Monitor.

            • sodium picosulfate/magnesium oxide/anhydrous citric acid

              doxycycline decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              sodium picosulfate/magnesium oxide/anhydrous citric acid decreases levels of doxycycline by cation binding in GI tract. Use Caution/Monitor. Take at least 2 hours before and not less than 6 hours after administration of sodium picosulfate, magnesium oxide and anhydrous citric acid to avoid magnesium chelation.

            • sonidegib

              doxycycline will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.

            • sucroferric oxyhydroxide

              sucroferric oxyhydroxide decreases levels of doxycycline by drug binding in GI tract. Use Caution/Monitor. Do not administer at the same time; take doxycycline at least 1 hr before sucroferric oxyhydroxide.

            • sufentanil SL

              doxycycline will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.

            • suvorexant

              doxycycline will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitors

            • tamsulosin

              doxycycline increases levels of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

            • tezacaftor

              doxycycline will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust tezacaftor dosage regimen if coadministered with a moderate CYP3A inhibitor.

            • tinidazole

              doxycycline will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tofacitinib

              doxycycline increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

            • trabectedin

              doxycycline will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • trimagnesium citrate anhydrous

              trimagnesium citrate anhydrous decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Multivalent cation-containing products may reduce bioavailability of tetracyclines; administer tetracycline at least 2 hr before or 6 hr after magnesium; use alternatives if available.

            • voclosporin

              doxycycline will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

            • zanubrutinib

              doxycycline will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib dose when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous dose of zanubrutinib. See zanubrutinib Dosage Modifications for precise recommendation.

            • zinc

              zinc will decrease the level or effect of doxycycline by cation binding in GI tract. Modify Therapy/Monitor Closely. Separate administration of oral tetracycline derivatives and oral zinc salts by at least 2 hr.

            Minor (31)

            • antithrombin alfa

              doxycycline increases effects of antithrombin alfa by pharmacodynamic synergism. Minor/Significance Unknown.

            • antithrombin III

              doxycycline increases effects of antithrombin III by pharmacodynamic synergism. Minor/Significance Unknown.

            • argatroban

              doxycycline increases effects of argatroban by pharmacodynamic synergism. Minor/Significance Unknown.

            • balsalazide

              doxycycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • bemiparin

              doxycycline increases effects of bemiparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • biotin

              doxycycline will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • bivalirudin

              doxycycline increases effects of bivalirudin by pharmacodynamic synergism. Minor/Significance Unknown.

            • colestipol

              colestipol decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • dalteparin

              doxycycline increases effects of dalteparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • enoxaparin

              doxycycline increases effects of enoxaparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • eslicarbazepine acetate

              eslicarbazepine acetate decreases levels of doxycycline by increasing metabolism. Minor/Significance Unknown.

            • estradiol vaginal

              doxycycline will increase the level or effect of estradiol vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • ethanol

              ethanol decreases levels of doxycycline by increasing elimination. Minor/Significance Unknown.

            • ethotoin

              ethotoin decreases levels of doxycycline by increasing metabolism. Minor/Significance Unknown.

            • fondaparinux

              doxycycline increases effects of fondaparinux by pharmacodynamic synergism. Minor/Significance Unknown.

            • fosphenytoin

              fosphenytoin decreases levels of doxycycline by increasing metabolism. Minor/Significance Unknown.

            • heparin

              doxycycline increases effects of heparin by pharmacodynamic synergism. Minor/Significance Unknown.

            • niacin

              doxycycline will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • oxcarbazepine

              oxcarbazepine decreases levels of doxycycline by increasing metabolism. Minor/Significance Unknown.

            • pantothenic acid

              doxycycline will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • phenindione

              doxycycline increases effects of phenindione by pharmacodynamic synergism. Minor/Significance Unknown.

            • phenytoin

              phenytoin decreases levels of doxycycline by increasing metabolism. Minor/Significance Unknown.

