What are the main differences between doxycycline monohydrate and hyclate. How do these antibiotics work to treat infections. What are the key uses and potential side effects of doxycycline formulations. When should doxycycline not be used.

Understanding Doxycycline: An Overview of Tetracycline Antibiotics

Doxycycline is a versatile antibiotic belonging to the tetracycline class of drugs. It plays a crucial role in treating various bacterial infections by inhibiting protein synthesis in bacteria, effectively halting their growth and reproduction. This mechanism of action classifies doxycycline as a bacteriostatic antibiotic.

Two common salt forms of doxycycline are available for medical use: doxycycline monohydrate and doxycycline hyclate. While both formulations contain the same active ingredient, they differ in their chemical structure and some properties. Understanding these differences can help healthcare providers choose the most appropriate form for specific patient needs.

Doxycycline Monohydrate: Properties and Applications

Doxycycline monohydrate, also known by the brand name Monodox, is characterized by its lower solubility compared to the hyclate form. This property can potentially lead to reduced gastrointestinal side effects, making it a preferable option for patients with sensitive stomachs.

Key features of doxycycline monohydrate:

• Less soluble salt form of doxycycline
• May cause fewer gastrointestinal side effects
• Available as oral capsules in various strengths
• Can be purchased as both brand-name and generic medications

Doxycycline monohydrate is effective against a wide range of bacterial infections, including:

1. Respiratory tract infections (pneumonia, chronic bronchitis)
2. Pelvic inflammatory disease
3. Urinary tract infections
4. Sexually transmitted infections (chlamydia, syphilis)
5. Traveler’s diarrhea
6. Malaria prevention and treatment
7. Less common infections like plague, melioidosis, and Q fever

Doxycycline Hyclate: Characteristics and Uses

Doxycycline hyclate, marketed under brand names such as Doryx and Vibramycin, is the more soluble salt form of doxycycline. This increased solubility can lead to faster absorption in the body but may also contribute to a higher incidence of gastrointestinal side effects in some patients.

Notable aspects of doxycycline hyclate:

• Higher solubility compared to the monohydrate form
• Traditionally less expensive than doxycycline monohydrate
• Available as oral capsules and other formulations
• Offered as both brand-name and generic medications

Doxycycline hyclate shares similar indications with its monohydrate counterpart, effectively treating various bacterial infections such as:

1. Respiratory tract infections
2. Urinary tract infections
3. Sexually transmitted infections
4. Skin infections
5. Dental infections
6. Malaria prophylaxis and treatment

Comparing Doxycycline Monohydrate and Hyclate: Similarities and Differences

While doxycycline monohydrate and hyclate share the same active ingredient and primary mechanism of action, several factors distinguish these two formulations:

Similarities:

• Both are tetracycline antibiotics
• Effective against a broad spectrum of gram-positive and gram-negative bacteria
• Work by inhibiting bacterial protein synthesis
• Used to treat similar types of infections
• Available as oral capsules in various strengths
• Require similar precautions and have comparable contraindications

Differences:

• Chemical structure: Monohydrate vs. hyclate salt form
• Solubility: Hyclate is more soluble than monohydrate
• Gastrointestinal tolerability: Monohydrate may cause fewer side effects
• Cost: Historically, hyclate has been less expensive

Despite these differences, both forms of doxycycline demonstrate comparable efficacy in treating bacterial infections when administered at equivalent doses.

Indications and Therapeutic Uses of Doxycycline

Doxycycline, in both its monohydrate and hyclate forms, is a versatile antibiotic used to treat a wide range of bacterial infections. Its broad-spectrum activity makes it an valuable tool in the medical arsenal against various pathogens.

Common indications for doxycycline include:

1. Respiratory tract infections: pneumonia, bronchitis, sinusitis
2. Skin and soft tissue infections: acne, rosacea, cellulitis
3. Sexually transmitted infections: chlamydia, syphilis, gonorrhea
4. Urinary tract infections
5. Gastrointestinal infections: traveler’s diarrhea, cholera
6. Lyme disease and other tick-borne illnesses
7. Malaria prophylaxis and treatment
8. Periodontal diseases
9. Anthrax
10. Certain ophthalmic infections

In addition to its antibacterial properties, doxycycline also exhibits anti-inflammatory effects, making it useful in managing certain inflammatory conditions such as rheumatoid arthritis and periodontal disease.

Mechanism of Action: How Doxycycline Fights Bacterial Infections

Understanding the mechanism of action of doxycycline helps explain its effectiveness against a wide range of bacterial pathogens. The drug works primarily by inhibiting bacterial protein synthesis, which is crucial for bacterial growth and reproduction.

Key steps in doxycycline’s mechanism of action:

1. Penetration: Doxycycline enters bacterial cells through passive diffusion and active transport mechanisms.
2. Binding: The drug binds to the 30S ribosomal subunit within the bacterial cell.
3. Inhibition: This binding prevents the attachment of aminoacyl-tRNA to the mRNA-ribosome complex.
4. Protein synthesis disruption: As a result, the bacteria cannot synthesize new proteins essential for their growth and survival.
5. Bacteriostatic effect: By halting protein synthesis, doxycycline prevents bacterial replication, effectively stopping the infection’s spread.

This mechanism of action makes doxycycline effective against both gram-positive and gram-negative bacteria, as well as some atypical pathogens like Mycoplasma and Chlamydia.

Side Effects and Precautions: What to Watch Out For

While doxycycline is generally well-tolerated, it can cause various side effects. Some of these effects may differ slightly between the monohydrate and hyclate forms due to their varying solubility and gastrointestinal absorption patterns.

