Antibiotics

Doxycycline (Doxy) Interactions

Doxycycline Drug Interactions

Antacids (containing aluminum, calcium, or magnesium), calcium or magnesium supplements, products containing iron or zinc can decrease doxycycline absorption. Separate by 1 to 2 hours.
Antiepileptics: the serum levels of doxycycline are reduced in persons on long-term treatment with barbiturates, phenytoin or carbamazepine. As a result doxycycline may be less effective 2. To adapt this potential problem it has been suggested that the doxycycline dose could be doubled 3.
Retinoic acid derivatives - doxycycline may enhance the toxic effect of retinoic acid derivatives. The development of pseudotumor cerebri or benign intracranial hypertension is of particular concern.
Warfarin: Doxycycline can enhance the anticoagulant effect of warfarin5. Concomitant use of doxycycline and warfarin may result in severe bleeding.

Can you take Doxycycline and Prednisone together?

There are no interactions between doxycycline and prednisone. These medications can be used safely at the same time.

Can you take Doxycycline and Rifampicin (Rifampin) together?

The combination of doxycycline plus rifampin has been used in clinical practice. However, rifampicin may cause a significant reduction in doxycycline levels, which can led to treatment failure4.

Can you take Doxycycline with Metronidazole (Flagyl®)?

Yes. The combination of doxycycline and metronidazole has been recommended as a treatment choice for pelvic inflammatory disease6.

However, the combination of doxycycline and metronidazole increases the gastrointestinal and vaginal colonization by Candida organisms7. In other words, despite the lack of drug interaction, this combo increases the chance of getting yeast infections.

Oral doxycycline can be used along with metronidazole topical gel (MetroGel®) 11.

Can you take Doxycycline with Ciprofloxacin (Cipro®) or Levofloxacin (Levaquin®)?

There are no contraindications on the concomitant use of doxycycline with fluoroquinolone antibiotics (e.g. ciprofloxacin, levofloxacin, moxifloxacin)8.

Can you take Doxycycline and co-trimoxazole (Bactrim®) together?

Yes. Doxycycline can be taken with co-trimoxazole at the same time9.

Can you take Doxycycline with Ibuprofen, Naproxen, or any other NSAID?

Yes. Doxycycline can be taken in combination with ibuprofen10 and other NSAIDs12.

Can you take Doxycycline with food or dairy products?

While food and milk may decrease gastrointestinal absorption of doxycycline by up to 20%, you can take doxycycline with food to avoid gastric irritation.

Orange juice and coffee do not interact with doxycycline.

Doxycycline during Pregnancy & Lactation

Pregnancy Risk Factor: D

Exposure to doxycycline during the second or third trimester may cause permanent yellow-gray-brown discoloration of the teeth. Most reports do not show substantial teratogenic risk with the exception of a potential small increased risk for cleft palate or esophageal stenosis.

According to CDC, doxycycline may be warranted in pregnant women with life-threatening illness when suspicion of ehrlichiosis or RMSF is high.

Breast-Feeding: Only minimal amounts of doxycycline are excreted in human milk and the relative amount of tooth staining has been reported to be lower when compared to other tetracyclines. American Academy of Pediatrics states maternal short term use of doxycycline is generally compatible with breast-feeding.

References:

1. U.S. FDA Doxycycline hyclate Prescribing Information PDF
2. Penttilå O, Neuvonen PJ, Aho K, Lehtovaara R. Interaction between doxycycline and some antiepileptic drugs. Br Med J. 1974 Jun 1;2(5917):470-2. PubMed
3.Penttila O, Lehtovaara R, Aho K. Effect of antiepileptic drugs on the elimination of various tetracycline derivatives. Eur J Clin Pharmacol. 1975 Dec 19;9(2-3):147-54. PubMed
4. Colmenero JD, Fernández-Gallardo LC, Agúndez JAG, Sedeño J, Benítez J, Valverde E. Possible implications of doxycycline-rifampin interaction for the treatment of brucellosis. Antimicrob Agents Chemother (1994) 38, 2798–2802 PubMed
5. Hasan SA. Interaction of doxycycline and warfarin: an enhanced anticoagulant effect. Cornea. 2007 Jul;26(6):742-3. PubMed
6. Pelvic Inflammatory Disease - 2015 STD Treatment Guidelines - CDC
7. Maraki S, Margioris AN, Orfanoudaki E, Tselentis Y, Koumantakis E, Kontoyiannis DP, Rovithi M, Samonis G. Effects of doxycycline, metronidazole and their combination on Candida species colonization of the human oropharynx, intestinal lumen and vagina. J Chemother. 2003 Aug;15(4):369-73. PubMed
8. Firsov AA, Vostrov SN, Lubenko IY, Portnoy YA, Zinner SH. Prevention of the selection of resistant Staphylococcus aureus by moxifloxacin plus doxycycline in an in vitro dynamic model: an additive effect of the combination. Int J Antimicrob Agents. 2004 May;23(5):451-6. PubMed
9. Khajehei M, Keshavarz T, Tabatabaee HR. Randomised double-blind trial of the effect of vitamin C on dyspareunia and vaginal discharge in women receiving doxycycline and triple sulfa for chlamydial cervicitis. Aust N Z J Obstet Gynaecol. 2009 Oct;49(5):525-30. PubMed
10. Ng VW, Bissada NF. Clinical evaluation of systemic doxycycline and ibuprofen administration as an adjunctive treatment for adult periodontitis. Clinical evaluation of systemic doxycycline and ibuprofen administration as an adjunctive treatment for adult periodontitis. PubMed
11. Fowler JF Jr. Combined effect of anti-inflammatory dose doxycycline (40-mg doxycycline, usp monohydrate controlled-release capsules) and metronidazole topical gel 1% in the treatment of rosacea. J Drugs Dermatol. 2007 Jun;6(6):641-5. PubMed
12. Tay YK, Goh CL, Chan RK, Ling AE. Dual therapy with doxycycline and ketoprofen compared to doxycycline in the treatment of uncomplicated non-gonococcal urethritis. Ann Acad Med Singapore. 1995 Jul;24(4):519-22.

By HealthyStock Research Group, September 2009
Medical resources reviewed: August 2018