Doxycycline hyclate pneumonia: Doxycycline Monohydrate vs Hyclate: Main Differences and Similarities
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 (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 (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.
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.
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.
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. 
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. Tetracyclines, such as doxycycline, have shown effectiveness in treating acne vulgaris, rosacea, bullous dermatoses, granulomatous disease, and livedo vasculitis.
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.
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.
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. 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. The ternary complex attempts to bind the aa-tRNA to the A site but fails to do so. 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.  Doxycycline initiates anti-inflammatory actions in diseases such as osteoarthritis by inhibition of nitric acid synthase.
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.
Administration of Doxycycline Hyclate:
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.
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.
- 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.
The course of prescribed doxycycline hyclate should be finished in its entirety, even if symptoms disappear sooner.
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
Throat irritation or trouble swallowing
Exacerbation of systemic lupus erythematosus
Shortness of breath
Irregular or fast heart rate
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.  They have also observed a unique case of fever, lymphadenopathy, nephritis, hepatitis, and severe pneumonitis with respiratory failure resulting from oral administration of doxycycline.
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.
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.
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
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)
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. Doxycycline hyclate metabolism mainly occurs in the duodenum. Elimination primarily occurs through the gastrointestinal tract, but 30 to 40% occurs through renal excretion.
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.
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.
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. 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).  Rapid recovery is expected within 4 to 6 weeks after discontinuation of doxycycline hyclate and treatment with corticosteroids.
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]
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Doxycycline Hyclate Uses,Images & Side effects
capsule, blue, imprinted with VIBRA, PFIZER 095
round, orange, imprinted with WW 112
capsule, blue/white, imprinted with Westward, 3141
capsule, blue, imprinted with Westward, 3142
capsule, blue, imprinted with West-ward 3142
oval, white, imprinted with A2 25
capsule, brown, imprinted with GLD, 40
capsule, blue/white, imprinted with Mylan 145, Mylan 145
round, white, imprinted with M, D 31
round, white, imprinted with M, D 32
round, yellow, imprinted with LCI, 1335
round, white, imprinted with LCI, 1336
oval, yellow, imprinted with LCI 1338
round, yellow, imprinted with LCI, 1535
round, yellow, imprinted with LCI, 1537
capsule, white, imprinted with WATSON 410, 50 mg
capsule, brown/white, imprinted with 100 mg, WATSON 411
capsule, blue, imprinted with DAN 5440, DAN 5440
capsule, blue/white, imprinted with DAN 5535, DAN 5535
round, orange, imprinted with 5553, DAN
round, orange, imprinted with WW 112
capsule, orange, imprinted with ADOXA, 150 mg
capsule, brown/white, imprinted with MONODOX 75, M 075
capsule, brown/yellow, imprinted with MONODOX 100, M 259
round, orange, imprinted with I61
round, peach, imprinted with I63
round, beige, imprinted with 312 B
capsule, white, imprinted with par 726, par 726
capsule, brown, imprinted with par 727, par 727
capsule, blue/white, imprinted with MUTUAL 100, MUTUAL 100
capsule, blue, imprinted with MUTUAL 105, MUTUAL 105
round, peach, imprinted with MP 37
round, white, imprinted with MP 573
round, orange, imprinted with WW 112
capsule, blue, imprinted with West-ward, 3142
capsule, blue/white, imprinted with 2984, 2984
oval, white, imprinted with D 0
oval, white/yellow specks, imprinted with D 5
Adoxa 100 mg
round, yellow, imprinted with B, 729
Adoxa 50 mg
round, yellow, imprinted with 728, B
Adoxa 75 mg
round, orange, imprinted with B, 730
Doryx 100 mg
oval, white/yellow specks, imprinted with D100
Doryx 75 mg
oval, white/yellow specks, imprinted with D75
Doxycycline 100 mg Cap-VER
capsule, blue, imprinted with Westward, 3142
Doxycycline 100 mg Cap-VER
capsule, turquoise, imprinted with Westward, 3142
Doxycycline 100 mg Tab-IVA
round, peach, imprinted with Z 3626
Doxycycline 100 mg-EON
capsule, brown, imprinted with E810, E810
Doxycycline 100 mg-MUT
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
round, yellow, imprinted with 1121
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
round, orange, imprinted with 1122
Doxycycline monohydrate 150 mg 707101124
round, orange, imprinted with 1124
Monodox 100 mg
brown/yellow, imprinted with MONODOX 100, M 259
white, imprinted with TM Periostat, 20 mg
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Mustafa MI, Al-Marzooq F, How SH, Kuan YC, Ng TH. The use of multiplex real-time PCR improves the detection of the bacterial etiology of community acquired pneumonia. Trop Biomed. 2011 Dec. 28(3):531-44. [Medline].
