Although oral tetracycline medications (such as doxycycline) are extremely valuable in
the management of patients with hordeolum, lid disease in the presence of rosacea, and
non-responding ocular surface disease, these agents often cause several undesirable side
effects. The most common side effects of doxycycline use include gastritis or upset stomach;
photosensitivity or an increased risk of sunburn; yeast infections; and, in rare cases,
pseudotumor cerebri.
Here are some suggestions about how you can help your patients limit their incidence of side effects
secondary to doxycycline use.
- Prescribe low dosages of doxycycline (e.g., 20mg). Research from the DEWS report suggests
that patients who take lower doses of doxycycline may experience the same anti-inflammatory effect
as patients who take 100mg-doses, but with significantly fewer side effects.¹
- Instruct your patients on b.i.d. dosing not to take the second doxycycline pill before going to
bed or immediately lying down. There have been reports of localized irritation if the pill remains
in the upper GI or esophagus.² Instead, ask your patients to take their second pill at least two
to three hours before bedtime.
- Because the tetracycline medications are highly acidic to begin with, tell your patients not to take
the pills with acidic beverages, such as orange juice, apple juice, coffee, etc. I base this suggestion
upon the experiences of one of my patients who had significant gastrointestinal issues after taking her
morning pill, but not her evening pill. The patient told me that she usually took her morning pill with
orange juice and her evening pill with water. When she switched to water at both times, her stomach
problems ceased.
- Instruct your patients to take doxycycline with food to decrease the incidence of stomach-related
side effects. Now, this suggestion may sound confusing because the pharmacy instructions clearly state
that these pills should NOT be taken with food. The primary reason for this labeling is because the ingestion
of dairy products immediately before or after dosing can render doxycycline completely ineffective. So,
inform your patients that they can safely take doxycycline with food if they do not consume a significant
volume of dairy products. (Otherwise, patients should take doxycycline at least one hour before or two
hours after eating dairy products.)
|
