Doxycycline

Pronunciation

(doks i SYE kleen)

U.S. Brand Names

Adoxa™; Doryx®; Doxy-100®; Monodox®; Periostat®; Vibramycin®; Vibra-Tabs®

Synonyms

Doxycycline Calcium; Doxycycline Hyclate; Doxycycline Monohydrate

Generic Available

Yes: Excludes powder for oral solution, syrup

Canadian Brand Names

Apo-Doxy®; Apo-Doxy Tabs®; Doxycin; Doxytec; Novo-Doxylin; Nu-Doxycycline; Vibra-Tabs®

Use

Principally in the treatment of infections caused by susceptible Rickettsia , Chlamydia , and Mycoplasma ; alternative to mefloquine for malaria prophylaxis; treatment for syphilis, uncomplicated Neisseria gonorrhoeae , Listeria , Actinomyces israelii , and Clostridium infections in penicillin-allergic patients; used for community-acquired pneumonia and other common infections due to susceptible organisms; anthrax due to Bacillus anthracis, including inhalational anthrax (postexposure); treatment of infections caused by uncommon susceptible gram-negative and gram-positive organisms including Borrelia recurrentis , Ureaplasma urealyticum , Haemophilus ducreyi , Yersinia pestis , Francisella tularensis , Vibrio cholerae , Campylobacter fetus , Brucella spp, Bartonella bacilliformis , and Calymmatobacterium granulomatis

Use - Dental

Treatment of periodontitis associated with presence of Actinobacillus actinomycetemcomitans (AA); Atridox™ is indicated for the treatment of chronic adult periodontitis for gain in clinical attachment, reduction in probing depth, and reduction in bleeding on probing; Periostat® is indicated for use as an adjunct to scaling and root planing to promote attachment level gain and to reduce pocket depth in adult periodontitis (systemic levels are subinhibitory against bacteria)

Use - Unlabeled/Investigational

Sclerosing agent for pleural effusion injection; vancomycin-resistant enterococci (VRE)

Pregnancy Risk Factor

Pregnancy Implications

Exposure during the last half or pregnancy causes permanent yellow-gray-brown discoloration of the teeth. Tetracyclines also form a complex in bone-forming tissue, leading to a decreased fibula growth rate when given to premature infants.

According to the FDA, the Teratogen Information System concluded that therapeutic doses during pregnancy are unlikely to produce substantial teratogenic risk, but data are insufficient to say that there is no risk. In general, reports of exposure have been limited to short durations of therapy in the first trimester. When considering treatment for life-threatening infection and/or prolonged duration of therapy (such as in anthrax), the potential risk to the fetus must be balanced against the severity of the potential illness.

Lactation

Enters breast milk/not recommended

Contraindications

Hypersensitivity to doxycycline, tetracycline or any component of the formulation; children <8 years of age, except in treatment of anthrax (including inhalational anthrax postexposure prophylaxis); severe hepatic dysfunction; pregnancy

Warnings/Precautions

Do not use during pregnancy - use of tetracyclines during tooth development may cause permanent discoloration of the teeth and enamel hypoplasia; prolonged use may result in superinfection, including oral or vaginal candidiasis; photosensitivity reaction may occur with this drug; avoid prolonged exposure to sunlight or tanning equipment. Avoid in children

8 years of age.

Additional specific warnings for Periostat®: Effectiveness has not been established in patients with coexistent oral candidiasis; use with caution in patients with a history or predisposition to oral candidiasis

Adverse Reactions

Frequency not defined.

Cardiovascular: Intracranial hypertension, pericarditis

Dermatologic: Angioneurotic edema, exfoliative dermatitis (rare), photosensitivity, rash, urticaria

Endocrine & metabolic: Brown/black discoloration of thyroid gland (no dysfunction reported)

Gastrointestinal: Anorexia, diarrhea, dysphagia, enterocolitis, esophagitis (rare), esophageal ulcerations (rare), glossitis, inflammatory lesions in anogenital region, tooth discoloration (children)

Hematologic: Eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia

Renal: Increased BUN

Miscellaneous: Anaphylactoid purpura, anaphylaxis, bulging fontanels (infants), SLE exacerbation

Note: Adverse effects in clinical trials with Periostat® occurring at a frequency more than 1% greater than placebo included nausea, dyspepsia, joint pain, diarrhea, menstrual cramp, and pain.

