Sexually transmitted diseases: for the treatment of diseases such as uncomplicated gonococcal infections (except for anorectal infections in men), uncomplicated urethral and endocervical infections, and rectal infections caused by Chlamydia trachomatis, non-gonococcal urethritis caused by Ureapumlasma, the recommended dose mg 2 times a day for 7 days.
For the treatment of acute epididymo-orchitis caused by Chlamydia trachomatis or Neisseria gonorrhea, the drug should be used 100 mg 2 times a day for 10 days.
For the treatment of primary and secondary syphilis, the recommended dose for patients without a confirmed pregnancy and with an allergy to penicillins is 200 mg orally 2 times a day for 2 weeks (as an alternative to penicillin therapy).
Epidemic relapsing fever, tick-borne relapsing fever: the recommended dose is 100-200 mg once, depending on the severity of the disease.
Chloroquine-resistant tropical malaria: The recommended dose is 200 mg / day for at least 7 days due to the potentially severe course of the infectious disease.
As an adjunct therapy to doxycycline, a fast-acting schizonticide (eg quinine) should always be used, the dose of which is different depending on the case, due to the potentially severe course of the infectious disease.
Prevention of malaria: The recommended dose for adults is 100 mg / day. For children over the age of 12, the recommended dose ranges from 2 mg / kg / day to a total dose of 100 mg / day. Prophylaxis can be started 1–2 days before traveling to an area with malaria. Prophylactic use of the drug should be continued every day while in the malaria region and for 4 weeks after leaving the malaria region. You should also take into account the current standards of treatment for malaria.
Prevention of Japanese river fever: The recommended dose is 200 mg once.
Prevention of traveler's diarrhea in adults: the recommended dose of the drug is 200 mg on the 1st day of travel (used in a single dose of 200 or 100 mg every 12 hours) and 100 mg / day during the next days of travel. There is no information on the use of the drug for more than 21 days for the purpose of prophylaxis.
Prevention of leptospirosis: the recommended dose is 200 mg once a week during the entire stay in the region with leptospirosis and 200 mg at the end of the trip. There is no information on the use of the drug for more than 21 days for the purpose of prophylaxis.
Use of the drug in elderly patients: the drug can be used in normal doses without special warnings. There is no need for dose adjustment in case of impaired renal function. Doxycycline may be the drug of choice for elderly patients because it is less associated with irritation and ulceration of the esophagus.
Use of the drug in patients with impaired renal function: the use of the drug in the recommended doses does not lead to the accumulation of the antibiotic in this category of patients (see SPECIAL INSTRUCTIONS).
Use of the drug in patients with impaired liver function: see SPECIAL INSTRUCTIONS.
Contraindications
- hypersensitivity to doxycycline, to any auxiliary substance of the drug or to other tetracyclines;
severe liver dysfunction;
During pregnancy and breastfeeding;
patients with allergic reactions to soy or peanuts should not use this medication.
Side effects
In patients receiving tetracycline, including doxycycline, the following adverse reactions were noted.
Infections and invasions: superinfection, which can cause candidiasis, glossitis, stomatitis, enterocolitis, pseudomembranous colitis (with increased growth of Clostridium difficile), acute inflammation of the vulva and vagina in women (vulvovaginitis), proctitis, itching in the anal area (anal itching) ...
From the hematopoietic and lymphatic system: blood coagulation disorders, decreased prothrombin activity, hemolytic anemia, leukopenia, leukocytosis, thrombocytopenia, anemia, lymphocytopenia, lymphadenopathy, the presence of atypical lymphocytes and toxic granulocyte granulocytes, neutropenia, eosinophilia.
Immune system disorders: photosensitization, hypersensitivity reactions (including anaphylactic shock, anaphylaxis, angioedema, dyspnoea, serum sickness, peripheral edema, tachycardia, urticaria), anaphylactoid reactions, anaphylactoid purpura, pseudo-anaphylactic reaction polymorphic exudative erythema, reversible local edema of the skin, mucous membrane or joints (angioedema), asthma, local exanthema of the genitals and other zones, malignant exudative erythema, facial edema, tongue edema, laryngeal edema with narrowing of the airways, tachycardia, arterial hypotension, which can progress to shock, severe skin reactions with general reactions (such as exfoliative dermatitis and Lyell's syndrome), pericarditis, exacerbation of systemic lupus erythematosus. Allergic reactions to soy proteins can occur.