Common side effects of doxycycline include:

• Gastrointestinal disturbances: nausea, vomiting, diarrhea
• Photosensitivity: increased sensitivity to sunlight
• Esophageal irritation
• Headache
• Vaginal yeast infections
• Tooth discoloration (particularly in children)

Precautions and contraindications:

1. Pregnancy: Doxycycline is contraindicated during pregnancy due to potential harm to the developing fetus.
2. Children: Not recommended for children under 8 years old due to the risk of permanent tooth discoloration.
3. Systemic lupus erythematosus (SLE): May exacerbate symptoms in some patients.
4. Porphyria: Can trigger acute attacks in individuals with this condition.
5. Hepatic impairment: Dose adjustments may be necessary for patients with liver disease.
6. Renal impairment: While doxycycline is generally safe in renal failure, monitoring is advised.

Patients should be advised to take doxycycline with plenty of water and to remain upright for at least 30 minutes after ingestion to prevent esophageal irritation.

Drug Interactions: Maximizing Safety and Efficacy

Doxycycline can interact with various medications and substances, potentially affecting its efficacy or increasing the risk of adverse effects. Healthcare providers must be aware of these interactions to ensure safe and effective treatment.

Common drug interactions with doxycycline:

• Antacids, iron supplements, and calcium supplements: Can reduce doxycycline absorption
• Oral contraceptives: May decrease the effectiveness of birth control pills
• Anticoagulants: Can increase the risk of bleeding
• Barbiturates, carbamazepine, and phenytoin: May decrease doxycycline levels in the blood
• Methoxyflurane: Increased risk of nephrotoxicity
• Isotretinoin: Potential for increased intracranial pressure

To minimize these interactions, it’s recommended to space out the administration of doxycycline and interacting substances. For example, take doxycycline at least 2 hours before or 6 hours after taking antacids or iron supplements.

Healthcare providers should conduct a thorough medication review before prescribing doxycycline and adjust treatment plans as necessary to avoid potential interactions.

Dosing and Administration: Optimizing Treatment Outcomes

Proper dosing and administration of doxycycline are crucial for achieving optimal therapeutic outcomes while minimizing the risk of side effects. The dosage may vary depending on the specific infection being treated, the patient’s age and weight, and other individual factors.

General dosing guidelines for adults:

• Typical dose: 100 mg every 12 hours on the first day, followed by 100 mg daily
• Severe infections: 100 mg every 12 hours
• Specific conditions (e.g., syphilis): May require higher doses or longer treatment duration

Administration tips:

1. Take doxycycline with a full glass of water to prevent esophageal irritation.
2. Remain upright for at least 30 minutes after taking the medication.
3. Can be taken with or without food, although food may help reduce stomach upset.
4. Avoid taking doxycycline with dairy products or calcium-fortified juices, as these can interfere with absorption.
5. If a dose is missed, take it as soon as remembered unless it’s close to the time for the next dose.

Healthcare providers should consider the patient’s specific circumstances, including renal and hepatic function, when determining the appropriate dosage and administration schedule.

By understanding the similarities and differences between doxycycline monohydrate and hyclate, as well as their proper use and potential side effects, healthcare providers can make informed decisions to optimize patient care in the treatment of bacterial infections.

Doxycycline Monohydrate vs Hyclate: Main Differences and Similarities

Doxycycline monohydrate and doxycycline hyclate both belong to the group of antibiotics called tetracyclines. They work by blocking protein synthesis which prevents the growth of bacteria. Therefore, these antibiotics are considered bacteriostatic. The only difference between doxycycline monohydrate and doxycycline hyclate is in their salt form. We’ll discuss their similarities and differences here.

Doxycycline Monohydrate

Doxycycline monohydrate (Monodox) is an antibiotic that belongs to the tetracycline group. It is used in the treatment of respiratory tract infection including pneumonia and chronic bronchitis, pelvic inflammatory disease, urinary tract infection, chlamydia, syphilis, mycoplasma, traveller’s diarrhea, cholera, malaria, plague, melioidosis, brucellosis, Q fever and other infections.

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Doxycycline monohydrate (What is Doxycycline Monohydrate?) is the less soluble salt form of doxycycline. Therefore, it may have less gastrointestinal side effects associated with it.

Doxycycline monohydrate can be purchased as a brand or generic drug. It is available as an oral capsule in varying strengths. Doxycycline monohydrate use is contraindicated in pregnancy, children, systemic lupus erythematosus (SLE), and porphyria.

Doxycycline Hyclate

Doxycycline hyclate (Doryx, Vibramycin) is an antibiotic that also belongs to the tetracyclines. It is used in treating a wide variety of infections including respiratory tract infection including pneumonia and chronic bronchitis, pelvic inflammatory disease, urinary tract infection, syphilis, chlamydia, mycoplasma, cholera, malaria, and other diseases.

Doxycycline hyclate (What is Doxycycline Hyclate?) is considered the more soluble salt form of doxycycline. It has also been the least expensive of the two salt forms.

Doxycycline hyclate can be purchased as a brand or generic drug and is usually taken as an oral capsule. Its use is contraindicated in pregnancy, children, porphyria, and systemic lupus erythematosus (SLE).

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Doxycycline Monohydrate vs Doxycycline Hyclate

Doxycycline monohydrate and doxycycline hyclate are similar drugs that differ only in their salt form. Their features can be found in the comparison table below.