Overdosage/Toxicology

Symptoms of overdose include nausea, anorexia, and diarrhea. Treatment is supportive.

Drug Interactions

Substrate of CYP3A4 (major); Inhibits CYP3A4 (moderate)

Antacids (containing aluminum, calcium, or magnesium): Decreased absorption of tetracyclines

Anticoagulants: Tetracyclines may decrease plasma thrombin activity; monitor

Barbiturates: Decreased half-life of doxycycline

Carbamazepine: Decreased half-life of doxycycline

CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of doxycycline. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.

CYP3A4 substrates: Doxycycline may increase the levels/effects of CYP3A4 substrates. Example substrates include benzodiazepines, calcium channel blockers, mirtazapine, nateglinide, nefazodone, tacrolimus, and venlafaxine. Selected benzodiazepines (midazolam and triazolam), cisapride, ergot alkaloids, selected HMG-CoA reductase inhibitors (lovastatin and simvastatin), and pimozide are generally contraindicated with strong CYP3A4 inhibitors.

Iron-containing products: Decreased absorption of tetracyclines

Methoxyflurane: Concomitant use may cause fatal renal toxicity.

Oral contraceptives: Anecdotal reports suggesting decreased contraceptive efficacy with tetracyclines have been refuted by more rigorous scientific and clinical data.

Phenytoin: Decreased half-life of doxycycline

Ethanol/Nutrition/Herb Interactions

Ethanol: Chronic ethanol ingestion may reduce the serum concentration of doxycycline.

Food: Doxycycline serum levels may be slightly decreased if taken with food or milk. Administration with iron or calcium may decrease doxycycline absorption. May decrease absorption of calcium, iron, magnesium, zinc, and amino acids.

Herb/Nutraceutical: St John's wort may decrease doxycycline levels. Avoid dong quai, St John's wort (may also cause photosensitization).

Stability

Capsules/tablets: Store at controlled room temperature; protect from light

I.V. infusion: Following reconstitution with sterile water for injection, dilute to a final concentration of 0.1-1 mg/mL using a compatible solution. Solutions for I.V. infusion may be prepared using 0.9% sodium chloride, D5W, Ringer's injection, lactated Ringer's, D5LR. Protect from light. Stability varies based on solution.

Compatibility

Solutions for I.V. infusion may be prepared using NS, D5W, Ringer's injection, LR, D5LR

Y-site administration: Compatible: Acyclovir, amifostine, amiodarone, aztreonam, cisatracurium, cyclophosphamide, diltiazem, docetaxel, etoposide, filgrastim, fludarabine, gemcitabine, granisetron, hetastarch, hydromorphone, magnesium sulfate, melphalan, meperidine, morphine, ondansetron, perphenazine, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa, vinorelbine. Incompatible: Allopurinol, heparin, piperacillin/tazobactam. Variable (consult detailed reference): Meropenem

Compatibility in syringe: Compatible: Doxapram

Compatibility when admixed: Compatible: Ranitidine. Variable (consult detailed reference): Meropenem

Mechanism of Action

Inhibits protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit(s) of susceptible bacteria; may also cause alterations in the cytoplasmic membrane

Periostat® capsules (proposed mechanism): Has been shown to inhibit collagenase activity in vitro . Also has been noted to reduce elevated collagenase activity in the gingival crevicular fluid of patients with periodontal disease. Systemic levels do not reach inhibitory concentrations against bacteria.

