Vibramycin®

GoodRx

doxycycline · oral capsule

Antibiotic

Approved uses

Trachoma caused by Chlamydia trachomatis

Adults, 200 mg on day 1 given as 100 mg every 12 hours, then 100 mg daily

Inclusion conjunctivitis caused by Chlamydia trachomatis

Adults, 200 mg on day 1 given as 100 mg every 12 hours, then 100 mg daily

OFF-LABELNot in the FDA label for this product

Meibomian gland dysfunction

20 mg twice daily for 1 month

Cochrane · very low certainty

A randomized trial in 150 patients with chronic meibomian gland dysfunction refractory to lid hygiene compared 20 mg twice daily, 200 mg twice daily and placebo: both active arms beat placebo on tear break-up time, Schirmer score and symptom counts at 1 month with no significant difference between the two doses, while side effects were more frequent on the high dose (39.13% versus 17.39%, P=0.002). A 2021 Cochrane review of oral antibiotics for chronic blepharitis pooled this and one other trial (220 participants total) and graded the evidence very low certainty for both symptoms and clinical signs.

Yoo SE, Lee DC, Chang MH. The effect of low-dose doxycycline therapy in chronic meibomian gland dysfunction. Korean J Ophthalmol. 2005;19(4):258-263; Onghanseng N, Ng SM, Halim MS, Nguyen QD. Oral antibiotics for chronic blepharitis. Cochrane Database Syst Rev. 2021;6:CD013697 (10.1002/14651858.CD013697.pub2)

Ocular rosacea

100 mg daily for 16 weeks

RCT · n=39 · no placebo arm

A randomized trial of 39 patients with moderate to severe papulopustular rosacea compared this regimen against low-dose oral isotretinoin: ocular symptoms and meibomian gland dysfunction grading improved more in the doxycycline arm (P<0.05), while the other measured parameters, best corrected acuity, Schirmer, break-up time and rose bengal staining, did not reach statistical significance.

Andrade FMX, Picosse FR, Cunha LP, et al. Ocular surface changes in the treatment of rosacea: comparison between low-dose oral isotretinoin and doxycycline. Arq Bras Oftalmol. 2020;83(2):109-112

Recurrent corneal erosion syndrome

50 mg twice daily with topical fluorometholone 0.1% three times daily for at least 4 weeks

Retrospective series · n=21

A retrospective single-observer case series of 21 patients reported 15 of 21 (71%) symptom free at 8 weeks, with 15 of 18 (83%) and 11 of 15 (73%) denying relapse at 6 and 12 months. An earlier retrospective interventional series of 7 eyes used 50 mg twice daily for 2 months plus a topical corticosteroid and saw pain resolve and epithelial defects heal within 2 to 10 days, with no recurrence over a mean 21.9 months. No randomized trial exists for this indication.

Wang L, Tsang H, Coroneo M. Treatment of recurrent corneal erosion syndrome using the combination of oral doxycycline and topical corticosteroid. Clin Exp Ophthalmol. 2008;36(1):8-12; Dursun D, Kim MC, Solomon A, Pflugfelder SC. Am J Ophthalmol. 2001;132(1):8-13 (10.1016/s0002-9394(01)00913-8)

Contraindications

Hypersensitivity to any of the tetracyclines

Available Forms

50 mg and 100 mg capsules

Mechanism of Action

Inhibits bacterial protein synthesis by binding the 30S ribosomal subunit, and is bacteriostatic against a broad range of Gram-positive and Gram-negative bacteria including Chlamydia trachomatis. Ocular surface use rests instead on a non-antibacterial effect, a reduction in matrix metalloproteinase-9 amount and activity in human corneal epithelial cultures.