Di Marco E, Cangemi G, Filippetti M, Melioli G, Biassoni R. Development and clinical validation of a real-time PCR using a uni-molecular Scorpion-based probe for the detection of Mycoplasma pneumoniae in clinical isolates. New Microbiol. 2007 Oct. 30(4):415-21. [Medline].
Gullsby K, Storm M, Bondeson K. Simultaneous detection of Chlamydophila pneumoniae and Mycoplasma pneumoniae by use of molecular beacons in a duplex real-time PCR. J Clin Microbiol. 2008 Feb. 46(2):727-31. [Medline]. [Full Text].
Chen CJ, Hung MC, Kuo KL, Chung JL, Wu KG, Hwang BT, et al. The role of eosinophil cationic protein in patients with Mycoplasma pneumoniae infection. J Chin Med Assoc. 2008 Jan. 71(1):37-9. [Medline].
Llibre JM, Urban A, Garcia E, Carrasco MA, Murcia C. Bronchiolitis obliterans organizing pneumonia associated with acute Mycoplasma pneumoniae infection. Clin Infect Dis. 1997 Dec. 25(6):1340-2. [Medline].
Nagashima M, Higaki T, Satoh H, Nakano T. Cardiac thrombus associated with Mycoplasma pneumoniae infection. Interact Cardiovasc Thorac Surg. 2010 Dec. 11(6):849-51. [Medline].
Li CM, Gu L, Yin SJ, et al. Age-specific Mycoplasma pneumoniae pneumonia-associated myocardial damage in children. J Int Med Res. 2013 Oct. 41(5):1716-23. [Medline].
Daxboeck F. Mycoplasma pneumoniae central nervous system infections. Curr Opin Neurol. 2006 Aug. 19(4):374-8. [Medline].
Smith R, Eviatar L. Neurologic manifestations of Mycoplasma pneumoniae infections: diverse spectrum of diseases. A report of six cases and review of the literature. Clin Pediatr (Phila). 2000 Apr. 39(4):195-201. [Medline].
Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections: summary of cases at the University of Helsinki and review. Clin Infect Dis. 1993 Aug. 17 Suppl 1:S52-7. [Medline].
Luby JP. Pneumonia caused by Mycoplasma pneumoniae infection. Clin Chest Med. 1991 Jun. 12(2):237-44. [Medline].
Kurata M, Kano Y, Sato Y, Hirahara K, Shiohara T. Synergistic Effects of Mycoplasma pneumoniae Infection and Drug Reaction on the Development of Atypical Stevens-Johnson Syndrome in Adults. Acta Derm Venereol. 2016 Jan. 96 (1):111-3. [Medline]. [Full Text].
Kaler J, Mukhtar O, Khan B, Shrestha B, Kaler R, Ting B, et al. Rhabdomyolysis: An Unusual Presentation of Mycoplasma pneumoniae Infection in an Adult-A Case Report and Literature Review. Case Rep Med. 2018. 2018:6897975. [Medline].
Khan FY, Sayed H. Rhabdomyolysis associated with Mycoplasma pneumoniae pneumonia. Hong Kong Med J. 2012 Jun. 18(3):247-9. [Medline].
Oishi T, Narita M, Ohya H, et al. Rhabdomyolysis associated with antimicrobial drug-resistant Mycoplasma pneumoniae. Emerg Infect Dis. 2012 May. 18(5):849-51. [Medline]. [Full Text].
Moon HJ, Yang JK, In DH, Kwun DH, Jo HH, Chang SH. A Case of a 14-year-old Girl Who Developed Dermatomyositis Associated with Mycoplasma pneumonia Infection. Soonchunhyang Med Sci. December 2015. 21:130-33. [Full Text].
Liu EM, Janigian RH. Mycoplasma pneumoniae: the other masquerader. JAMA Ophthalmol. 2013 Feb. 131(2):251-3. [Medline].
Smith LG. Mycoplasma pneumonia and its complications. Infect Dis Clin North Am. 2010 Mar. 24(1):57-60. [Medline].
Biondi E, McCulloh R, Alverson B, Klein A, Dixon A. Treatment of mycoplasma pneumonia: a systematic review. Pediatrics. 2014 Jun. 133(6):1081-90. [Medline].
Colin AA, Yousef S, Forno E, Korppi M. Treatment of Mycoplasma pneumoniae in pediatric lower respiratory infection. Pediatrics. 2014 Jun. 133(6):1124-5. [Medline].