Pharmacodynamics/Kinetics

Absorption: Oral: Almost complete; reduced by food or milk by 20%

Distribution: Widely into body tissues and fluids including synovial, pleural, prostatic, seminal fluids, and bronchial secretions; saliva, aqueous humor, and CSF penetration is poor; readily crosses placenta; enters breast milk

Protein binding: 90%

Metabolism: Not hepatic; partially inactivated in GI tract by chelate formation

Half-life elimination: 12-15 hours (usually increases to 22-24 hours with multiple doses); End-stage renal disease: 18-25 hours

Time to peak, serum: 1.5-4 hours

Excretion: Feces (30%); urine (23%)

Dosage

Children:

Anthrax: Doxycycline should be used in children if antibiotic susceptibility testing, exhaustion of drug supplies, or allergic reaction preclude use of penicillin or ciprofloxacin. For treatment, the consensus recommendation does not include a loading dose for doxycycline.

Inhalational (postexposure prophylaxis) ( MMWR , 2001, 50:889-893): Oral, I.V. (use oral route when possible):

8 years: 2.2 mg/kg every 12 hours for 60 days

>8 years and 45 kg: 2.2 mg/kg every 12 hours for 60 days

>8 years and >45 kg: 100 mg every 12 hours for 60 days

Cutaneous (treatment): Oral: See dosing for "Inhalational (postexposure prophylaxis)"

Note: In the presence of systemic involvement, extensive edema, and/or lesions on head/neck, doxycycline should initially be administered I.V.

Inhalational/gastrointestinal/oropharyngeal (treatment): I.V.: Refer to dosing for inhalational anthrax (postexposure prophylaxis); switch to oral therapy when clinically appropriate; refer to Adults dosing for "Note" on combined therapy and duration

Children 8 years (<45 kg): Susceptible infections: Oral, I.V.: 2-5 mg/kg/day in 1-2 divided doses, not to exceed 200 mg/day

Children >8 years (>45 kg) and Adults: Susceptible infections: Oral, I.V.: 100-200 mg/day in 1-2 divided doses

Acute gonococcal infection (PID) in combination with another antibiotic: 100 mg every 12 hours until improved, followed by 100 mg orally twice daily to complete 14 days

Community-acquired pneumonia: 100 mg twice daily

Lyme disease: Oral: 100 mg twice daily for 14-21 days

Early syphilis: 200 mg/day in divided doses for 14 days

Late syphilis: 200 mg/day in divided doses for 28 days

Uncomplicated chlamydial infections: 100 mg twice daily for 7 days

Endometritis, salpingitis, parametritis, or peritonitis: 100 mg I.V. twice daily with cefoxitin 2 g every 6 hours for 4 days and for 48 hours after patient improves; then continue with oral therapy 100 mg twice daily to complete a 10- to 14-day course of therapy

Sclerosing agent for pleural effusion injection (unlabeled use): 500 mg as a single dose in 30-50 mL of NS or SWI

Periodontitis: Oral (Periostat®): 20 mg twice daily as an adjunct following scaling and root planing; may be administered for up to 9 months. Safety beyond 12 months of treatment and efficacy beyond 9 months of treatment have not been established.

Adults:

Anthrax:

Inhalational (postexposure prophylaxis): Oral, I.V. (use oral route when possible): 100 mg every 12 hours for 60 days ( MMWR , 2001, 50:889-93); Note: Preliminary recommendation, FDA review and update is anticipated.

Cutaneous (treatment): Oral: 100 mg every 12 hours for 60 days. Note: In the presence of systemic involvement, extensive edema, lesions on head/neck, refer to I.V. dosing for treatment of inhalational/gastrointestinal/oropharyngeal anthrax

Inhalational/gastrointestinal/oropharyngeal (treatment): I.V.: Initial: 100 mg every 12 hours; switch to oral therapy when clinically appropriate; some recommend initial loading dose of 200 mg, followed by 100 mg every 8-12 hours ( JAMA , 1997, 278:399-411). Note: Initial treatment should include two or more agents predicted to be effective (per CDC recommendations). Agents suggested for use in conjunction with doxycycline or ciprofloxacin include rifampin, vancomycin, imipenem, penicillin, ampicillin, chloramphenicol, clindamycin, and clarithromycin. May switch to oral antimicrobial therapy when clinically appropriate. Continue combined therapy for 60 days