Summary

Doxycycline monohydrate and doxycycline hyclate are antibiotics used in the treatment of a wide range of infections. Both forms of doxycycline are effective against a broad range of gram-negative and gram-positive bacteria. They work by preventing the growth of bacteria and blocking bacterial protein synthesis.

Doxycycline monohydrate and doxycycline hyclate differ only in their salt form- monohydrate and hyclate. Hyclate has greater solubility than monohydrate. However, the monohydrate form may be more tolerable. Regardless of their solubility differences, both forms are effective at treating infections.

Both forms of doxycycline should not bused in pregnant and breastfeeding women. It is also not advised to give doxycycline to children under 8 years of old.

Doxycycline monohydrate and doxycycline hyclate have significant interactions with other drugs and should not be administered with them.

The information provided here is meant for educational purpose and should be evaluated by your doctor to find the best treatment for you.

Doxycycline Hyclate – StatPearls – NCBI Bookshelf

Continuing Education Activity

Doxycycline hyclate is a medication used in the management and treatment of a variety of infections. It is in the tetracyclines class of drugs. This activity outlines the indications, action, and contraindications for doxycycline hyclate as a valuable agent in treating and managing skin, dental, respiratory, and urinary tract infections.

Objectives:

• Identify the mechanism of action and administration of doxycycline hyclate.

• Describe the adverse effects and contraindications of doxycycline hyclate.

• Review cases of doxycycline hyclate toxicity and describe the appropriate monitoring process.

• Explain the importance of improving care coordination amongst the interprofessional team to enhance the delivery of care for patients with doxycycline hyclate toxicity.

Access free multiple choice questions on this topic.

Indications

Doxycycline hyclate is a water-soluble tetracycline antibiotic that kills and prevents the growth of a wide range of gram-positive and -negative bacteria. It plays a role in managing and treating acne, malaria (for prophylaxis and treatment), skin infections, sexually transmitted infections (i.e., chlamydia, syphilis, gonorrhea, pelvic inflammatory disease) Lyme disease. Doxycycline hyclate is also effective for treating outbreaks such as cholera, mycoplasma, tularemia, typhus, and Rickettsia infections. [1] 

Several studies have also proven that tetracyclines, especially doxycycline, contain immunomodulating properties and can be used to control inflammation in diseases such as rheumatoid arthritis.[2] Tetracyclines, such as doxycycline, have shown effectiveness in treating acne vulgaris, rosacea, bullous dermatoses, granulomatous disease, and livedo vasculitis.[3]

Doxycycline hyclate has a specific indication for adult periodontal disease for its anti-collagenase and anti-matrix metalloproteinase activity in the gingival crevicular fluid. There is no evidence of changes or antibiotic susceptibility to normal periodontal flora or opportunistic pathogens.[4]

Mechanism of Action

Doxycycline hyclate works systemically in various tissues. Compared to other tetracyclines, its high lipophilicity allows doxycycline to cross multiple membranes to reach target molecules. Tetracyclines act as cationic coordination complexes to cross the OmpF and OmpC porin channels in gram-negative bacteria.  Similarly, in gram-positive bacteria, the electroneutral, lipophilic form traverses the cytoplasmic membrane. Uptake across the cytoplasmic membrane is energy-dependent and driven by the proton motive force.[5] 

The bacteriostatic action of tetracyclines, like doxycycline hyclate, is intended to stop the growth of bacteria by allosterically binding to the 30S prokaryotic ribosomal unit during protein synthesis.[5] Doxycycline hyclate prevents the association of the charged aminoacyl-tRNA (aa-tRNA) with the ribosomal A site to stall the elongation phase, yielding an unproductive cycle of protein synthesis. Doxycycline affects the binding rate of the ternary complex (comprised of elongation factor Tu (EF-Tu), GTP, and aa-tRNA) to the ribosome.[6] The ternary complex attempts to bind the aa-tRNA to the A site but fails to do so.[7] This process halts the translation of the growing polypeptide chain, impeding the production of essential proteins and eventually killing the bacteria.  

Tetracyclines, such as doxycycline hyclate, present immunomodulating properties that inhibit leukocyte movement during inflammation by preventing calcium-dependent microtubular assembly and lymphocytic proliferation. [4] Doxycycline initiates anti-inflammatory actions in diseases such as osteoarthritis by inhibition of nitric acid synthase.[8]  

Bacterial ribosomal protection proteins Tet(O) and Tet(M) employ a variety of resistance mechanisms that include efflux, enzymatic degradation, and rRNA mutations. Tet(O) prevents tetracyclines from attaching to the primary binding site. Tet(O) and Tet(M) displace tetracyclines from the ribosome and increases the disassociation constant, Kd, and allow the aa-tRNA to bind to the A site so protein synthesis can resume.[7]

Administration

Administration of Doxycycline Hyclate: 

Bacterial Infections

• For mild to moderate infections, Doxycycline hyclate should be taken in doses of 100 mg every 12 hours on the first day and then 100 mg/day onwards. For pelvic infections, the dose is 100 mg twice a day for one week.  

• The maximum dosage is 300 mg/day, except in the case of acute gonorrheal infection, which is often treated with 600 mg/day for five days.  

• The drug is best on an empty stomach at least 1 hour before or 2 hours after eating. Take medication with at least 8 ounces of water.  

• For optimal gastrointestinal absorption, the medication should be taken 2 to 3 hours before or after consuming any supplements or drugs with magnesium, zinc, calcium, aluminum, iron, or sodium bicarbonate.  

