Doxycycline-hyclate interactions to avoid

Key takeaways | Drug interactions | Other interactions | Avoiding interactions | When to see a doctor

Doxycycline hyclate is a member of a drug class called tetracycline antibiotics. Doxycycline hyclate is approved by the U.S. Food and Drug Administration (FDA) to treat various types of bacterial infections, such as urinary tract infections (UTIs), respiratory tract infections, sexually transmitted infections (such as chlamydia or gonorrhea), Lyme disease, anthrax, and others. Although doxycycline hyclate treats bacterial infections, it does not work for viral infections such as the common cold or flu. Doxycycline hyclate is commonly known by brand names such as Vibramycin, Doryx, Oracea, and Acticlate. It is available in several formulations, such as immediate-release tablets and capsules, delayed-release tablets and capsules, oral suspension (liquid), and by injection.

Common side effects of doxycycline hyclate include:

• Stomach problems like nausea, vomiting, and diarrhea
• Appetite loss
• Rectal itching
• Vaginal swelling, itching, irritation, or discharge
• Painful or difficult urination
• Sore throat
• Swelling of the tongue
• Dry mouth 
• Anxiety 
• Back pain
• Discoloration of the skin, nails, eyes, mouth, or scars

Serious adverse effects may include allergic reactions, skin reactions, increased pressure in the skull (pseudotumor cerebri), unusual bleeding or bruising, severe diarrhea, and others. 

Doxycycline hyclate interacts with various drugs, including the blood thinner warfarin, penicillin antibiotics, antacids, and others. For those who take doxycycline hyclate, it’s important to be aware of possible interactions that can affect the effectiveness of this antibiotic.

Key takeaways:

• Doxycycline hyclate is a generic antibiotic drug used to treat various bacterial infections. 
• Doxycycline hyclate interacts with various medications, such as warfarin, penicillin, antibiotics, and antacids. Interactions can affect how doxycycline hyclate works.
• Always tell your healthcare provider about your complete medical history, medication allergies, and all medicines taken, including prescription medications, OTC drugs, vitamins, and supplements.

Doxycycline hyclate drug interactions

Doxycycline hyclate interferes with prescription and over-the-counter medications, such as warfarin, penicillin antibiotics, certain antacids, and vitamins.

Jantoven (warfarin)

Blood thinners are prescription drugs that prevent blood clots from forming. Jantoven (warfarin) is an anticoagulant, a type of blood thinner that slows down the body’s process of making blood clots. 

Doxycycline interacts with warfarin, increasing the risk of bleeding. People who take warfarin may need to take a lower dose while taking doxycycline hyclate. The healthcare provider may recommend a dose decrease and increase the frequency of INR monitoring. The patient will also likely be asked to be alert to signs of bleeding, such as bleeding gums, blood in the stool, and bruising. 

Penicillin antibiotics

Penicillin antibiotics are a type of antibiotic used to treat various types of bacterial infections. Besides penicillin, some examples of other drugs in this class include Amoxil (amoxicillin) and Augmentin (amoxicillin and clavulanate). The interaction is only partially understood, but if given in combination, doxycycline hyclate can interfere with how well the penicillin antibiotic may work, making the penicillin antibiotic less effective. Generally, healthcare providers will not prescribe this combination of antibiotics. 

Barbiturates and certain other seizure medications

Certain seizure medications interact with doxycycline hyclate, such as phenobarbital (and other barbiturates), Tegretol (carbamazepine), and Dilantin (phenytoin). These medications increase the speed at which doxycycline is processed and eliminated by the body, possibly making it less effective. In patients who must take a combination of these medications, a higher doxycycline dose may be required, as well as close monitoring. 

Hormonal contraceptives 

If you use hormonal contraceptives (such as birth control pills, patches, vaginal rings, or injections), ask your healthcare provider if you should use an effective backup form of birth control (such as a condom) while taking doxycycline hyclate, and for some time after you finish the course of antibiotics. Doxycycline hyclate may make hormonal contraceptives less effective, increasing the risk of an unintended pregnancy. You can discuss effective forms of birth control with your healthcare provider.

Retinoids

Retinoids are vitamin-A-based medications used for acne. Examples of retinoids include topical products such as Retin-A (tretinoin) and Tazorac (tazarotene), as well as oral medications such as acitretin (used for severe psoriasis) and Accutane (isotretinoin, used for severe acne). These medications, like doxycycline hyclate, can cause increased pressure in the skull. The prescribing information for doxycycline hyclate states that a retinoid should never be taken with doxycycline hyclate. 