Mental disorders: fear, anxiety, agitation, convulsions (reported a case of epileptic seizure after oral administration of doxycycline).
From the nervous system: headache, paresthesias, malignant intracranial hypertension (Pseudotumor cerebri), disappearing after stopping treatment and characterized by headache, nausea, vomiting, possible visual impairment (blurred vision, scotoma, diplopia, temporary loss of vision) due to edema of the optic nerve , hot flashes, reversible partial loss of olfactory and gustatory sensitivity, prolonged loss of vision. Bulging fontanelle in neonates and benign intracranial hypertension in children and adults have been reported with tetracyclines at full therapeutic doses.
On the part of the organ of hearing and vestibular apparatus: ringing in the ears, tinnitus, vertigo.
On the part of the cardiovascular system: tachycardia.
From the digestive tract: nausea, diarrhea, dyspepsia, heartburn, abdominal pain, discoloration of tooth enamel, vomiting, dysphagia, esophagitis, pancreatitis, villous tongue, blackening of the tongue, enamel hypoplasia, bloating, flatulence, steatorrhea, stomatitis, stomatitis dysphonia, difficulty swallowing, pseudomembranous enterocolitis, anorexia, irreversible discoloration of teeth and damage to enamel. If the doxycycline monohydrate tablet is improperly swallowed (for example, in the supine position), ulcers of the esophagus can occur, since the tablets adhere to the esophageal mucosa and powerful acids can be released locally by hydrolysis. Common symptoms of esophagitis and esophageal ulcers include odonophagia, chest pain, and dysphagia.
From the hepatobiliary system: hepatitis, jaundice, hepatic failure, hepatotoxicity with a temporary increase in liver function values.
On the part of the skin and subcutaneous tissue: exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, rash, including maculopapular and erythematous rashes, photosensitivity of the skin (redness, edema, blistering and skin discoloration), photoonycholysis can cause an allergic reaction nails (peeling and discoloration of nails), drug hypersensitivity syndrome with eosinophilia and systemic symptoms (DRESS).
Musculoskeletal and connective tissue disorders: myalgia, arthralgia.
From the kidneys and urinary tract: hematuria, interstitial nephritis, acute renal failure, anuria, increased blood urea levels. Metabolized tetracyclines caused a syndrome similar to Fanconi's syndrome, including albuminuria, aminoaciduria, hypophosphatemia, hypokalemia, and renal tubular acidosis.
Tetracyclines can cause nephrotoxicity or worsen previous kidney damage (characterized by elevated plasma creatinine and urea levels).
Other disorders: when using tetracyclines for a long time, microscopic staining of thyroid tissue in a brown-black color was noted. At the same time, no pathology of the thyroid gland was revealed.
Special instructions
Photosensitivity. cases of photosensitivity with clinical manifestations of a severe sunburn reaction can occur in patients using tetracycline drugs after exposure to direct sunlight or ultraviolet radiation. patients with the likelihood of being under direct sunlight or ultraviolet radiation should be informed about the development of these reactions when using tetracycline drugs with a recommendation to stop treatment at the first signs of erythema.
Patients with impaired liver function. Doxycycline should be used with caution in patients with impaired liver function, as well as those who are simultaneously using potentially hepatotoxic drugs. Liver function abnormalities occurring during both oral and parenteral administration of tetracyclines, including doxycycline, have been reported rarely. In case of prolonged use and in case of impaired liver function, the level of doxycycline in the blood plasma should be monitored and, if necessary, dose adjustment should be made.
Patients with impaired renal function. In patients with normal renal function, excretion of doxycycline by the kidneys is about 40% in 72 hours. This figure can decrease to 1–5% in 72 hours in patients with severe renal insufficiency (creatinine clearance 10 ml / min). The results of the study indicate that there is no significant difference in T½ of doxycycline from blood plasma in patients with normal renal function and in severe renal failure. Hemodialysis does not affect the T½ of doxycycline from blood plasma.