Anti-inflammation 

• Doxycycline hyclate can be taken at sub-acute doses of 40 mg daily for anti-inflammatory effects. The anti-microbial mechanism will not be in action at this sub-antimicrobial dose, sparing healthy bacteria and maintaining the body’s microbiome.  

Malaria Prevention

• Must be taken at 100 mg dose once daily for malaria prophylaxis. Highly recommended to be taken with an adequate amount of fluids and food. The first dose should be taken 1 to 2 days before traveling, and the regimen should continue while traveling in high-risk areas and four more weeks after returning.  Doxycycline hyclate should be used in conjunction with chloroquine.[9]

The course of prescribed doxycycline hyclate should be finished in its entirety, even if symptoms disappear sooner.  

Adverse Effects

Common Reactions 

• Mild diarrhea 

• Photosensitivity  

• Nausea  

• Vomiting 

• Skin rash/itching 

• Headaches 

• Tooth discoloration 

Doxycycline hyclate is a highly tolerated drug compared to its tetracycline counterparts and has limited evidence for causing serious adverse effects. The following are some of the rarely observed adverse events: 

Severe Adverse Effects

• Bloody diarrhea 

• Leukopenia

• Migraines 

• Hemolytic anemia 

• Throat irritation or trouble swallowing 

• Chest pain 

• Exacerbation of systemic lupus erythematosus  

• Shortness of breath 

• Irregular or fast heart rate 

• Dysuria  

• Intracranial hypertension 

• Esophagitis/esophageal ulcerations if taken without water 

Researchers described a Type I anaphylactic reaction with hypotension, bronchospasms, and urticaria in a patient who received intravenous doxycycline with a beta-blocker during general anesthesia. [10] They have also observed a unique case of fever, lymphadenopathy, nephritis, hepatitis, and severe pneumonitis with respiratory failure resulting from oral administration of doxycycline.[11]

In rare cases, Doxycycline hyclate has also reportedly caused Steven-Johnson Syndrome, potentially life-threatening mucocutaneous eruptions with a diffuse distribution of purpuric macules or targetoid lesions. Treatment usually entails hospitalization and supportive care for symptoms, with the administration of hydroxyzine hydrochloride, mupirocin ointment, and prednisone.[12]

Administration of doxycycline with warfarin has resulted in an enhanced anticoagulant effect due to the competitive interaction for albumin binding and potential inhibition of the cytochrome P-450 pathway.[13]

Contraindications

Absolute Contraindications

• Pregnancy or breastfeeding due to teratogenicity and permanent teeth discoloration after in utero exposure 

• Children under the age of 12 due to teeth discoloration 

• Allergy to tetracycline antibiotics 

• Use with penicillin or isotretinoin  

Relative Contraindications  

• Liver disease due to rare fatal hepatotoxicity 

• History of yeast infections 

• Recent colitis caused by antibiotic use 

• Kidney disease diarrhea from C.  Dificile 

• History of lupus (autoimmune) 

• Porphyria (a blood disease) 

• Myasthenia gravis 

Monitoring

Doxycycline hyclate has proven to have an effective therapeutic spectrum. Oral administration is most common, but delivery can also via an IV if necessary. An oral dose of 100 to 200 mg is absorbed rapidly. Data shows doxycycline was detectable in the blood as soon as 15 minutes after administration. It has a reported peak plasma concentration of 1.7 to 5.9 mg/mL after 2 to 3 hours and an elimination half-life of 15 to 30 hours.[14] Doxycycline hyclate metabolism mainly occurs in the duodenum.[15] Elimination primarily occurs through the gastrointestinal tract, but 30 to 40% occurs through renal excretion.[4] 

There are no standard routine tests to monitor the use of doxycycline. The most significant side effect is hepatic injury, which can be avoided by administering doxycycline hyclate at the recommended dosage and keeping contraindications and adverse effects in mind.   

Tetracyclines are contraindicated in pregnancy, lactation, and children under 12 due to proven human teratogenic effects, yet there is no evidence against doxycycline specifically.[1]

Toxicity

In rare instances, doxycycline has correlated with hepatic injury about 1 to 2 weeks after starting therapy. Hepatic injury can range from hepatocellular to cholestatic or mixed. There is often a quick onset with reported symptoms of DRESS syndrome, such as rash, fever, and eosinophilia.[16]

Acute doxycycline hepatitis was noted in a patient receiving treatment of pulmonary actinomycosis after 1.5 months of 200 mg/daily dose of doxycycline. Liver function tests showed markedly elevated ALT, AST, ALP, and GGT. Liver biopsy demonstrated centrilobular necrosis, indicative of toxic hepatitis.[17] A liver reaction with non-specific hepatitis appeared within 24 hours of oral doxycycline therapy in a patient with a suspected pneumonia infection. The diagnosis was confirmed with liver biopsy showing cholestasis and inflammation as well as increased liver enzymes (ALT, AST, ALP). [18] Rapid recovery is expected within 4 to 6 weeks after discontinuation of doxycycline hyclate and treatment with corticosteroids.[12]

Enhancing Healthcare Team Outcomes

Clinicians need to be more diligent when prescribing doxycycline to avoid a dangerous drug-resistant infection. Doxycycline hyclate therapy requires an interprofessional team approach, with clinicians, nurses, and pharmacists all collaborating to achieve optimal patient results. Since adverse effects are rare and varied in symptoms, it is crucial for those involved in the care of patients undergoing doxycycline hyclate therapy to understand the mechanism of action, dosing protocols, and signs of toxicity. If toxicity occurs, normal liver function should be confirmed with liver enzyme tests and biopsy, if required. The clinician and pharmacist are responsible for medication reconciliation to prevent drug-drug interactions. After the patient stabilizes, the healthcare team should determine the reason for toxicity and potentially report any new findings. Interprofessional care will result in better patient outcomes and fewer adverse events with doxycycline. [Level 5]

References

1.

