Atridox
doxycycline†
(dox-i-sye-kleen) doxycycline,Apprilon
(trade name),Atridox
(trade name),Doryx
(trade name),Doxy
(trade name),Doxy Caps
(trade name),Doxycin
(trade name),Doxytab
(trade name),Monodox
(trade name),Oracea
(trade name),Periostat
(trade name),Vibramycin
(trade name),Vibra-Tabs
(trade name)Classification
Therapeutic: anti infectivesPharmacologic: tetracyclines
† As the recommendations for treating/preventing anthrax are still evolving, all health care professionals are urged the check the most current recommendations at the Centers for Disease Control and Prevention Web site (www.bt.cdc.gov)
Indications
- Mycoplasma,
- Chlamydia,
- Rickettsia,
- Borellia burgdorferi.
Action
Therapeutic effects
- Bacillus anthracis(anthrax),
- Clostridium perfringens,
- Clostridium tetani,
- Listeria monocytogenes,
- Nocardia,
- Propionibacterium acnes,
- Actinomyces israelii.
- Haemophilus influenzae,
- Legionella pneumophila,
- Yersinia enterocolitica,
- Yersinia pestis,
- Neisseria gonorrhoeae,
- Neisseria meningitidis.
- Mycoplasma,
- Treponema pallidum,
- Chlamydia,
- Rickettsia,
- Borrelia burgdorferi.
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
| PO | 1–2 hr | 1.5–4 hr | 12 hr |
| IV | rapid | end of infusion | 12 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- benign intracranial hypertension (higher in children)
- headache
Gastrointestinal
- pseudomembranous colitis (life-threatening)
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- esophagitis
- hepatotoxicity
- pancreatitis
Dermatologic
- drug rash with eosinophilia and systemic symptoms (life-threatening)
- erythema multiforme (life-threatening)
- stevens-johnson syndrome (life-threatening)
- toxic epidermal necrolysis (life-threatening)
- photosensitivity (most frequent)
- rash
Hematologic
- blood dyscrasias
Local
- phlebitis at IV site
Miscellaneous
- hypersensitivity reactions
- superinfection
Interactions
Drug-Drug interaction
May ↑ effect of warfarin.May ↓ effectiveness of estrogen-containing oral contraceptives.Antacids, calcium, iron, and magnesium form insoluble compounds (chelates) and ↓ absorption of tetracyclines; this effect is least with doxycycline.Cholestyramine or colestipol ↓ absorption of tetracyclines.Adsorbent antidiarrheals may ↓ absorption.Barbiturates, carbamazepine, or phenytoin may ↓ effectiveness.Calcium in foods or dairy products ↓ absorption by forming insoluble compounds (chelates); this effect is minimal with doxycycline.Route/Dosage
More common infections
Inhalational anthrax
Cutaneous anthrax
Availability (generic available)
Nursing implications
Nursing assessment
- Infection: Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome or toxic epidermal necrolysis. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis and/or eosinophilia.
- Intravenous: Assess IV site frequently; may cause thrombophlebitis.
- Lab Test Considerations: Monitor renal and hepatic functions and CBC periodically during long-term therapy.
- May cause ↑ AST, ALT, serum alkaline phosphatase, bilirubin, and amylase concentrations.
- May cause false ↑ in urinary catecholamine levels.
Potential Nursing Diagnoses
Risk for infection (Indications, Side Effects)Noncompliance (Patient/Family Teaching)
Implementation
- Do not confuse Oracea with Orencia.
- May cause yellow-brown discoloration and softening of teeth and bones if administered prenatally or during early childhood. Not recommended for children under 8 yr of age or during pregnancy or lactation, unless used for the treatment of anthrax.
- The Oracea product is only indicated for rosacea, not for infections.
- Oral: Administer around the clock, at least 1 hr before or 2 hr after meals. May be taken with food or milk if GI irritation occurs. Administer with a full glass of liquid and at least 1 hr before going to bed to avoid esophageal ulceration. Use calibrated measuring device for liquid preparations. Shake liquid preparations well. Do not administer within 1–3 hr of other medications.
- Capsules may also be administered by carefully opening and sprinkling capsule contents on a spoonful of applesauce. The applesauce should be swallowed immediately without chewing and followed with a cool 8-ounce glass of water to ensure complete swallowing of the capsule contents. The applesauce should not be hot, and it should be soft enough to be swallowed without chewing. If mixture cannot be taken immediately, discard; do not stored for later use.
- Do not open, break, crush or chew extended release capsules and tablets.
