Doxycycline: Action, Uses, Availability, Administration, Dosage, Side Effects and Nursing Considerations by Nurses Note

  Doxycycline 

PHARMACOTHERAPEUTIC: Tetracycline.

CLINICAL: Antibiotic.

Uses of Doxycycline 

Treatment of susceptible infections due to H. ducreyi, Pasteurella pestis, P. tularensis, Bacteroides spp., V. cholerae, Brucella spp., Rickettsiae, Y. pestis, Francisella tularensis, M. pneumoniae, including brucellosis, chlamydia,

cholera, granuloma inguinale, lymphogranuloma venereum, malaria prophylaxis,

nongonococcal urethritis, pelvic inflammatory disease (PID), plague, psittacosis,relapsing fever, rickettsia infections, primary and secondary syphilis, tularemia. 

(Oracea): Treatment of inflammatory lesions in adults with rosacea.

 OFF LABEL: Sclerosing agent for pleural effusion; vancomycin-resistant enterococci  (VRE); alternative for MRSA, treatment of refractory periodontitis, juvenile periodontitis. 

Precautions of Doxycycline 

Contraindications: Hypersensitivity to doxycycline, other tetracyclines.

Cautions: History or predisposition to oral candidiasis (Oracea). Avoid use during pregnancy, during tooth development in children. Avoid prolonged exposure to sunlight.

Action of Doxycycline 

Inhibits bacterial protein synthesis by binding to ribosomes.

Therapeutic Effect: Bacteriostatic.

Pharmacokinetics

Rapidly absorbed after PO administration. Protein binding: 90%. Partially excreted in urine; partially eliminated in bile. Half-life: 15–24 hrs.

Lifespan considerations

Pregnancy/Lactation: Crosses placenta; distributed in breast milk. 

Children: May cause permanent discoloration of teeth, enamel hypoplasia.

Elderly: No age-related precautions noted.

Interactions of Doxycycline 

DRUG: Antacids containing aluminum, calcium, magnesium; laxatives containing magnesium, oral iron preparations decrease absorption. Barbiturates, carBAMazepine, phenytoin may decrease concentration. Cholestyramine, colestipol may decrease absorption. May decrease effects of oral contraceptives. 

HERBAL: Dong quai, St. John’s wort may increase photosensitization. St. John’s wort may decrease concentration/effects.

FOOD: None known. LAB VALUES: May increase serum alkaline phosphatase, amylase, bilirubin, ALT, AST. May alter CBC. 

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Availability (Rx) of Doxycycline 

Capsules: 40 mg, 50 mg, 75 mg, 100 mg, 150 mg.

Injection, Powder for Reconstitution: 100 mg. Oral Suspension: 25 mg/5 mL.

Syrup: 50 mg/5 mL.

Tablets: 20 mg, 50 mg, 75 mg, 100 mg, 150 mg.

Tablets, delayed release: 50 mg, 75 mg, 100 mg, 150 mg, 200 mg.

Administration/handling of Doxycycline 

Do not administer IM or subcutaneous. Space doses evenly around clock.

IV

Reconstitution

• Reconstitute each 100-mg vial with 10 mL Sterile Water for Injection for concentration of 10 mg/mL.

• Further dilute each 100 mg with at least 100 mL D5W, 0.9% NaCl, lactated Ringer’s.

Rate of Administration

• Give by intermittent IV infusion (piggyback).

• Infuse over 1–4 hrs.

Storage

• After reconstitution, IV infusion (piggyback) is stable for 12 hrs at room

temperature or 72 hrs if refrigerated.

• Protect from direct sunlight. Discard if precipitate forms.

PO

• Oral suspension is stable for 2 wks at room temperature.

• Give with full glass of fluid.

• Instruct pt to sit up for 30 min after taking to reduce risk of esophageal irritation and ulceration.

• Give without regard to food. Oracea should be given 1 hr before or 2 hrs after meals.

• Avoid concurrent use of antacids, milk; separate by 2 hrs.

IV incompatibilities

Allopurinol (Aloprim), heparin, piperacillin/tazobactam (Zosyn).

IV Compatibilities

Acyclovir (Zovirax), amiodarone (Cordarone), dexmedetomidine (Precedex),

diltiaZEM (Cardizem), granisetron (Kytril), HYDROmorphone (Dilaudid),

magnesium sulfate, meperidine (Demerol), morphine, ondansetron (Zofran),

propofol (Diprivan).

Indications/routes/dosage of Doxycycline 

Usual Dosage

IV/PO: ADULTS, ELDERLY, CHILDREN OLDER THAN 8 YRS; WEIGHING MORE THAN 45 KG: 100–200 mg/day in 1–2 divided doses.

CHILDREN OLDER THAN 8 YRS; WEIGHING 45 KG OR LESS: 2–4 mg/kg/day (Maximum: 200 mg/day) in 1–2 divided doses.

Dosage in Renal/Hepatic Impairment: No dose adjustment.

Side effects of Doxycycline 

Frequent: Anorexia, nausea, vomiting, diarrhea, dysphagia, photosensitivity (may be severe). Occasional: Rash, urticaria.

Adverse effects/toxic reactions

Superinfection (esp. fungal), benign intracranial hypertension (headache, visual

changes) may occur. Hepatotoxicity, fatty degeneration of liver, pancreatitis

occur rarely.

Nursing considerations of Doxycycline 

Baseline assessment

Question for history of allergies, esp. to tetracyclines, sulfites.

Intervention/evaluation

Monitor daily pattern of bowel activity, stool consistency. Assess skin for rash.

Monitor LOC due to potential for increased intracranial pressure (ICP). Be alert

for superinfection: fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal

changes (ulceration, pain, erythema).

Patient/family teaching

• Avoid unnecessary exposure to sunlight.

• Do not take with antacids, iron products.

• Complete full course of therapy.

• After application of dental gel, avoid brushing teeth, flossing the treated areas

for 7 days.

• Report severe diarrhea.

• May cause nausea, vomiting. If GI upset occurs, may take with small amount

food; however, Oracea should be taken on an empty stomach.