doxycycline

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using doxycycline and call your doctor at once if you have any of these serious side effects: severe headache, dizziness, blurred vision; fever, chills, body aches, flu symptoms; severe blistering, peeling, and red skin rash; urinating less than usual or not at all; pale or yellowed skin, dark colored urine, fever, confusion or weakness; severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate; loss of appetite, jaundice (yellowing of the skin or eyes); or easy bruising or bleeding, unusual weakness. Less serious side effects may include: swollen tongue, trouble swallowing; mild nausea, vomiting, diarrhea, or stomach upset; white patches or sores inside your mouth or on your lips; sores or swelling in your rectal or genital area; or vaginal itching or discharge. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Nervous system side effects have included phrenic nerve paralysis after sclerotherapy, and intracranial hypertension (pseudotumor cerebri). Headache, dizziness, drowsiness, and amnesia have also been reported.

Intracranial hypertension resulting in significant loss of vision has been reported. A 70-year-old female patient with no significant medical history suddenly developed a severe headache followed by vomiting about 15 minutes after the initial dose of doxycycline. The patient also experienced memory dysfunction; she could not remember the events of the afternoon prior to the doxycycline dose and could not retain the information after she was reminded. The incident lasted about 30 minutes and she was transported to the hospital for further evaluation. No further cause, such as intoxication or trauma, could be elicited. Once at the hospital, the patient was able to remember the events of the afternoon and could retain new information, but amnesia regarding the events of the 30 minutes following the onset of the headache persisted. The patient's laboratory results, CT scan, MRI scan, cerebrospinal fluid, and EEG showed no pathology. When the patient was discharged 2 days later, the amnesia for the 30 minutes continued. After elimination of other symptomatic causes, the amnesia was concluded to be due to the doxycycline because of the close relation of the doxycycline dose and the onset of symptoms.

Ocular side effects have included diplopia, papilledema, and loss of vision associated with doxycycline-induced intracranial hypertension.

Doxycycline, like other tetracycline-class antibiotics, can cause fetal harm when administered to a pregnant woman. If any tetracycline is used during pregnancy or if the patient becomes pregnant while taking these drugs, the patient should be informed of the potential hazard to the fetus and treatment stopped immediately. Tetracyclines should not be used in this age group, except for anthrax, including inhalational anthrax (post-exposure) unless other drugs are not likely to be effective or are contraindicated.

Tetracycline class antibiotics are known to cause hyperpigmentation. Tetracycline therapy may induce hyperpigmentation in many organs, including nails, bone, skin, eyes, thyroid visceral tissue, oral cavity (teeth, mucosa, alveolar bone), sclerae and heart valves. Skin and oral pigmentation has been reported to occur independently of time or amount of drug administration, whereas other pigmentation has been reported to occur upon prolonged administration. Skin pigmentation includes diffuse pigmentation as well as over sites of scars or injury.

Hepatic side effects have included individual reports of acute hepatocellular injury and cholestatic reactions associated with low-dose oral doxycycline.

1. Oesophagitis and oesophageal ulceration following ingestion of doxycycline tablets. Geschwind A Med J Aust 1984;140:223.
2. Clinical challenges and images in GI. Pill esophagitis. Grochenig HP, Tilg H, Vogetseder W Gastroenterology 2006;131:996, 1365.
3. Short report: severe hiccups secondary to doxycycline-induced esophagitis during treatment of malaria. Tzianetas I, Habal F, Keystone JS Am J Trop Med Hyg 1996;54:203-4.
4. Delayed microbial cure of lymphogranuloma venereum proctitis with doxycycline treatment. de Vries HJ, Smelov V, Middelburg JG, Pleijster J, Speksnijder AG, Morre SA Clin Infect Dis 2009;48:e53-6.
5. Clinical practice. Early Lyme disease. Wormser GP N Engl J Med 2006;354:2794-801.
6. Doxycycline tolerance study: incidence of nausea after doxycycline administration to healthy volunteers: a comparison of 2 formulations (Doryx' vs vibramycin'). Story MJ, McCloud PI, Boehm G Eur J Clin Pharmacol 1991;40:419-21.
7. Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis. Golledge CL, Riley TV Lancet 1995;345:1377-8.
8. Images in clinical medicine. Lingua villosa nigra. Ramsakal A, Mangat L N Engl J Med 2007;357:2388.
9. Clinical practice. Malaria prevention in short-term travelers. Freedman DO N Engl J Med 2008;359:603-12.
10. Efficacy of Gentamicin plus Doxycycline versus Streptomycin plus Doxycycline in the Treatment of Brucellosis in Humans. Hasanjani Roushan MR, Mohraz M, Hajiahmadi M, Ramzani A, Valayati AA Clin Infect Dis 2006;42:1075-80.
11. Product Information. Periostat (doxycycline) Anonymous Collagenex Pharmaceuticals, Newtown, PA. PROD;
12. Product Information. Adoxa (doxycycline). Anonymous Doak Dermatologics Division, Fairfield, NJ.
13. Low-Dose Doxycycline (Oracea) for Rosacea. Med Lett Drugs Ther 2007;49:5-6.
14. Product Information. Oracea (doxycycline). Anonymous Collagenex Pharmaceuticals, Newtown, PA.
15. Postexposure treatment with doxycycline for the prevention of tick-borne relapsing fever. Hasin T, Davidovitch N, Cohen R, et al. N Engl J Med 2006;355:148-55.
16. Doxycycline-induced oesophageal ulceration. Adverse Drug Reactions Advisory Committee Med J Aust 1994;161:490.
17. Doxycycline for the prevention of tick-borne relapsing fever. Croft AM, Jackson CJ, Darbyshire AH N Engl J Med 2006;355:1614; author reply 1614-5.
18. Doxycyline-induced esophageal ulceration. Foster JA, Sylvia LM Ann Pharmacother 1994;28:1185-7.
19. Safety of doxycycline and minocycline: a systematic review. Smith K, Leyden JJ Clin Ther 2005;27:1329-42.
20. Product Information. Vibramycin (doxycycline). Anonymous Pfizer US Pharmaceuticals, New York, NY. PROD;
21. Doxycycline-induced staining of adult teeth: the first reported case. Nelson R, Parker SR Arch Dermatol 2006;142:1081-2.
22. Oesophageal ulceration associated with ingestion of doxycycline. Aarons B, Bruns BJ N Z Med J 1980;91:27.
23. Two randomized phase III clinical trials evaluating anti-inflammatory dose doxycycline (40-mg doxycycline, USP capsules) administered once daily for treatment of rosacea. Del Rosso JQ, Webster GF, Jackson M, et al. J Am Acad Dermatol 2007;56:791-802.
24. Doxycycline-induced amnesia : a case report. Heveling T, Kubalek R Eur J Clin Pharmacol 2006;63:95-6.
25. Comparison of efficacy of azithromycin vs. doxycycline in the treatment of rosacea: a randomized open clinical trial. Akhyani M, Ehsani AH, Ghiasi M, Jafari AK Int J Dermatol 2008;47:284-8.
26. Doxycycline-induced esophagitis. Amendola MA, Spera TD JAMA 1985;253:1009-11.
27. Doxycycline-induced pseudotumor cerebri. Tabibian JH, Gutierrez MA South Med J 2009;102:310-1.