The anti-anabolic effect of tetracyclines can increase blood urea levels. Studies have shown that this anti-anabolic effect does not occur when doxycycline is used in patients with severe renal impairment.
Tetracyclines can cause nephrotoxicity or worsen existing kidney damage (characterized by elevated plasma creatinine and urea levels).
Increased microflora growth. The use of antibiotics in some cases can lead to an increase in the growth of insensitive microorganisms, including Candida.
Due to the increased resistance of many strains of groups of microorganisms, after isolation of the pathogen, it is necessary to check its sensitivity to the drug. In case of development of superinfection caused by resistant microorganisms, the antibiotic should be canceled and appropriate therapy should be prescribed.
Cases of pseudomembranous colitis have been reported with the use of almost all classes of antibacterial drugs, including doxycycline. The occurrence of pseudomembranous colitis has been reported in patients treated with antibacterial drugs, including doxycycline. The severity of the disease ranged from mild to life-threatening. It is important to consider the possibility of having this diagnosis in patients with diarrhea that is a consequence of antibiotic therapy.
With the use of antibacterial drugs, including doxycycline, the development of diarrhea associated with Clostridium difficile (CDAD), with a severity from mild to fatal colitis, has been reported. The use of antibacterial drugs affects the normal intestinal flora and leads to an increased growth of C. difficile.
C. difficile produces toxins A and B, which in turn cause CDAD.
Toxin-producing strains of C. difficile can increase morbidity and mortality because such infections are resistant to antibiotic therapy and may require colectomy. It is important to consider the possibility of having this diagnosis in patients with diarrhea that is a consequence of antibiotic therapy. A careful analysis of the anamnesis is necessary, since the development of CDAD was reported after 2 months after the end of antibiotic therapy.
Doxycycline can cause discoloration of teeth and enamel hypoplasia.
Esophagitis. It has been reported about the development of esophagitis and ulcers of the esophagus with the use of tetracyclines, including doxycycline, in the form of tablets and capsules. Most patients with such complaints used the drug immediately before bedtime or with insufficient fluid.
Porphyria. The development of porphyria in patients using tetracyclines has rarely been reported.
Venereal diseases. During treatment for sexually transmitted diseases, if a concomitant disease with syphilis is suspected, appropriate diagnostics should be carried out, including microscopic examination in a dark field. In such cases, serological tests should be performed monthly for at least 4 months.
Some patients with spirochete infections may develop a Jarisch-Herxheimer reaction soon after starting treatment with doxycycline. In this case, patients need to be explained that this reaction is a consequence of antibiotic therapy for infections caused by spirochetes, and usually goes away on its own.
Infections caused by β-hemolytic streptococcus. For infections caused by group A β-hemolytic streptococci, treatment should be carried out for at least 10 days.
Myasthenia gravis. Due to the possibility of a weak neuromuscular blockade, the drug should be used with caution in patients with myasthenia gravis.
Systemic lupus erythematosus. The use of tetracyclines can lead to an exacerbation of the course of systemic lupus erythematosus.
Methoxyflurane. Caution should be exercised when using methoxyflurane with tetracyclines.
Benign intracranial hypertension. Bulging fontanelle in newborns and benign intracranial hypertension in adolescents and adults have been reported with the drug at full therapeutic doses. The clinical manifestations of these disorders quickly disappeared after discontinuation of doxycycline.
Application during pregnancy or lactation. The drug is contraindicated for use during pregnancy. Doxycycline crosses the placental barrier. The risks associated with the use of tetracyclines during pregnancy are mainly due to their effect on tooth enamel and skeletal development.
The use of tetracyclines during the development of the teeth (during pregnancy) can cause a permanent discoloration of the teeth (yellow-brown-gray). Such an adverse reaction occurs more often with prolonged use, but is also possible with repeated short courses of treatment. There have also been reports of enamel hypoplasia.
Tetracyclines penetrate into breast milk, therefore, the use of the drug is contraindicated during breastfeeding.
Children. The drug is contraindicated in children under 12 years of age.
Like other tetracyclines, doxycycline forms stable calcium complexes in any tissue that forms bone. A decrease in the level of fibular growth was noted in premature infants who received oral tetracycline at a dose of 25 mg / kg every 6 hours. This adverse reaction is reversible when the drug is discontinued.
