8 years of age; pregnancyCardiovascular: Pericarditis
Central nervous system: Intracranial pressure increased, bulging fontanels in infants, pseudotumor cerebri, paresthesia
Dermatologic: Photosensitivity, pruritus, pigmentation of nails, exfoliative dermatitis
Endocrine & metabolic: Diabetes insipidus syndrome
Gastrointestinal: Discoloration of teeth and enamel hypoplasia (young children), nausea, diarrhea, vomiting, esophagitis, anorexia, abdominal cramps, antibiotic-associated pseudomembranous colitis, staphylococcal enterocolitis, pancreatitis
Hematologic: Thrombophlebitis
Hepatic: Hepatotoxicity
Renal: Acute renal failure, azotemia, renal damage
Miscellaneous: Superinfection, anaphylaxis, hypersensitivity reactions, candidal superinfection
Antacids: May decrease tetracycline absorption; separate doses.
Calcium supplements (oral): May decrease tetracycline absorption; separate doses.
CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of tetracycline. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.
CYP3A4 substrates: Tetracycline may increase the levels/effects of CYP3A4 substrates. Example substrates include benzodiazepines, calcium channel blockers, cyclosporine, mirtazapine, nateglinide, nefazodone, sildenafil (and other PDE-5 inhibitors), 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.
Didanosine: May decrease tetracycline absorption; separate doses.
Digoxin: Tetracyclines may rarely increase digoxin serum levels.
Iron: May decrease tetracycline absorption; separate doses.
Methoxyflurane anesthesia when concurrent with tetracycline may cause fatal nephrotoxicity.
Oral contraceptives: Anecdotal reports suggesting decreased contraceptive efficacy with tetracyclines have been refuted by more rigorous scientific and clinical data.
Quinapril: May decrease tetracycline absorption; separate doses.
Warfarin with tetracyclines may result in increased anticoagulation.
Food: Tetracycline serum concentrations may be decreased if taken with dairy products.
Herb/Nutraceutical: Avoid dong quai, St John's wort (may also cause photosensitization)
Absorption: Oral: 75%
Distribution: Small amount appears in bile
Relative diffusion from blood into CSF: Good only with inflammation (exceeds usual MICs)
CSF:blood level ratio: Inflamed meninges: 25%
Protein binding: ~65%
Half-life elimination: Normal renal function: 8-11 hours; End-stage renal disease: 57-108 hours
Time to peak, serum: Oral: 2-4 hours
Excretion: Urine (60% as unchanged drug); feces (as active form)
Children >8 years: 25-50 mg/kg/day in divided doses every 6 hours
Adults: 250-500 mg/dose every 6 hours
Helicobacter pylori eradication: 500 mg 2-4 times/day depending on regimen; requires combination therapy with at least one other antibiotic and an acid-suppressing agent (proton pump inhibitor or H2 blocker)
Dosing interval in renal impairment:
Clcr 50-80 mL/minute: Administer every 8-12 hours
Clcr 10-50 mL/minute: Administer every 12-24 hours
Clcr<10 mL/minute: Administer every 24 hours
Dialysis: Slightly dialyzable (5% to 20%) via hemo- and peritoneal dialysis or via continuous arteriovenous or venovenous hemofiltration; no supplemental dosage necessary
Dosing adjustment in hepatic impairment: Avoid use or maximum dose is 1 g/day
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. Long-term use associated with oral candidiasis.Capsule, as hydrochloride: 250 mg, 500 mg
Suspension, oral, as hydrochloride (Sumycin®): 125 mg/5 mL (480 mL) [contains sodium benzoate and sodium metabisulfite; fruit flavor]
Tablet, as hydrochloride (Sumycin®): 250 mg, 500 mg
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