Journal Club Compound Database

01Journal Club 02All Compounds

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Doxycycline Nursing Considerations & Implications | Bioavailable

Compound database
Tetracyclines
Doxycycline

DoxycyclineNursing considerations

Known brand names include Vibramycin, Doryx, Acticlate, Monodox, Adoxa, Oracea, Periostat, and Targadox.

A tetracycline antibiotic taken by mouth for many infections, including Rocky Mountain spotted fever and other tick-borne illnesses, chlamydia, some pneumonias, and anthrax exposure, and to prevent malaria. It can stain developing teeth, make skin burn easily in the sun, and irritate the esophagus, so it is taken with plenty of water and not right before lying down.

Nursing implications

Hold parameters

Stop at the first sign of skin redness from sun exposure
Stop immediately for a severe skin reaction
Get a prompt eye exam for any visual disturbance, which can signal intracranial hypertension
In children 8 and under, use only for severe or life-threatening infections such as anthrax or Rocky Mountain spotted fever
Evaluate for C. difficile with any diarrhea after treatment

Sources: [1][2]

Administration

Give with a full glass of fluid to wash it down, and avoid giving it right before bedtime
May be given with food or milk if it upsets the stomach; food barely changes absorption
Separate from antacids, calcium, magnesium, iron, and bismuth subsalicylate
Strep infections: continue for 10 days

Sources: [1]

Assess and report

Side effects by what to assess

GI

Anorexia, nausea, vomiting, diarrhea, glossitis
Esophagitis and esophageal ulceration, mostly with doses taken right before bed (serious)
C. difficile-associated diarrhea, up to 2 months after therapy (serious)

Skin and allergy

Photosensitivity with exaggerated sunburn
Severe skin reactions: exfoliative dermatitis, SJS, TEN, DRESS, fixed drug eruption (serious)

Infection

Vaginal candidiasis and other superinfections

Teeth

Permanent yellow-gray-brown tooth discoloration and enamel hypoplasia during tooth development (serious)

Neurologic

Intracranial hypertension: headache, blurred or double vision, possible permanent vision loss (serious)

Labs

Anaphylaxis, hemolytic anemia, thrombocytopenia, rare hepatotoxicity, rise in BUN (serious)

Sources: [1][2][3]

Labs and vitals

BUN (blood urea nitrogen)

Why: Dose-related rise in BUN from the antianabolic effect
When: Periodically during long-term therapy
Normal: 6 to 20 mg/dL.

Sources: [1][2][3]

INR (prothrombin time)

Why: Depressed prothrombin activity in patients on anticoagulants
When: When started in a patient on warfarin
Act on: The anticoagulant dose may need lowering
Normal: INR 0.8 to 1.1 when not on a blood thinner. On warfarin, the usual target is 2.0 to 3.0.

Sources: [1][2]

White blood cell count

Why: Hematologic effects with long-term therapy
When: Periodically during long-term therapy
Normal: 4,500 to 11,000 per microliter.

Sources: [1][2]

Safety

High-alert status

Doxycycline is not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Antidote or reversal

No specific antidote. For overdose, stop the drug and give symptomatic and supportive care; dialysis does not help.

Sources: [1]

Patient teaching

Take it with plenty of water, and do not take it just before lying down for bed
Avoid strong sun and tanning beds, and use sunscreen; stop and call if your skin burns or breaks out
Take antacids, calcium, magnesium, and iron at a different time than doxycycline
Finish the full course even if you feel better
Call your provider for watery or bloody diarrhea, even 2 months after the last dose
Report headache with blurred or double vision
For malaria prevention, start 1 to 2 days before travel, take it daily, continue 4 weeks after leaving, and still avoid mosquito bites

Sources: [1][2][3][4]

Sound-alike and look-alike names

None listed in the ISMP list of confused drug names.

Sources: [1]

Dosing

Doses come from the FDA label. Study tool, not for clinical decisions.

Adult dose

Usual adult dose: 200 mg on day 1 (100 mg every 12 hours), then 100 mg daily; 100 mg every 12 hours for more severe infections.
Chlamydia or nongonococcal urethritis: 100 mg twice daily for 7 days.
Inhalational anthrax, post-exposure: 100 mg twice daily for 60 days.
Malaria prophylaxis: 100 mg daily, from 1 to 2 days before travel until 4 weeks after leaving.

Sources: [1]

Renal adjustment

No adjustment; it does not accumulate in renal impairment, and the half-life is unchanged. Hemodialysis does not remove it.

Sources: [1][2]

Hepatic adjustment

No labeled dose change. Rare hepatotoxicity has been reported; check liver studies periodically with long-term therapy.

Sources: [1][2]

How it works

Mechanism

A bacteriostatic tetracycline that inhibits protein synthesis by binding the 30S ribosomal subunit, with a broad gram-positive and gram-negative spectrum plus rickettsiae, chlamydiae, mycoplasma, and spirochetes. Cross-resistance with other tetracyclines is common. It is nearly completely absorbed, has a half-life of about 18 to 22 hours, is not removed by hemodialysis, and does not accumulate in renal impairment.

Sources: [1][2][3]