The use of tetracyclines during the development of the teeth (in children under 12 years of age) can cause permanent discoloration of the teeth (yellow-brown-gray). Such an adverse reaction occurs more often with prolonged use, but is also possible with repeated short courses of treatment. There have also been reports of enamel hypoplasia.
The ability to influence the reaction rate when driving or working with other mechanisms. The effect of doxycycline on the ability to drive vehicles or work with other mechanisms has not been studied. If you experience such undesirable reactions as arterial hypotension, ringing in the ears, blurred vision, scotoma, diplopia or long-term loss of vision, you should refrain from driving or working with other mechanisms.
Interactions
The absorption of doxycycline in the gastrointestinal tract can be reduced with the simultaneous use of antacids containing aluminum, calcium, magnesium, or other drugs and products containing these cations (for example, milk, dairy products and fruit juices containing calcium), with oral administration of zinc, preparations of iron salts or bismuth, activated carbon, or cholestyramine. the use of doxycycline together with such drugs should be maximally distributed over time.
Bacteriostatic drugs can affect the bactericidal effect of penicillin, therefore it is recommended to avoid the simultaneous use of doxycycline with penicillin.
There have been reports of prolongation of prothrombin time in patients taking anticoagulants (eg warfarin, phenprocoumon) and doxycycline. Tetracyclines reduce the activity of prothrombin in the blood plasma, therefore, with this combined use, blood coagulation parameters should be constantly monitored and, if necessary, the dose of anticoagulants should be reduced.
Rifampicin, by inducing substances of the class of barbiturates, as well as drugs with anticonvulsants such as carbamazepine, diphenylhydantoin and primidone, can accelerate the metabolism of doxycycline in the liver by inducing liver enzymes, resulting in the achievement of therapeutically effective concentrations of doxycycline in the blood when taken in a standard dose. impossible.
Alcohol can lower the T½ of doxycycline.
The drug may enhance the hypoglycemic effect of sulfonylurea derivatives. With this combined use, you should constantly monitor the level of glucose in the blood and, if necessary, reduce the dose of these drugs.
Doxycycline can increase the plasma concentration of cyclosporin A, increasing its toxic effect. In the case of the combined use of these drugs, careful monitoring is required.
Simultaneous use with methotrexate can lead to an increase in the toxicity of the latter.
The simultaneous use of doxycycline with β-lactam antibiotics (penicillins, cephalosporins) should be avoided, as this can lead to a decrease in their antibacterial effectiveness.
The combined use of methoxyflurane or other potentially nephrotoxic agents and doxycycline can cause potentially fatal nephrotoxicity side reactions.
When treating acne with isotretinoin, it is necessary to withstand a break after therapy with doxycycline, since both drugs in some cases can lead to a reversible increase in intracranial pressure.
The combined use of theophylline and doxycycline increases the risk of gastrointestinal side effects.
Doxycycline can lead to both an increase and a decrease in the level of lithium in the blood plasma when used simultaneously with lithium preparations.
In rare cases, the effectiveness of oral hormonal contraceptives may be reduced. Several cases of pregnancy and breakthrough bleeding have been reported with concomitant use of doxycycline and oral contraceptives. Therefore, it is recommended to use non-hormonal contraceptives.
Interaction with laboratory tests: the use of tetracyclines can lead to inaccurate laboratory test results when determining the level of glucose, protein, urobilinogen and catecholamines in urine.
Tetracycline can suppress the breakdown of ergot alkaloids in the liver (individual cases of ergotism are possible).
Because doxycycline contains magnesium, it can potentiate the effects of tubocurarine, succinylcholine, and other muscle relaxants.
Overdose
Acute antibiotic overdose is rarely noted. overdose can be manifested by damage to the renal parenchyma, the development of pancreatitis.
In case of an overdose, the drug should be discontinued, gastric lavage and supportive therapy should be performed.
In case of an overdose of oral doxycycline, it is possible to use antacids, magnesium or calcium salts to bind the unabsorbed part of the drug, since tetracycline can form chelate complexes with these substances that are not absorbed. Dialysis has almost no effect on T½ from blood plasma, so it is ineffective in overdose.
Storage conditions
At a temperature not exceeding 30 ° c.