- To prepare doses for infants and children exposed to anthrax (used only in a Declared Public Health Emergency): place one 100 mg tablet in a small bowl and crush to a fine powder with a metal spoon, leaving no large pieces. Add 4 level tsp of lowfat milk, lowfat chocolate milk, regular chocolate milk, chocolate pudding or an apple juice and sugar mixture made by combining 4 teaspoons of sugar and 4 teaspoons of apple juice. Mix food or drink and doxycycline powder until powder dissolves. Mixture is stable in a covered container for 24 hrs if refrigerated (if made with milk or pudding) or at room temperature (if made with juice). Number of teaspoons to administer/dose is based on child's weight (0–12.5 lbs—1/2tsp; 12.5–25 lbs—1 tsp; 25–37.5 lbs—11/2tsp; 37.5–50 lbs—2 tsp; 50–62.5 lbs—21/2tsp; 62.5–75 lbs—3 tsp; 75–87.5 lbs—31/2tsp; 87.5–100 lbs—4 tsp).
- Avoid administration of calcium, antacids, magnesium-containing medications, sodium bicarbonate, or iron supplements within 1–3 hr of oral doxycycline.
Intravenous Administration
- Intermittent Infusion: Reconstitute each 100 mg with 10 mL of sterile water or 0.9% NaCl for injection. Diluent: Dilute further in 100–1000 mL of 0.9% NaCl, D5W, D5/LR, Ringer’s, or lactated Ringer’s solution. Solution is stable for 12 hr at room temperature and 72 hr if refrigerated. If diluted with D5/LR or lactated Ringer’s solution, administer within 6 hr. Protect solution from direct sunlight. Concentration: Concentrations of less than 1 mcg/mL or greater than 1 mg/mL are not recommended.
- Rate: Administer over a minimum of 1–4 hr. Avoid rapid administration. Avoid extravasation.
- Y-Site Compatibility: acyclovir, alemtuzumab, alfentanyl, amifostine, amikacin, aminophylline, amiodarone, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, cefotaxime, ceftriaxone, chlorpromazine, cisatracurium, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doxacurium, doxarubicin, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibitide, ertapenem, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, gemcitabine, gentamicin, glycopyrrolate, granisetron, hetastarch, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methyldopate, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitoxantrone, morphine, multivitamins, mycophenolate, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, pantoprazole, papaverine, pentamidine, pentazocine, perphenazine, phentolamine, phenylephrine, phytonadione, potassium chloride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, streptokinase, succinylcholine, sufentanil, tacrolimus, telavancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tirofiban, tobramycin, tolazoline, trastuzumab, vancomycin, vasopressin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zoledronic acid
- Y-Site Incompatibility: allopurinol, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, ampicillin, ampicillin/sulbactam, azathioprine, cefazolin, cefoperazone, cefotetan, cefoxitin, ceftazidime, cefuroxime, chloramphenicol, dantrolene, dexamethasone, diazepam, diazoxide, erythromycin, fluorouracil, folic acid, furosemide, ganciclovir, heparin, hydrocortisone, indomethacin, ketorolac, methotrexate, methylprednisolone, nafcillin, oxacillin, palonosetron, pemetrexed, penicillin G, pentobarbital, phenobarbital, phenytoin, piperacillin/tazobactam, potassium acetate, sodium bicarbonate, trimethoprim/sulfamethoxazole
Patient/Family Teaching
- Instruct patient to take medication around the clock and to finish the drug completely as directed, even if feeling better. Take missed doses as soon as possible unless it is almost time for next dose; do not double doses. Advise patient that sharing of this medication may be dangerous.
- Advise patient to avoid taking antacids, calcium, magnesium-containing medications, sodium bicarbonate, and iron supplements within 1–3 hr of oral doxycycline.
- Instruct patient to notify health care professional immediately if rash, diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professionals.
- Advise female patient to use a nonhormonal method of contraception while taking tetracyclines and until next menstrual period.
- Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
- Advise patient to report the signs of superinfection (black, furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools). Skin rash, pruritus, and urticaria should also be reported.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Instruct patient to notify health care professional of medication regimen before treatment or surgery.
- Instruct patient to notify health care professional if symptoms do not improve within a few days for systemic preparations.
- Caution patient to discard outdated or decomposed doxycycline; they may be toxic.
- Malaria Prophylaxis: Advise patient to avoid being bitten by mosquitoes by using protective measures, especially from dusk to dawn (e.g., staying in wellscreened areas, using mosquito nets, covering the body with clothing, and using an effective insect repellant). Doxycycline prophylaxis should begin 1-2 days before travel to the malarious area, continued daily while in the malarious area and after leaving the malarious area, should be continued for 4 more weeks to avoid development of malaria. Do not exceed 4 mo.
Evaluation/Desired Outcomes
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
- Decrease in acne lesions.
- Treatment of inhalational anthrax (postexposure) or treatment of cutaneous anthrax.
- Prevention of malaria.
- Reduction in inflammatory lesions associated with rosacea.