Dosing adjustment in renal impairment: No adjustment necessary

Dialysis: Not dialyzable; 0% to 5% by hemo- and peritoneal methods or by continuous arteriovenous or venovenous hemofiltration: No supplemental dosage necessary

Administration

Oral: Administer with adequate fluid to reduce risk of esophageal irritation and ulceration; may administer with meals to decrease GI upset

Doryx®: Capsules may be opened and contents sprinkled on applesauce. Applesauce should be swallowed immediately; do not chew. Follow with 8 ounces of water. Applesauce should not be hot and should be soft enough to swallow without chewing.

I.V.: Infuse I.V. doxycycline over 1-4 hours; avoid extravasation

Test Interactions

False elevations of urine catecholamine levels; false-negative urine glucose using Clinistix®, Tes-Tape®

Dietary Considerations

Take with food if gastric irritation occurs. While administration with food may decrease GI absorption of doxycycline by up to 20%, administration on an empty stomach is not recommended due to GI intolerance. Of currently available tetracyclines, doxycycline has the least affinity for calcium.

Patient Education

Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. If administered by infusion, report immediately any acute back pain, difficulty breathing or swallowing, chest tightness, pain, redness, or swelling at infusion site. Oral: Do not take any new medication during therapy unless approved by prescriber. Take entire prescription as directed, even if you are feeling better. Take each oral dose with food or a full glass of water to reduce stomach upset. Avoid alcohol and maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. If you have diabetes, drug may cause false test results with Clinistix® urine glucose monitoring; use of another form of glucose monitoring is preferable. You may be very sensitive to sunlight (use sunblock, wear protective clothing and eyewear, or avoid exposure to direct sunlight). May cause lightheadedness, dizziness, or drowsiness (use caution when driving or engaging in tasks that require alertness until response to drug is known); nausea or vomiting (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (buttermilk, boiled milk, or yogurt may help). Report skin rash or itching; easy bruising or bleeding; yellowing of skin or eyes; pale stool or dark urine; unhealed mouth sores; vaginal itching or discharge; fever, chills, or unusual cough. Pregnancy/breast-feeding precautions: Inform prescriber if you are pregnant. Do not get pregnant while taking this medication. Consult prescriber for appropriate barrier contraceptive measures. Breast-feeding is not recommended.

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Glossitis and tooth discoloration (children). Opportunistic "superinfection" with Candida albicans ; tetracyclines are not recommended for use during pregnancy or in children

8 years of age since they have been reported to cause enamel hypoplasia and permanent teeth discoloration. The use of tetracyclines should only be used in these patients if other agents are contraindicated or alternative antimicrobials will not eradicate the organism.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

Tetracyclines have been reported to cause memory disturbance, mood stabilizing and antidepressant effects

Mental Health: Effects on Psychiatric Treatment

May cause neutropenia; use caution with clozapine and carbamazepine; barbiturates and carbamazepine increase the clearance of doxycycline

Dosage Forms

Capsule, as hyclate: 50 mg, 100 mg

Vibramycin®: 100 mg

Capsule, as monohydrate (Monodox®): 50 mg, 100 mg

Capsule, coated pellets, as hyclate (Doryx®): 75 mg, 100 mg

Injection, powder for reconstitution, as hyclate (Doxy-100®): 100 mg

Powder for oral suspension, as monohydrate (Vibramycin®): 25 mg/5 mL (60 mL) [raspberry flavor]

Syrup, as calcium (Vibramycin®): 50 mg/5 mL (480 mL) [contains sodium metabisulfite; raspberry-apple flavor]

Tablet, as hyclate: 100 mg

Periostat®: 20 mg

Vibra-Tabs®: 100 mg

Tablet, as monohydrate (Adoxa™): 50 mg, 75 mg, 100 mg

Extemporaneously Prepared

If liquid doxycycline is unavailable for the treatment of anthrax, emergency doses may be prepared for children using the tablets.