Cardinale F, Chironna M, Chinellato I, Principi N, Esposito S. Clinical relevance of Mycoplasma pneumoniae macrolide resistance in children. J Clin Microbiol. 2013 Feb. 51(2):723-4. [Medline]. [Full Text].
Kawai Y, Miyashita N, Kubo M, et al. Therapeutic efficacy of macrolides, minocycline, and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae pneumonia in pediatric patients. Antimicrob Agents Chemother. 2013 May. 57(5):2252-8. [Medline]. [Full Text].
Uh Y, Hong JH, Oh KJ, et al. Macrolide resistance of Mycoplasma pneumoniae and its detection rate by real-time PCR in primary and tertiary care hospitals. Ann Lab Med. 2013 Nov. 33(6):410-4. [Medline]. [Full Text].
Centers for Disease Control and Prevention. Antibiotic Treatment and Resistance. Available at https://www.cdc.gov/pneumonia/atypical/mycoplasma/hcp/antibiotic-treatment-resistance.html. April 13, 2018; Accessed: December 28, 2018.
Pereyre S, Goret J, Bébéar C. Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment. Front Microbiol. 2016. 7:974. [Medline].
Todd SR, Dahlgren FS, Traeger MS, Beltrán-Aguilar ED, Marianos DW, Hamilton C, et al. No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever. J Pediatr. 2015 May. 166 (5):1246-51. [Medline]. [Full Text].
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
To observe the benefit (clinical and microbiological) of Ivermectin and Doxycycline in Confirmed Covid 19 cases.
- To observe the clinical outcome in trial group and the placebo group.
- To observe the duration require controlling viral replication (negative RT-PCR) in the trial and placebo group.
- To compare the outcome between the two groups.
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.
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 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
Doxycycline is indicated for the treatment of various infections by gram-positive and gram-negative bacteria, aerobes and anaerobes, as well other types of bacteria. A complete list of organisms is available in the FDA label and in the “indications” section of this drug entry Label.
The following are some of the major infections that may be treated with doxycycline Label:
Rocky mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae
Respiratory tract infections caused by Mycoplasma pneumoniae
Lymphogranuloma venereum caused by Chlamydia trachomatis
Psittacosis (ornithosis) caused by Chlamydia psittaci
Trachoma caused by Chlamydia trachomatis, although the infectious agent is not always eliminated as judged by immunofluorescence
Inclusion conjunctivitis caused by Chlamydia trachomatis
Uncomplicated urethral, endocervical or rectal infections in adults caused by Chlamydia trachomatis
Nongonococcal urethritis caused by Ureaplasma urealyticum
Relapsing fever due to Borrelia recurrentis
A note regarding anti-microbial resistance
It is important to note that doxycycline is not the drug of choice in the treatment of any type of staphylococcal infection.
Up to 44 percent of strains of Streptococcus pyogenes and 74 percent of Streptococcus faecalis have been found to be resistant to tetracyclines. Therefore, tetracyclines such as doxycycline should not be used to treat streptococcal infections unless the microorganism has been demonstrated to be susceptible Label.
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The tetracyclines, including doxycycline, are mainly bacteriostatic and are thought to exert antimicrobial effects by the inhibition of protein synthesis. Bacteriostatic antibiotics suppress the growth of bacteria, or keep them in the stationary phase of growth 4. The tetracyclines, including doxycycline, have a similar antimicrobial spectrum of activity against a variety of gram-positive and gram-negative microorganisms, treating numerous infectious diseases. Cross-resistance of these microorganisms to tetracyclines is a common occurrence Label. Doxycycline shows favorable intra-cellular penetration, with bacteriostatic activity on a wide range of bacteria 5. Doxycycline has antiparasitic effects 2, 3, 4. In addition to the above effects, this drug has demonstrated anti-inflammatory actions, which may help to manage inflammatory conditions such as rosacea 6.
In bacterial replication, an interaction that is important for translation initiation of proteins occurs at the 3′ end of the 16S rRNA, found on the ribosome on the 30S subunit 12, 11, 13. The 30S subunit is the smaller subunit of the ribosome of prokaryotes, including bacteria17.
Tetracyclines such as doxycycline are thought to inhibit translation by binding to the 16S rRNA portion of the ribosome 9, preventing binding of tRNA to the RNA-30S bacterial ribosomal subunit, which is necessary for the delivery of amino acids for protein synthesis. As a result of the above actions, the initiation of protein synthesis by polyribosome formation is blocked. This stops the replication of bacteria and produces a bacteriostatic effect 15.