Cross R, Ling C, Day NP, McGready R, Paris DH. Revisiting doxycycline in pregnancy and early childhood–time to rebuild its reputation? Expert Opin Drug Saf. 2016;15(3):367-82. [PMC free article: PMC4898140] [PubMed: 26680308]

2.

Sapadin AN, Fleischmajer R. Tetracyclines: nonantibiotic properties and their clinical implications. J Am Acad Dermatol. 2006 Feb;54(2):258-65. [PubMed: 16443056]

3.

Webster G, Del Rosso JQ. Anti-inflammatory activity of tetracyclines. Dermatol Clin. 2007 Apr;25(2):133-5, v. [PubMed: 17430750]

4.

Valentín S, Morales A, Sánchez JL, Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clin Cosmet Investig Dermatol. 2009 Aug 12;2:129-40. [PMC free article: PMC3047926] [PubMed: 21436975]

5.

Chopra I, Roberts M. Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance. Microbiol Mol Biol Rev. 2001 Jun;65(2):232-60 ; second page, table of contents. [PMC free article: PMC99026] [PubMed: 11381101]

6.

Brodersen DE, Clemons WM, Carter AP, Morgan-Warren RJ, Wimberly BT, Ramakrishnan V. The structural basis for the action of the antibiotics tetracycline, pactamycin, and hygromycin B on the 30S ribosomal subunit. Cell. 2000 Dec 22;103(7):1143-54. [PubMed: 11163189]

7.

Connell SR, Tracz DM, Nierhaus KH, Taylor DE. Ribosomal protection proteins and their mechanism of tetracycline resistance. Antimicrob Agents Chemother. 2003 Dec;47(12):3675-81. [PMC free article: PMC296194] [PubMed: 14638464]

8.

Chukwudi CU. rRNA Binding Sites and the Molecular Mechanism of Action of the Tetracyclines. Antimicrob Agents Chemother. 2016 Aug;60(8):4433-41. [PMC free article: PMC4958212] [PubMed: 27246781]

9.

Tan KR, Magill AJ, Parise ME, Arguin PM., Centers for Disease Control and Prevention. Doxycycline for malaria chemoprophylaxis and treatment: report from the CDC expert meeting on malaria chemoprophylaxis. Am J Trop Med Hyg. 2011 Apr;84(4):517-31. [PMC free article: PMC3062442] [PubMed: 21460003]

10.

Hamilton LA, Guarascio AJ. Tetracycline Allergy. Pharmacy (Basel). 2019 Aug 03;7(3) [PMC free article: PMC6789857] [PubMed: 31382572]

11.

Robles DT, Leonard JL, Compton N, Waghmare A, McDonough KA, George E, Wolgamot G, Fleckman P. Severe drug hypersensitivity reaction in a young woman treated with doxycycline. Dermatology. 2008;217(1):23-6. [PubMed: 18332631]

12.

Cac NN, Messingham MJ, Sniezek PJ, Walling HW. Stevens-Johnson syndrome induced by doxycycline. Cutis. 2007 Feb;79(2):119-22. [PubMed: 17388211]

13.

Hasan SA. Interaction of doxycycline and warfarin: an enhanced anticoagulant effect. Cornea. 2007 Jul;26(6):742-3. [PubMed: 17592328]

14.

Lucchetti J, Fracasso C, Balducci C, Passoni A, Forloni G, Salmona M, Gobbi M. Plasma and Brain Concentrations of Doxycycline after Single and Repeated Doses in Wild-Type and APP23 Mice. J Pharmacol Exp Ther. 2019 Jan;368(1):32-40. [PubMed: 30396916]

15.

Sloan B, Scheinfeld N. The use and safety of doxycycline hyclate and other second-generation tetracyclines. Expert Opin Drug Saf. 2008 Sep;7(5):571-7. [PubMed: 18759709]

16.

Mailhol C, Tremeau-Martinage C, Paul C, Godel A, Lamant L, Giordano-Labadie F. [Severe drug hypersensitivity reaction (DRESS syndrome) to doxycycline]. Ann Dermatol Venereol. 2010 Jan;137(1):40-3. [PubMed: 20110067]

17.

Chavant F, Lafay-Chebassier C, Beauchant M, Perault-Pochat MC. [Doxycycline induced hepatitis]. Gastroenterol Clin Biol. 2008 Oct;32(10):825-7. [PubMed: 18823729]

18.