Crush one 100 mg tablet and grind into a fine powder. Mix with 4 teaspoons of food or drink (lowfat milk, chocolate milk, chocolate pudding, or apple juice). Appropriate dose may be taken from this mixture. Mixture may be stored for up to 24 hours. Dairy mixtures should be refrigerated; apple juice may be stored at room temperature.

U.S. Food and Drug Administration, Center for Drug Evaluation and Research, "How to Prepare Emergency Dosages of Doxycycline at Home for Infants and Children," April 25, 2003, viewable at http://www.fda.gov/cder/drug/infopage/penG_doxy/doxycyclinePeds.htm, last accessed May 8, 2003.

References

Abramowicz M, "Antimicrobial Prophylaxis in Surgery," Medical Letter on Drugs and Therapeutics, Handbook of Antimicrobial Therapy , 16th ed, New York, NY: Medical Letter, 2002.

Böcker R, Mühlberg W, Platt D, et al, "Serum Level, Half-Life and Apparent Volume of Distribution of Doxycycline in Geriatric Patients," Eur J Clin Pharmacol , 1986, 30(1):105-8.

Bryant SG, Fisher S, and Kluge RM, "Increased Frequency of Doxycycline Side Effects," Pharmacotherapy , 1987, 7(4):125-9.

Centers for Disease Control and Prevention, "Sexually Transmitted Diseases Treatment Guidelines - 2002," MMWR Recomm Rep , 2002, 51(RR-6):1-78. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5106a1.htm. Accessed July 25, 2003.

Centers for Disease Control and Prevention, "Update: Investigation of Anthrax Associated With Intentional Exposure and Interim Public Health Guidelines, October 2001," MMWR Morb Mortal Wkly Rep , 2001, 50(41):889-93, accessed October 19, 2001. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5041a1.htm.

Centers for Disease Control and Prevention, "Update: Investigation of Bioterrorism-Related Anthrax and Interim Guidelines for Exposure Management and Antimicrobial Therapy, October 2001," MMWR Morb Mortal Wkly Rep , October 26, 2001, 50(42):909-19. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5042a1.htm. Accessed October 26, 2001.

Daunt N, Brodribb TR, and Dickey JD, "Oesophageal Ulceration Due to Doxycycline," Br J Radiol , 1985, 58(696):1209-11.

Francke EL and Neu HC, "Chloramphenicol and Tetracyclines," Med Clin North Am , 1987, 71(6):155-68.

Joshi N and Miller DQ, "Doxycycline Revisited," Arch Int Med , 1997, 157(13):1421-8.

Ljungberg B and Nilsson-Ehle I, "Pharmacokinetics of Antimicrobial Agents in the Elderly," Rev Infect Dis , 1987, 9(2):250-64.

Rams TE and Slots J, "Antibiotics in Periodontal Therapy: An Update," Compendium , 1992, 13(12):1130, 1132, 1134.

Saivin S and Hovin G, "Clinical Pharmacokinetics of Doxycycline and Minocycline," Clin Pharmacokinet , 1985, 15:355-66.

Smilack JD, Wilson WR, and Cockerill FR 3d, "Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole," Mayo Clin Proc , 1991, 66(12):1270-80.

Wilson WR and Cockerill FR 3d, "Tetracyclines, Chloramphenicol, Erythromycin, and Clindamycin," Mayo Clin Proc , 1987, 62(10):906-15.

Wyler DJ, "Malaria: Overview and Update," Clin Infect Dis , 1993, 16(4):449-56.