            • protamine

              doxycycline increases effects of protamine by pharmacodynamic synergism. Minor/Significance Unknown.

            • pyridoxine

              doxycycline will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • pyridoxine (Antidote)

              doxycycline will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • rifabutin

              rifabutin decreases levels of doxycycline by increasing metabolism. Minor/Significance Unknown.

            • rose hips

              doxycycline decreases levels of rose hips by increasing elimination. Minor/Significance Unknown.

            • sucralfate

              sucralfate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • thiamine

              doxycycline will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

            • verteporfin

              doxycycline, verteporfin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased phototoxicity.

            • warfarin

              doxycycline increases effects of warfarin by pharmacodynamic synergism. Minor/Significance Unknown.

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            Adverse Effects

            Frequency Not Defined

            Anorexia

            Dental discoloration

            Diarrhea

            Dysphagia

            Enterocolitis

            Erythema multiform

            Esophageal ulcer

            Esophagitis

            Exacerbation of systemic lupus erythematosus

            Exfoliative dermatitis

            Glossitis

            Headache

            Hemolytic anemia

            Hepatotoxicity

            Hypoglycemia

            Inflammatory anogenital lesion

            Intracranial hypertension

            Nausea

            Neutropenia

            Pericarditis

            Serum sickness

            Skin hyperpigmentation

            Toxic epidermal necrolysis

            Thrombocytopenia

            Upper abdominal pain

            Urticaria

            Vomiting

            Drug rash with eosinophilia and systemic symptoms

            Postmarketing Reports

            Pancreatitis

            Stevens-Johnson syndrome

            Maculopapular and erythematous rashes

            Angioneurotic edema

            Anaphylaxis

            Anaphylactoid purpura

            Jarisch-Herxheimer reaction in the setting of spirochete infections

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            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            Use of tetracyclines during tooth development (last half of pregnancy through age 8 years) can cause permanent discoloration of teeth; use doxycycline in pediatric patients 8 years of age or less only when potential benefits expected to outweigh risks in severe or life-threatening conditions (eg, anthrax, Rocky Mountain spotted fever); particularly when there are no alternative therapies

            Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, and may range in severity from mild diarrhea to fatal colitis

            Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines

            May result in overgrowth of non-susceptible organisms, including fungi. If such infections occur, discontinue use and institute appropriate therapy

            Severe skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) reported; if severe skin reactions occur, discontinue therapy immediately and institute appropriate therapy

            Intracranial hypertension (pseudotumor cerebri) reported (rare) may occur; symptoms include headache, blurred vision, diplopia, and vision loss; papilledema can be found on funduscopy; women of childbearing age who are overweight or have a history of IH are at greater risk; possibility for permanent visual loss exists; if visual disturbance occurs during treatment, prompt ophthalmologic evaluation is warranted; intracranial pressure can remain elevated for weeks after drug cessation; monitor until they stabilize

            All tetracyclines form a stable calcium complex in any bone-forming tissue; decrease in fibula growth rate has been observed in prematures given an oral tetracycline; reaction was shown to be reversible when the drug was discontinue

            Antianabolic action of the tetracyclines may cause an increase in BUN; studies to date indicate that this does not occur with the use of doxycycline in patients with impaired renal function

            Doxycycline offers substantial but not complete suppression of the asexual blood stages of Plasmodium strains

            Prescribing doxycycline in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria

            In long-term therapy, periodic laboratory evaluation of organ systems, including hematopoietic, perform renal and hepatic studies

            Drug interaction overview

            • Because tetracyclines have been shown to depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage
            • Since bacteriostatic drugs may interfere with the bactericidal action of penicillin, it is advisable to avoid giving tetracyclines in conjunction with penicillin
            • Absorption of tetracyclines is impaired by antacids containing aluminum, calcium, or magnesium, bismuth subsalicylate, and iron-containing preparations
            • Concurrent use of tetracyclines, may render oral contraceptives less effective
            • Barbiturates, carbamazepine, and phenytoin decrease the half-life of doxycycline
            • Coadministration of tetracycline and methoxyflurane has been reported to result in fatal renal toxicity
            • False elevations of urinary catecholamines may occur due to interference with the fluorescence test
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            Pregnancy & Lactation