Björnsson E, Lindberg J, Olsson R. Liver reactions to oral low-dose tetracyclines. Scand J Gastroenterol. 1997 Apr;32(4):390-5. [PubMed: 9140164]

Doxycycline Hyclate Uses,Images & Side effects

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turquoise, imprinted with AP 0814, AP 0814

Doxycycline 100 mg-MYL

round, yellow, imprinted with M, D23

doxycycline 150 mg 605054384

capsule, green, imprinted with APO, 150

Doxycycline 150 mg-MYL

round, orange, imprinted with M, D 24

Doxycycline 20 mg-IVA

round, white, imprinted with Logo 20, 4626

Doxycycline 50 mg Cap-MUT

capsule, turquoise/white, imprinted with MUTUAL 100, MUTUAL 100

Doxycycline 50 mg-EON

capsule, yellow, imprinted with E805, E805

Doxycycline 50 mg-MUT

turquoise/white, imprinted with AP 0837, AP 0837

Doxycycline 50 mg-MYL

round, yellow, imprinted with M, D21

doxycycline 75 mg 605054382

round, blue, imprinted with APO, D75

Doxycycline 75 mg-MYL

round, orange, imprinted with M, D22

Doxycycline Hyclate 100 mg 597623690

capsule, blue, imprinted with VIBRA, PFIZER 095

Doxycycline Hyclate 100 mg 690970226

capsule, blue, imprinted with 2985

Doxycycline Hyclate 100 mg 690970227

round, orange, imprinted with 3626

Doxycycline Hyclate 100 mg Tab-URL

round, orange, imprinted with MP 37

Doxycycline Hyclate 100 mg Tab-URL

round, peach, imprinted with MP 37

Doxycycline Hyclate 100 mg tab-WAT

round, orange, imprinted with 5553, DAN

Doxycycline hyclate 50 mg 721430211

round, beige, imprinted with B 311

Doxycycline Mono 100 mg 433860792

capsule, brown/yellow, imprinted with NL 792, 100 mg

Doxycycline Mono 100 mg 518620042

capsule, brown/yellow, imprinted with ML 042

Doxycycline Mono 100 mg 681800652

capsule, brown/yellow, imprinted with LU, M73

Doxycycline mono 100 mg 707101123

round, yellow, imprinted with 1123

Doxycycline Mono 50 mg 433860790

capsule, white/yellow, imprinted with NL 790, 50 mg

Doxycycline Mono 50 mg 518620040

capsule, white/yellow, imprinted with ML 040

Doxycycline mono 50 mg 707101121

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Doxycycline Mono 75 mg 433860791

capsule, brown/white, imprinted with NL 791, 75 mg

Doxycycline Mono 75 mg 518620041

capsule, brown/white, imprinted with ML 041

Doxycycline Mono 75 mg 681800651

capsule, brown/yellow, imprinted with LU M72

Doxycycline mono 75 mg 707101122

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Doxycycline monohydrate 150 mg 707101124

round, orange, imprinted with 1124

Monodox 100 mg

brown/yellow, imprinted with MONODOX 100, M 259

Periostat

white, imprinted with TM Periostat, 20 mg

Mycoplasmal Pneumonia Medication: Antibiotic Therapy

Doxycycline: antibiotic to treat bacterial infections

Your dose of doxycycline depends on why you are taking it.

The usual dose is 100mg to 200mg once or twice a day. If you’re taking doxycycline more than once a day, try to space your doses evenly throughout the day. If you take it twice a day, this could be first thing in the morning, and in the evening.

For preventing malaria, you’ll take 100mg once a day, usually in the morning. Start taking doxycycline 1 or 2 days before going to an area where there is malaria. Carry on for 4 weeks after leaving the area. Check with your doctor or pharmacist that doxycycline is the best medicine to prevent malaria in the country you are travelling to.

How to take it

Always swallow your doxycycline capsule whole and have it with a full glass of water (a medium sized glass – 200ml).

You can take this medicine with or without food. However you’re less likely to feel sick if you have it with food.

It’s important to take doxycycline while you’re in an upright position. You can be sitting, standing or walking. This will stop the medicine irritating your food pipe or stomach.

What if I forget to take it?

If you forget to take a dose, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember your medicines.

What if I take too much?

Accidentally taking an extra dose of doxycycline is unlikely to harm you.

Speak to your pharmacist or doctor if you’re worried or you take more than 1 extra dose.

Clinical Trial of Ivermectin Plus Doxycycline for the Treatment of Confirmed Covid-19 Infection – Full Text View

OBJECTIVES:

General objectives:

To observe the benefit (clinical and microbiological) of Ivermectin and Doxycycline in Confirmed Covid 19 cases.

Specific objectives:

1. To observe the clinical outcome in trial group and the placebo group.
2. To observe the duration require controlling viral replication (negative RT-PCR) in the trial and placebo group.
3. To compare the outcome between the two groups.

RATIONALE:

Covid-19 is an emergent pandemic, threatens the life of millions of the people throughout the globe. There is increasing effort of the scientist to unveil a remedy of covid-19. Still it is unsuccessful. At present there is no other alternative other than experimenting the existent drug against the virus. There are several trials going throughout the globe. Among them Ivermectin showed good efficacy in vitro trial. Some clinical trial also proved it beneficial. The Doxycycline also has some anti viral role with its prominent anti-inflammatory role. Synergistic action of the two drugs might be proved some benefit in clinical trial. As both drugs are cheap and less toxic, if it does, it would be the blessing for the poor people of the globe.

METHODOLOGY:

Study type: Interventional Clinical trial Estimated enrollment: 200 participants per group

For superior trial, the formula is:

N=size per group; p=the response rate of standard treatment group; p0= the response rate of new drug treatment group; zx= the standard normal deviate for a one or two sided x; d= the real difference between two treatment effect; δ0= a clinically acceptable margin; S2= Polled standard deviation of both comparison groups.

All parameters were assumed as follows: p =0.40; p0=0.58; α=0.05;β=0.20; δ=0.18; δ0=0.10.

However, we are assuming that lost to follow up or refuse to include in trial will be 20%, that means 24. So at least 150 patients will be allocated randomly and power of this study will be 80%.