International Brand Names

Actidox® (PT); Aknefug DOXY® (DE); Amermycin® (TH); Antodox® (DE); Apodoxin® (FI); Apo-Doxy® (CA, SG); Apo-Doxy Tabs® (CA); Arclate® (ID); Atridox® (AT, DK, FI, SE); Azudoxat® (DE); Bassado® (IT, RU); Biocyclin® (AT); Biodoxi® (IN); Bronmycin® (SG, TH); By-Mycin® (IE); Celomicina® (CL); Chem mart Doxycycline® (AU); Ciclidoxan® (AR); Cildox® (ES); Clifordin® (BE); Clinofug D® (DE, SI); Cloridrato de Doxiciclina® (BR); Combaforte® (GR); Cyclidox EC® (ZA); Cyclidox® (ZA); Cyclodox® (GB); Dagracycline® (NL); Dagramycine® (LU); DBL Doxycycline® (AU); Demix® (GB); Deoxymykoin® (CZ); Diocimex® (CH); Docdoxycy® (BE); Docline Atlantic® (TH); Docostyl® (ES); Doksiciklin® (HR, RU, YU); Doksin® (RO, TR); Dopac® (BD); Dophar® (BE); Doryx® (AU, BE, CL, HK, NO, NZ, SG); Dosil® (ES); Dosyklin® (FI); Dotur® (AT, CR, CY, DO, GT, ID, JO, KW, LB, PA, PL, SV); Dovicin® (YU); Doxacil® (BD); Doxakne® (DE); Doxibiot® (AR); Doxibiotic® (IL); Doxicap® (BD); Doxi-C® (BD); Doxiciclina® (BR, CL, EC, RO); Doxiciclina L.CH.® (CL); Doxiciclina Normon® (ES); Doxiciclina Valomed® (ES); Doxiclat® (ES); Doxiclor® (CO); Doxicon® (BD); Doxicrisol® (ES); Doxigen® (BD); Doxil® (DO); Doxilin® (BD); Doxiline YSP® (SG); Doximal® (ZA); Doximed® (FI); Doximet® (BD); Doximycin® (CZ, FI); Doxinate® (ES); Doxin® (BD, ID, TH); Doxine® (NZ, SG); Doxirem® (BD); Doxitab® (ZA); Doxiten Bio® (ES); Doxithal® (CL); Doxitin® (FI); Doxsig® (AU); Doxt® (RU); Doxy-1A Pharma® (DE); Doxy-1® (IN); Doxy-50® (NZ); Doxy-100® (AU, BE); Doxy 100® (IL); Doxy-100® (NZ); Doxy 200® (LU); Doxy-A® (BD); Doxy AbZ® (DE); Doxy-acis® (DE); Doxy-basan® (CH); Doxybene® (AT, CZ); Doxycin (CA); Doxyclin® (CH, ZA); Doxycline® (LU, TH); Doxycyclin AL® (DE, HU); Doxycyclin Atid® (DE); Doxycyclin Basics® (DE); Doxycyclin® (BG); Doxycyclin-Chinoin® (HU); Doxycycline 3DDD® (BE); Doxycycline® (AU, GB, RU); Doxycycline-BC (AU); Doxycycline EG® (BE); Doxycycline-Ethypharm® (LU); Doxycycline-Eurogenerics® (LU); Doxycycline Faro® (AT); Doxycycline Hydrochloride® (RU); Doxycycline-ratiopharm® (BE); Doxycyclin Genericon® (AT, CH); Doxycyclin HelvePharm® (CH); Doxycyclin Heumann® (DE); Doxycyclin Jenapharm® (DE); Doxycyclin Lindo® (DE); Doxycyclin Nycomed® (RU); Doxycyclin PB® (DE); Doxycyclin Pharmavit® (HU); Doxycyclin-ratiopharm® (DE, LU); Doxycyclin Sandoz® (DE); Doxycyclin Stada® (DE, HU, PL); Doxycyclin Sun® (DE); Doxycyclinum® (PL); Doxycycmed® (BE); Doxy® (CY, FR, KW, LB, NZ, SY, TH); Doxycyklin "Dak"® (DK); Doxycyl® (ZA); Doxydar® (HK, JO, KW, LB, MT, MY, RO); Doxyderma® (DE); Doxyderm® (AT); Doxy Disp® (NL); Doxydoc® (DE); Doxydyn® (AT); Doxyferm® (SE); Doxyfim® (BE); Doxygram® (FR); Doxyhexal® (AT, AU, CZ, DE, LU, ZA); Doxy-HP® (DE); Doxy Komb® (DE, LU); Doxylag® (CH); Doxylan® (AT, RU); Doxylar® (GB); Doxylets® (BE, LU); Doxylin® (AU, IL, NO, TH); Doxy L.U.T.