            Pregnancy

            Therapy may cause discoloration deciduous teeth, and reversible inhibition of bone growth when administered during second and third trimester of pregnancy

            Available data from published studies over decades have not shown a difference in major birth defect risk compared to unexposed pregnancies with doxycycline exposure in first trimester of pregnancy

            The vast majority of reported experience during human pregnancy is short-term, first trimester exposure; there are no human data available to assess effects of long-term therapy in pregnant women such as that proposed for treatment of anthrax exposure

            An expert review of published data on experiences with doxycycline use during pregnancy concluded that therapeutic doses during pregnancy are unlikely to pose substantial teratogenic risk (the quantity and quality of data were assessed as limited to fair), but the data are insufficient to state that there is no risk; there are no adequate and well-controlled studies on use of drug in pregnant women

            A small prospective study of 81 pregnancies describes 43 pregnant women treated for 10 days with doxycycline during early first trimester; all mothers reported their exposed infants were normal at 1 year of age

            There are no available data on risk of miscarriage following exposure to doxycycline in pregnancy; advise patient of potential risk to fetus if drug is used during pregnancy

            Based on findings from a fertility study in animals, doxycycline may impair female and male fertility; the reversibility of this finding is unclear

            Lactation

            Based on available published data, doxycycline is present in human milk; there are no data that inform about levels of doxycycline in breastmilk, effects on breastfed infant, or on milk production

            Short-term use by lactating women not necessarily contraindicated; effects of prolonged exposure to doxycycline in breast milk are unknown; because of potential for serious adverse reactions in nursing infants from drug, a decision should be made whether to discontinue nursing or to discontinue drug, taking into account importance of drug to mother

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria; may block dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

            Absorption

            Oral: Almost complete; reduced 20% by food or milk

            Peak serum time: 1.5-4 hr

            Bioavailability: Reduced at high pH

            Distribution

            Protein bound: 90%

            Metabolism

            Liver

            Elimination

            Half-life: 15-25 hr

            Excretion: Urine (23%); feces (30%)

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            Administration

            Oral Administration

            Absorption decreased when taken with food, particularly food containing calcium

            Doryx MPC, delayed-release tablet

            • Do not substitute on a mg-per-mg basis with other oral doxycyclines because of differing bioavailability
            • Do not chew or crush tablets
            • The recommended dosage, frequency of administration, and weight-based dosage recommendations differ from that of other doxycyclines; exceed the recommended dose may increase incidence of adverse effects
            • Administer with adequate amount of fluid to was down the drug and reduce risk of esophageal irritation/ulceration
            • Switching from Doryx to Doryx MPC
              • Doryx MPC 60 mg replaces Doryx 50 mg
              • Doryx MPC 120 mg replaces Doryx 100 mg

            IV Incompatibilities

            Additive: Meropenem (comp at 1 g/L mero and 200 mg/L doxy; incomp at 20 g/L and 200 mg/L doxy)

            Y-site: Allopurinol, heparin, piperacillin/tazobactam

            IV Compatibilities

            Solution: D5W, NS

            Additive: Ranitidine

            Syringe: Doxapram

            Y-site (partial list): Acyclovir, amiodarone, aztreonam, hydromorphone, linezolid, MgSO4, meperidine, meropenem (comp at 1 mg/mL mero and 1 mg/mL doxy; incomp at 50 mg/mL mero and 1 mg/mL doxy), morphine SO4, propofol, remifentanil

            IV Preparation

            For IV infusion dilute to a final concentration of 0.1-1 mg/mL w/ NS, D5W, LR, or D5/LR