Allocation: Randomized Intervention model: Parallel assignment Intervention model description: Patient will be randomized 1:1 to placaebo with standard care and combined doxycycline and ivermectin with standard care.

Blinding: Double blind (The participant and the clinicians/data collectors will be unaware of the treatment the participant receives) Primary purpose: Treatment Official title: A phase III trial to promote recovery from covid 19 with combined Doxycycline and Ivermectin along standard care. Provider of placebo and active ingredients: Popular pharmaceutical limited Dosage of the drugs: Ivermactin 6 mg 2 tab stat, cap Doxycycline 100 mg 1 cap BD 5 days

Data collection technique:

Data will be collected by assigned. trained data collectors (Physician). Patient will be enrolled according to defined inclusion and exclusion criteria in the current research. Informed written consent will be obtained from the patient or their relatives. Each patient participating in the trial will be uniquely identified, and information such as his name, address is recorded in the trial ‘subject number list’. Only the principle investigator will be aware about the allocation of the drugs. The patients and the data collectors will be unaware about the group allocation of the drugs. The Data will be reviewed by the co-investigators. It will be managed by principle and co-principle investigators in designated computer.

Clinical assessment (fever, cough, Anorexia, Temperature, pulse, blood pressure, respiratory rate, oxygen saturation) will be done every day. Routine investigation (CBC, ESR, CRP, Creatinine, RBS, SGPT, chest x-ray, D- Dimer) will be done at admission and at day 3, 5, 7, 10 and 14 day. In case of the clinical deterioration it would done according to necessity. RT-PCR will be done at day-0, Day 5, day 7 and day 14.

Standard care: both the experimental and placebo will receive the available standard of care, like-

• Paracetamol, Antihistamine, Cough suppressant, Vitamins
• Oxygen therapy according to indication and need
• Low molecular weight heparin according to indication
• Appropriate other broad spectrum antibiotics
• Other drugs for associated co- morbid condition

Management of the adverse events:

Drugs adverse effect will be monitored by a defined committee. The patient experiencing adverse effect of the drugs will be discontinued from the study. It will be managed with priority to the highest possible level by the hospital authority as well as the investigators.

If the patient progresses from mild to moderate or severe disease, the study will be continued and available management of the appropriate severity will be immediately started. The patient will be monitored closely.

Data analysis:

Data will be analyzed by computer with the help of SPSS (Statistical Package for Social Sciences) version 26. Unpaired t-test would be used for testing quantitative data and for testing qualitative data two sample z- test will be used. Comparing drug outcome in between two groups hazard ratio, Kaplan-Meire curve will be used.

Dropout management: Likelihood based methods such as mixed models will be used to estimate unbiased treatment effects, under assumptions regarding the missingness mechanisms.

Doxycycline: Uses, Interactions, Mechanism of Action

Doxivet 50% BT – water-soluble broad-spectrum antibacterial drug

  DOXIVET 50% BT  
water soluble powder
for oral use  

1 g contains 0.5 g of doxycycline hyclate, excipients, filler.

Instructions for use

The drug is prescribed:
The drug is intended for the treatment of cattle, pigs and birds with diseases, the causative agents of which are sensitive to doxycycline.
The drug is effective for animals and birds with diseases of: respiratory organs; gastrointestinal tract; genitourinary system; septicemia; colibacillosis, salmonellosis, streptococcosis, erysipelas; bacterial and enzootic pneumonia; chlamydia; MMA syndrome; mastitis; arthritis, pododermatitis and other diseases.

Spectrum:

Doxycycline has a broad spectrum of antibacterial action, is effective against most gram-negative (E.coli, Klebsiella spp., Salmonella spp., Proteus spp., Campylobacter spp., Pseudomonas aeruginosa, Bordetella spp., Pasteurella spp., Haemophilus spp., Actinobacillus spp., Brucella spp.) and Gram-positive bacteria (Stpp. spp., Listeria monocytogenes, Corynebacterium spp., Erysipelothrix suis, Clostridium spp.), mycoplasma, chlamydia, rickettsia and borrelia.

Proteus, Pseudomonas aeruginosa and fungi are not sensitive to the preparation.

Cattle: 15–20 mg (7.5–10 mg by ADV) per kg of body weight.

pigs: 20–40 mg (10–20 mg according to ADV) per kg of body weight or 200 g of the drug per 1000 l of drinking water.

poultry (broiler chickens, replacement laying hens, goslings): 20-40 mg (10-20 mg ADV) per kg of body weight or 200 g of the drug per 1000 l of drinking water.

During the treatment period, the bird should receive only water containing the drug.

Waiting period
Meat – 15 days.

Form of issue
Packages of metallized polyethylene film, 500 grams

Shelf life
2 years from the date of manufacture.

Storage conditions
Store in a dry, dark place at temperatures from + 5 ° C to + 25 ° C.

Medicine Information | Public services portal

In order to avoid the spread of coronavirus infection, you can pass free testing for coronavirus infection at the clinic at the place of attachment. For this you need:

1. Using the portal of public services of the Moscow region: https: // uslugi.mosreg.ru/zdrav/ go to your personal account (enter the number of your compulsory medical insurance policy and your date of birth) and make an appointment with a doctor, then select a convenient date and time for the test in the “Clinical laboratory diagnostics” tab.
2. If you do not have access to the Internet, you can call the Single number 8-800-550-50-30 and make an appointment by phone.
3. If you are not attached to the clinic, but you have a compulsory medical insurance policy issued in the Moscow region, use our service.Find the nearest test point on the map and sign up by phone.
4. Networks of commercial medical centers and laboratories are also available for you, use our service. Find the nearest test point on the map and sign up by phone.