Warnings & Precautions

Intracranial hypertension: Headache, blurred vision, diplopia, vision loss and papilledema; risk is greater in women of childbearing age who are overweight or have a history of intracranial hypertension. Prompt ophthalmologic evaluation is warranted for visual disturbance during treatment, pressure can stay elevated for weeks after the drug is stopped, and permanent visual loss is possible.
Isotretinoin coadministration: Avoided because isotretinoin also causes pseudotumor cerebri.
Tooth discoloration: Permanent yellow-gray-brown staining and enamel hypoplasia when a tetracycline is used during tooth development, meaning the last half of pregnancy, infancy and childhood to age 8; reported after repeated short courses as well as long-term use.
Clostridioides difficile diarrhea: Ranges from mild diarrhea to fatal colitis and has been reported more than two months after the antibacterial was taken.
Severe skin reactions: Exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS; fixed drug eruptions can worsen on re-exposure, including generalized bullous forms. Discontinue immediately and treat.
Photosensitivity: Exaggerated sunburn reaction in some patients on tetracyclines; stop treatment at the first sign of skin erythema.
Skeletal effects: Tetracyclines form a stable calcium complex in any bone-forming tissue, and a reversible decrease in fibula growth rate occurred in premature infants given oral tetracycline.
Fetal risk: Animal studies show tetracyclines cross the placenta, reach fetal tissue and can be toxic to the developing fetus, often through retarded skeletal development.
BUN elevation: The antianabolic action of tetracyclines can raise BUN, though studies to date indicate this does not occur with doxycycline in patients with impaired renal function.

Common Side Effects

Ocular: Intracranial hypertension presents with blurred vision, diplopia and vision loss, with papilledema on fundoscopy; permanent visual loss is possible even though the syndrome usually resolves after the drug is stopped.
Gastrointestinal: Anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, pancreatitis and rare hepatotoxicity, though lower bowel effects including diarrhea have been infrequent given virtually complete oral absorption; esophagitis and esophageal ulceration occur mostly in patients who take the capsule immediately before lying down.
Skin: Photosensitivity with an exaggerated sunburn reaction, maculopapular and erythematous rash, fixed drug eruption, skin hyperpigmentation; toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme and uncommon exfoliative dermatitis reported.
Dental: Permanent discoloration and enamel hypoplasia when given during tooth development; superficial discoloration of adult permanent teeth reverses off drug with professional cleaning.
Immune: Urticaria, angioneurotic edema, anaphylaxis, anaphylactoid purpura, serum sickness, pericarditis, lupus exacerbation, DRESS, and Jarisch-Herxheimer reaction when spirochete infection is treated.
Hematologic: Hemolytic anemia, thrombocytopenia, neutropenia, eosinophilia.
Psychiatric: Depression, anxiety, suicidal ideation, insomnia, abnormal dreams, hallucination.
Renal: Rise in BUN, apparently dose related.

Pregnancy & Lactation

Absorption interference: Antacids containing aluminum, calcium or magnesium, iron-containing preparations and bismuth subsalicylate all impair tetracycline absorption.

Enzyme inducers: Barbiturates, carbamazepine, phenytoin and rifampin shorten the half-life and lower drug concentrations.

Anticoagulant potentiation: Tetracyclines depress plasma prothrombin activity, so anticoagulant doses may need to be reduced.

Penicillin antagonism: Bacteriostatic drugs may interfere with the bactericidal action of penicillin, so concurrent use is not advised.

Oral contraceptive failure: Concurrent tetracycline may render oral contraceptives less effective.

Superinfection: Overgrowth of nonsusceptible organisms including fungi, and an increased incidence of vaginal candidiasis.

Pregnancy: A TERIS expert review concluded therapeutic doses are unlikely to pose a substantial teratogenic risk, on data graded limited to fair, but insufficient to state there is no risk; a case-control study showed a weak, marginally significant association with total malformations that was not seen when analysis was confined to organogenesis, except for a marginal relationship with neural tube defect based on only two exposed cases. Tetracyclines cross the placenta and cause permanent tooth staining when used in the last half of pregnancy.

Lactation: Excreted in human milk, with the extent of infant absorption unknown. Short-term use by a lactating woman is not necessarily contraindicated, but the effects of prolonged exposure through milk are unknown.

Pediatric Use

Reserved for patients over 8 years; at 8 years or less use only for severe or life-threatening infection when no alternative exists.