            IV Administration

            Administer by slow IV infusion, usually over 1-2 hr

            Use central line if possible

            Avoid rapid administration

            Other parenteral routes not recommended

            Periodontal Preparation (Atridox)

            If refrigerated, remove Atridox from refrigeration at least 15 minutes prior to mixing

            Inject liquid contents of Syringe A (indicated by red stripe) into Syringe B (doxycycline powder) and then push the contents back into Syringe A

            Complete 100 mixing cycles at a pace of 1 cycle per second using brisk strokes

            Subgingival Administration (Atridox)

            Does not require local anesthesia for subgingival placement

            If desired, using an appropriate dental instrument, may be packed into the pocket

            Dipping the edge of the instrument in water before packing will help keep Atridox from sticking to the instrument, and will help speed coagulation of Atridox

            A few drops of water dripped onto the surface of Atridox once in the pocket will also aid in coagulation; if necessary, add more Atridox as described above and pack it into the pocket until the pocket is full

            Storage

            Tablets or capsules: Store at 20-25ºC (68-77ºF) excursions permitted to 15-30ºC (59-86ºF); protect from light and moisture; dispense in a tight, light-resistant container

            Atridox: Store at 2-30ºC (36-86ºF)

            Vibramycin (all formulations): Store <30ºC (86ºF) and dispensed in tight, light-resistant containers

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
            -
            50 mg capsule
            doxycycline monohydrate oral
            -
            150 mg tablet
            doxycycline monohydrate oral
            -
            75 mg tablet
            doxycycline monohydrate oral
            -
            40 mg capsule
            doxycycline monohydrate oral
            -
            75 mg capsule
            doxycycline monohydrate oral
            -
            150 mg tablet
            doxycycline monohydrate oral
            -
            100 mg tablet
            doxycycline monohydrate oral
            -
            75 mg tablet
            doxycycline monohydrate oral
            -
            100 mg tablet
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
            -
            75 mg capsule
            doxycycline monohydrate oral
            -
            150 mg capsule
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
            -
            50 mg capsule
            doxycycline monohydrate oral
            -
            75 mg capsule
            doxycycline monohydrate oral
            -
            50 mg capsule
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
            -
            100 mg tablet
            doxycycline monohydrate oral
            -
            150 mg capsule
            doxycycline monohydrate oral
            -
            25 mg/5 mL suspension
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
            -
            25 mg/5 mL suspension
            doxycycline monohydrate oral
            -
            50 mg tablet
            doxycycline monohydrate oral
            -
            50 mg tablet
            doxycycline monohydrate oral
            -
            75 mg tablet
            doxycycline monohydrate oral
            -
            50 mg tablet
            doxycycline monohydrate oral
            -
            100 mg tablet
            doxycycline monohydrate oral
            -
            150 mg tablet
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
            -
            100 mg capsule
            doxycycline monohydrate oral
            -
            50 mg capsule
            doxycycline monohydrate oral
            -
            100 mg tablet
            doxycycline monohydrate oral
            -
            100 mg tablet
            doxycycline monohydrate oral
            -
            25 mg/5 mL suspension
            doxycycline monohydrate oral
            -
            50 mg capsule
            doxycycline monohydrate oral
            -
            75 mg capsule
            doxycycline monohydrate oral
            -
            75 mg capsule
            Vibramycin oral
            -
            25 mg/5 mL suspension
            Vibramycin oral
            -
            100 mg capsule
            Vibramycin oral
            -
            50 mg/5 mL syrup
            Monodox oral
            -
            100 mg capsule
            Monodox oral
            -
            50 mg capsule
            Monodox oral
            -
            75 mg capsule
            Avidoxy oral
            -
            100 mg tablet
            Oracea oral
            -
            40 mg capsule
            Oracea oral
            -
            40 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            doxycycline monohydrate oral

            DOXYCYCLINE - ORAL

            (dox-ee-SYE-kleen)