Tetracyclines, such as doxycycline, are readily absorbed and are bound to plasma proteins by varying degrees. Doxycycline is almost completely absorbed after oral administration. This drug is highly lipid soluble and has a low affinity for calcium binding Label. Absorption is not significantly affected by the concomitant ingestion of food or milk 15. Peak serum levels of approximately 2.6 mcg/ml are reached at 2 hours following a 200 mg tablet oral dose 15.
Doxycycline diffuses readily into most body tissues, fluid and/or cavities and the volume of distribution has been measured as 0.7 L/kg 15.
>90% Label, 16.
Doxycycline is metabolized in the liver and gastrointestinal tract and concentrated in bile Label, 16.
Major metabolic pathways of doxycycline have not been identified, however, enzyme inducers have been found to decrease the half-life of doxycycline 16.
Mainly the urine and feces as active and unchanged drug Label. Between 40% and 60% of an administered dose can be accounted for in the urine by 92 hours, and approximately 30% can be accounted for in the feces 16.
16.33 hr (± 4.53 sd) Label.
The excretion of doxycycline by the kidney is about 40% over 72 hours in individuals with normal kidney function (creatinine clearance approximately 75 mL/min). This rate may fall as low as 1-5% over 72 hours in individuals with severe renal insufficiency (creatinine clearance below 10 mL/min). Some clinical studies have shown no major difference in serum half-life of doxycycline (range 18-22 hours) in patients with normal and severely impaired renal function. Hemodialysis does not affect serum half-life of doxycycline Label.
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There are various precautions to be undertaken while doxycyline is administered 15. A full list of adverse events is included in the “Adverse Effects” section of this drug entry.
A note on tooth development and tetracycline use
The use of tetracyclines, including doxycycline, during tooth development (i.e. the last half of pregnancy, throughout infancy, and in childhood up to 8 years of age) may lead to tooth enamel hypoplasia and yellow-gray discoloration of teeth. It is advisable not to administer doxycycline in this age group according to the FDA label, except for in cases of post-exposure cases of anthrax (including inhalational anthrax) Label. Other sources state that doxycycline should not be administered in children under 12 years 15.
A note on Clostridium difficile
Clostridium difficile associated diarrhea (CDAD) and antibiotic associated pseudomembranous colitis may result from doxycycline use. Administering antibacterial agents changes the normal flora of the colon leading to an overgrowth of C. difficile. This bacteria produces toxins A and B, which contribute to the development of CDAD 15. in moderate to severe cases, therapy with a suitable oral antibacterial agent effective against Clostridium difficile should be considered. Fluids, electrolytes and protein replacement should be provided when warranted 15.
A note on gastrointestinal irritation
Gastrointestinal irritation may also occur. Rarely, esophagitis and esophageal ulcers have been reported in patients receiving doxycycline. Most of these patients took medication immediately before going to bed. Administration of appropriate amounts of fluid with the tablets is recommended to reduce the risk of esophageal irritation and ulceration, and late evening ingestion of the dose should be avoided 15. To decrease the risk of gastric irritation, it is recommended that doxycycline is taken with food or milk. The absorption of doxycycline is not significantly influenced by simultaneous ingestion of food or milk 15.
Results of animal research indicate that tetracyclines cross the placenta, are found in fetal tissues and exert toxic effects on the developing fetus, manifested by retardation of skeletal development. The importance of this in humans is not known, however, doxycycline should not be used in pregnant women unless the benefit significantly outweighs the risk 15.
In vivo studies conducted in rats and mice have not provided conclusive evidence that tetracyclines may be carcinogenic or that they affect fertility. In two mammalian cell lines, positive tests for mutagenicity occurred at concentrations of 60 and 10 mcg/ml respectively. In humans, no association between tetracyclines and these effects have been established 15.
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.
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.
Meat – 15 days.
Form of issue
Packages of metallized polyethylene film, 500 grams
2 years from the date of manufacture.
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:
- 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.
- 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.
- 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.
- 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.
- 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:
- Call 8-800-550-50-30;
- Place a call on the public services portal;
- 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
1y. the preparation contains the active substance:
doxycycline hyclate-100 mg;
tylosin tartrate – 100 mg.
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.
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.
902 Appearance 11
reaction with sulfuric acid, yellow color appears
2.0 ~ 3.0
at 349 nm (1%) 300 ~ 355
Specific optical rotation
GG lt; 20 ppm
Light absorbing impurities
@ 490nm ≤0.07