Testing is carried out by the method of Polymerase chain reaction (PCR) .This is a high-precision method of molecular genetic diagnostics, which allows you to identify various infectious and diseases in a person, both in the acute stage and long before the disease can manifest itself.

A swab is taken from the nose and oropharynx.

Simple preparation required for research:

• Two hours before the test, it is recommended not to eat, drink or smoke.
• For 30 minutes, do not chew gum and suck candy, gargle, use a spray or nasal drops.

Networks of certified government and commercial medical organizations and laboratories are available for you, where you can get tested on a paid basis, use our service. Find the nearest point on the map and sign up by phone.

Appointment to doctors:

• renewed appointment to see physicians, pediatricians, surgeons, oncologists, obstetricians-gynecologists, dentists, psychiatrists-narcologists, psychiatrists, phthisiatricians, dermatovenerologists;
• appointments to narrow specialists: cardiologist, endocrinologist, neurologist – by referral from a general practitioner, pediatrician and general practitioner;
• It is possible to make an independent appointment with a narrow specialist if you are registered with him at the dispensary.

Temporarily suspended:

• preliminary, periodic preventive medical examinations;
• vaccine prophylaxis;
• planned prophylactic medical examination;
• hospitalization in day care hospitals.

IF you have a fever, cough and runny nose, you need to stay at home and call a doctor in one of the following ways:

1. Call 8-800-550-50-30;
2. Place a call on the public services portal;
3. Call an ambulance at 112.

Powder Pharmadox P (doxycycline hyclate-100 mg; tylosin tartrate-100 mg.) BioTestLab 1 kg, price 1740.84 UAH

Powder Pharmadox P (doxycycline hyclate-100 mg; tylosin tartrate- 100 mgab.) BioTestLab. 1 BioTestL

Ingredients:

1y. the preparation contains the active substance:

doxycycline hyclate-100 mg;

tylosin tartrate – 100 mg.

Excipients.

Pharmacological action:

PHARMADOX is a combined preparation containing doxycycline and tylosin.

Doxycycline – bacteriostatic antibiotic, belongs to the group of tetracyclines. Acts on the ribosomes of bacteria, interfering with protein synthesis. The drug has a wide spectrum of antimicrobial action against gram-positive and gram-negative bacteria (Staphylococcus spp., Diplococcus pneumonia, Streptococcusspp., Haemophilusinfluenza, E.coli, Pneumococci, Bacillusantracis, Clostridiumtetani, Clostridiumperfringes, Listeriamonocytogens, Actinomycesspp., Entirobacterspp., Klebsiellaspp., Salmonellaspp., Shigellaspp., Yersiniaspp.), and also mycoplasma.

Tylosin is an antibiotic of the macrolide group, active against gram-negative and gram-positive microorganisms (Staphylococcus spp., Streptococcus spp., Diplococcus spp., Corynebacterium spp., Clostridium spp., Erysipelothrixrhusiopathiae, Neisseriaspp., Bacteriodesnodosus, Moraxellabovis, Pasteurellaspp., Spirocheta spp.). Especially sensitive to tylosin are mycoplasmas (Mycoplasmagallisepticum, Mycoplasmahyopneumoniae, Mycoplasmasynoviae, Mycoplasmameleagridis, Mycoplasmaagalactiae, Mycoplasmabovigenitalium), as well as chlamydia (Chlamydia) and rickettsia (Rickettsppias).

The mechanism of action of tylosin is to block the synthesis of proteins in a bacterial cell by forming a complex with the 50S-subunits of ribosomes.The presence of feed in the alimentary canal does not significantly affect the absorption of PHARMADOX P.

Doxycycline – after oral administration, it is well absorbed in the alimentary canal and reaches its maximum concentration in the blood serum after 2 hours. Doxycycline penetrates well into the lungs, therefore it is effective in the treatment of respiratory infections.

Tylosin – after oral administration, it is well absorbed, penetrates into all internal organs and is maintained at a therapeutic level in the blood of animals and poultry for 6-8 hours.The maximum concentration in the blood is reached 30 minutes after feeding the drug. The bioavailability of tylosin is not affected by feed intake. Tylosin is excreted in the urine, bile and feces.

Application:

Calves, kids and lambs aged 4 to 8 weeks, pigs: treatment of animals for respiratory diseases (bronchopneumonia, enzootic pneumonia, atrophic rhinitis and others), digestive tract (colibacillosis, salmonellosis), septicemia.

Poultry (chickens, broilers, turkeys, replacement chickens) – treatment of poultry, with colibacillosis, salmonellosis, chlamydia, septicemia, as well as respiratory diseases.

For the treatment of animals, the drug is administered orally for 3-5 days at the rate of:
calves, lambs, kids – with feed, drinking water or milk at a dose of 1 g of the drug per 10 kg of body weight once a day; pigs – with feed or drinking water 1 g per 10 kg of body weight, once a day.Poultry – with food or drinking water 1 g per 10 kg of body weight, or 1 g per 1 liter of water.

Depending on the severity of the disease, the first dose of the drug can be doubled.

Prophylaxis: it is recommended to reduce the therapeutic dosage by 2 times. Duration – 3-5 days.

China Doxycycline Hyclate (24390-14-5) Manufacturers, Suppliers, Factory

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