            COMMON BRAND NAME(S): Acticlate, Monodox, Vibra-Tabs, Vibramycin

            USES: This medication is used to treat a wide variety of bacterial infections, including those that cause acne. This medication is also used to prevent malaria. This medication is known as a tetracycline antibiotic. It works by stopping the growth of bacteria.This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

            HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start taking doxycycline and each time you get a refill. If you have any questions, ask your doctor or pharmacist.This medication is best taken by mouth on an empty stomach, at least 1 hour before or 2 hours after a meal, usually 1 or 2 times daily or as directed by your doctor. Take this medication with a full glass of water (8 ounces/240 milliliters) unless directed otherwise. If stomach upset occurs, taking it with food or milk may help. However, doxycycline may not work as well if you take it with food or milk (or anything high in calcium - more details below ), so ask your doctor or pharmacist if you may take it that way. Do not lie down for at least 10 minutes after taking this medication.Take this medication 2 to 3 hours before or after taking any products containing aluminum, calcium, iron, magnesium, zinc, or bismuth subsalicylate. Some examples include antacids, didanosine solution, quinapril, vitamins/minerals, dairy products (such as milk, yogurt), and calcium-enriched juice. These products bind with doxycycline, preventing your body from fully absorbing the drug.When using to prevent malaria, this medication is usually taken once daily. Take the first dose of this medication 1 to 2 days before travel or as directed by your doctor. Continue to take this medication daily while in the malarious area. Upon returning home, you should keep taking this medication for 4 more weeks. If you are unable to finish this course of doxycycline, contact your doctor.If you are using the liquid form of this medication, shake the bottle well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition and response to treatment. For children, the dosage may also be based on weight.For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day.Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition persists or worsens.

            SIDE EFFECTS: Stomach upset, diarrhea, nausea, or vomiting may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: painful/difficult swallowing, signs of kidney problems (such as change in the amount of urine).Tetracycline drugs such as doxycycline may rarely cause a serious increase in pressure inside the skull (intracranial hypertension-IH). The risk of this side effect is greater for women of childbearing age who are overweight or who have had IH in the past. If IH develops, it usually goes away after doxycycline is stopped; however, there is a chance of permanent vision loss or blindness. Get medical help right away if you have: persistent/severe headache, vision changes (such as blurred/double vision, decreased vision, sudden blindness), persistent nausea/vomiting.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever that doesn't go away, new or worsening lymph node swelling, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: See also Side Effects section.Before taking doxycycline, tell your doctor or pharmacist if you are allergic to it; or to other tetracyclines (such as minocycline); or if you have any other allergies. This product may contain inactive ingredients (such as sulfites, soy found in some brands), which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: trouble swallowing, esophagus problems (such as hiatal hernia or reflux/heartburn).Doxycycline may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Before having surgery, tell your doctor or dentist that you are taking this medication.This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Children younger than 8 years may be more sensitive to the side effects of doxycycline, especially tooth discoloration. Tooth discoloration has also occurred in older children and young adults. Discuss the risks and benefits of this medication with the doctor.Tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while using doxycycline. Doxycycline may harm an unborn baby. If you become pregnant, talk to your doctor right away about the risks and benefits of this medication.This medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: retinoid medications taken by mouth (such as acitretin, isotretinoin), barbiturates (such as phenobarbital), "blood thinners" (such as warfarin), digoxin, anti-seizure medications (such as phenytoin), strontium.This medication may interfere with certain laboratory tests (including urine catecholamine levels), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Do not share this medication with others.If this medication is being used to prevent malaria, it is important to understand that it is still possible to get the disease even if you have used this medication. Avoid being bitten by mosquitoes when trying to prevent malaria. Avoid contact with mosquitoes, especially from dusk to dawn, by staying in well-screened areas, wearing protective clothing, and using insect repellent and bed nets.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.Laboratory and/or medical tests (such as complete blood count, liver/kidney function) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Taking outdated tetracycline-related drugs can result in serious illness. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.