Drugs and vitamins that must be separated from doxycycline by several hours

Certain prescription and OTC products interfere with the absorption of doxycycline hyclate. Depending on the product, these medications/vitamins should be separated from doxycycline hyclate by several hours to avoid an interaction. Examples of interacting drugs include:

• Antacids that contain aluminum, calcium, or magnesium, such as Mylanta, Tums, or Milk of Magnesia
• Laxatives that contain magnesium
• Pepto-Bismol (bismuth subsalicylate)
• Iron or calcium supplements
• Carafate (sucralfate)
• Questran (cholestyramine) or Colestid (colestipol)
• Multivitamins that contain manganese or zinc

If you take any of the medications/vitamins listed above, ask your healthcare provider or pharmacist how to best time your doxycycline hyclate doses.

Other doxycycline hyclate interactions

In addition to drug-drug interactions, doxycycline hyclate also interacts with alcohol as well as certain medical conditions. 

Doxycycline hyclate and alcohol

Alcohol can decrease levels of doxycycline, making the medication less effective. Also, frequent drinking may affect the immune system, making it harder to recover from your infection. Additionally, alcohol can cause dehydration, making you experience symptoms like fatigue and headache. If you are not feeling well, this can make you feel even worse. When you are sick, it’s best to rest and drink plenty of fluids to stay hydrated and avoid alcohol. 

Doxycycline hyclate and the sun

Doxycycline hyclate can cause sun sensitivity. To minimize your risk:

• Stay out of the sun as much as possible, especially when the sun is strongest (between 10 a.m. and 4 p.m.)
• If you must be in the sun, use sunscreen and reapply frequently. Wear protective clothing and a hat. 
• Avoid sunlamps and tanning beds.

Doxycycline hyclate and certain medical conditions

Doxycycline hyclate is not safe for everyone to take and has some contraindications (situations where you should not take this medication), including if:

• You are allergic to doxycycline or any type of tetracycline medication (such as tetracycline or minocycline)
• You take or use a retinoid medication such as isotretinoin, acitretin, tretinoin, or tazarotene
• You are pregnant or breastfeeding

Also, doxycycline hydroxide should not be taken by anyone under 8 years of age because it could cause permanent tooth discoloration.

How to minimize doxycycline hyclate interactions

Although doxycycline hyclate has some potential interactions, it can still be taken safely with some precautions in many cases. 

Always consult your healthcare provider before beginning a new medicine. Before you start taking doxycycline hyclate, make your provider aware of all of your medical conditions, especially if you: 

• Are pregnant, trying to become pregnant, or breastfeeding 
• Have kidney or liver disease
• Are regularly exposed to long periods of sun
• Have had recent stomach surgery
• Have any conditions of the stomach or intestines
• Have vision problems
• Have a yeast infection of the mouth or vagina
• Have you ever had an allergic reaction to doxycycline or any type of tetracycline antibiotics

Tell your physician about all your medicines, including prescription and OTC drugs, vitamins, and dietary supplements. While taking doxycycline hyclate, do not start any new medication unless approved by your health care provider.

Your healthcare provider may need to change your medicine or adjust the dose of doxycycline hyclate (or another medicine) in the event of a potential drug interaction. 

Always take your medication as directed by your healthcare provider. Since doxycycline hyclate is an antibiotic, you should finish the full course of medication as prescribed. This will help clear the infection as well as prevent antibiotic resistance. Exceptions to this will be if your doctor tells you to stop taking this medicine or if you have an allergic or skin reaction, which could be life-threatening. Symptoms of an allergic reaction may include hives, difficulty breathing, or swelling of the face, lips, tongue, or throat. Symptoms of a skin reaction may include fever, sore throat, burning eyes, skin pain, rash, and blistering or peeling skin. If you have any of these symptoms, get emergency medical attention. 

When to talk to a healthcare provider about doxycycline hyclate interactions

This article provides an overview of various doxycycline hyclate interactions but is not a complete list of every potential interaction. Be sure to tell your healthcare professional about all your medical conditions and the medicines you take, including prescription medicines, over-the-counter drugs, vitamins, and supplements. This helps ensure proper management and monitoring of your condition. Also, while taking doxycycline hyclate, do not start any new medication unless approved by your healthcare provider.