® (DE); Doxymerck® (DE); Doxymono® (DE); Doxy-M-ratiopharm® (DE); Doxy M-ratiopharm® (LU); doxy M von ct® (DE); Doxymycine® (LU); Doxymycin® (SG, ZA); Doxy-N-Tablinen® (DE); Doxypal-Dr® (IN); Doxypal® (IN); Doxypalu® (FR); Doxypharm® (HU); Doxy-P® (TH); Doxy-Puren® (DE); Doxyratio® (PL); Doxysina® (BD); Doxy SMB® (LU); Doxysol® (CH); Doxyson® (BD); Doxystad® (AT); Doxytab® (BE); Doxytab® [caps.] (LU); Doxy Tablets® (AU); Doxy-Tablinen® (AT); Doxytec (CA); Doxytrex® (PT); Doxytrim® (IL); doxy von ct® (DE); Doxy-Wolff® (DE); Dumoxin® [compr.] (NO); Dumoxin® (CY, EG, ID, JO, KW, LB, TH, ZA); Duo Gobens® (ES); Etidoxina® (CO); GenRX Doxycycline® (AU); Granudoxy® (FR, LU); Healthsense Doxycycline® (AU); Hiramicin® (HR); Huma-Doxylin® (HU); Impedox® (BD); Interdoxin® (ID); Ivamycin® (GR); Jenacyclin® (DE); Lentomyk® (GR); Madoxy® (TH); Medomycin® (BG, CY, RU, SG, TH, UA, VN); Medoxin® (TH); Mespafin® (DE); Miraclin® (IT); Monadox® (BD); Monodoks® (TR); Monodoxin® (DO); Navadox® (BD); Neo-Dagracycline® (NL); Noritet® (ZA); Novo-Doxylin (CA); Nu-Doxycycline (CA); Oriodox® (BD); Peledox® (ES); Periostat® (AT, CH, GB, IL); Poli-Cycline® (TH); Proderma® (ES); Protectina® (BR); Randoclin® (ZA); Remycin® (CY, RO); Retens® (ES); Rexilen® (ES); Roxyne® (BE); Rudocyclin® (CH); Servidoxyne® (BD, CH, HK, TH); Siadocin® (TH); Siclidon® (ID); Sigadoxin® (CH, CL, DE, PT); Spanor® (FR); Supracyclin® (AT, CH, DE, LU, PL); Supramycina® (EC); Tasmacyclin Akne® (CH); Tenutan® (HU); Terry White Chemists Doxycycline® (AU); Tetradox® (PL, RU, SG, TH); Tolexine® (FR); Topdoxy® (BE); Torymycin® (TH); Unidox® (BD, BE, JO, LU, NL, PL, RO, RU); Unidox Solutab® (RO); Veemycin® (TH); Velacin® (BD); Verboril® (AR); Viadoxin® (ID); Vibracare® (BE); Vibracina® (ES); Vibradox® (DK); Vibramicina® (AR, BR, CL, CO, MX, PT); Vibramycin® (AT, AU, CH, CY, CZ, DE, DK, DO, EG, GB, GR, HK, HR, HU, ID, IE, IL, JO, JP, KW, LB, NL, NO, RO, RU, SE, SG, SI, TH, YU, ZA); Vibramycin-D® (GB, IE); Vibramycine® (BE, LU); Vibramycine N® (FR); Vibramycin Tabs® (CH); Vibra-S® (NL); Vibratab® (BE, LU); Vibra-Tabs® (AU, CA); Vibraveineuse® (FR); Vibravenosa® (ES); Vibravenös® (AT, CH, DE); Vidox® (BD); Visubiotic® (GR); Wanmycin® (HK, SG); Zadorin® (CH, CY, EG, HK, JO, KW, LB)

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