Doxycycline
Brands (AU): APX-Doxycycline, Blooms The Chemist Doxycycline, DOXYCYCLINE-WGR, Doryx, Doxsig, Doxycycline Sandoz, Doxyhexal, Doxylin…
Also known as: Adoxa, Apo-Doxy, BIODOXI, Doxy 100, Doxy-100, Monodox, Ocudox, Oracea…
Item code, max quantity & repeats below. Open the prescriber to generate a printable script — you write the directions.
AU-authoritative guidance for dental use, from Therapeutic Guidelines: Antibiotic (accessed 2026-06-24, licensed). This leads the record; the reference sections below are US/UK-sourced and superseded for AU practice where they differ.
Infective endocarditis prophylaxis — severe penicillin allergy
When IE prophylaxis is indicated (a high-risk cardiac condition and a high-risk dental procedure manipulating gingival/periapical tissue or perforating the oral mucosa) in a patient with severe penicillin hypersensitivity:
Doxycycline orally, 60 minutes before the procedure — adult 100 mg (child <21 kg 2.2 mg/kg; 21–<26 kg 50 mg; 26–35 kg 75 mg; >35 kg 100 mg). Take with a large glass of water and stay upright ≥30 min (oesophageal irritation). Short courses (<21 days) do not stain teeth, so doxycycline is usable in children of all ages.
Dental-specific drug data from MIMS Drugs4dent® (MIMS Australia × University of Melbourne). View the full MIMS entry ↗
- Drug class
- Tetracyclines (also Antimalarials)
- Indications
- tetracycline antibiotic — systemic bacterial infection; malaria prophylaxis/treatment
- Dental procedural considerations
- No known dental procedural considerations
- Oral adverse effects
- Intrinsic staining (doxycycline) — MIMS lists tooth staining as a doxycycline oral AE. Reconciliation note: TG states short courses (≤10 days) have NOT been associated with staining even in children; MIMS flags the class staining potential. Both true — the risk is dose/duration/age dependent (children ≤8 yr contraindicated).
tetracycline hypersensitivity; concomitant methoxyflurane (nephrotoxicity), vitamin A, oral retinoids (isotretinoin, etretinate) (intracranial hypertension); pregnancy (>16 wks postconception); lactation.
Precautions
not drug of choice for staph/strep (incl S. pneumoniae, pyogenes, haemolytic strep URTI), H. influenzae or enteric bacteria; spirochete infection (Jarisch-Herxheimer risk); suspected syphilis (darkfield + serology); gonococcal resistance monitoring; prolonged use (monitor haemopoietic/renal/hepatic); avoid direct sun / UV (photosensitivity); 50 mg tab not a paediatric formulation; women of childbearing potential (overweight + intracranial-hypertension history); pregnancy (1st 16 wks); children ≤8 yr (esp infants, long-term/repeated short courses) — should NOT use (the classic tetracycline tooth-staining contraindication).
Drug & allergy interactions — 230 total (severe shown)
SEVERE (16, page 1):
- Oral retinoids — acitretin, etretinate, isotretinoin, tretinoin, palovarotene (Severe) → intracranial hypertension (pseudotumor cerebri).
- Ergot derivatives — dihydroergotamine, ergometrine, ergotamine, methylergometrine, methysergide (Severe) → ergotism/vasospasm.
- Methoxyflurane (Severe) → nephrotoxicity (also a contraindication).
- Warfarin sodium, Phenindione (Severe, Well Established) → tetracyclines potentiate anticoagulant effect → bleeding (monitor INR) — the key dental interaction. MODERATE (from row 17):
- Antacid / polyvalent-cation chelation — aluminium (all salts), and by class magnesium/calcium/iron/zinc → chelation reduces doxycycline absorption (counsel: separate doses; avoid dairy/antacids/iron near dosing).
- Barbiturates (amobarbital) + other enzyme inducers → ↓ doxycycline levels.
- (Remaining ~205 rows pp.2–10: more cations, anticoagulants, oral contraceptives, enzyme inducers. Not reproduced; see MIMS.)
Official AU regulatory prescribing information from the TGA (Doxylin). General — not dental-specific; the guidance above takes precedence for dental decisions. View the official PI on TGA ↗
DosingPI §4.2
Note:
- The 50 mg tablet is not a paediatric formulation.
- Administration of adequate amounts of fluid with the tablets is recommended to reduce the risk of oesophageal irritation and ulceration. Morning, rather than late night, dosing may be preferable. As the recumbent posture may delay oesophageal transit of the tablets, the patient should not lie down for some time after taking the tablets. To reduce the possibility of gastric irritation, it is recommended that DOXYLIN be given with food or milk. The absorption of doxycycline is not markedly influenced by simultaneous ingestion of food or milk. Antacids containing aluminium, calcium or magnesium, bismuth salts and preparations containing iron impair absorption and should not be given to patients taking DOXYLIN (see section 4.4 SPECIAL WARNINGS AND PRECAUTIONS FOR USE).
- The usual dosage and frequency of administration of DOXYLIN differs from that of other tetracyclines. Exceeding the recommended dosage may result in an …
ContraindicationsPI §4.3
Hypersensitivity to doxycycline, any of the excipients in DOXYLIN or to any of the tetracyclines. Use in pregnancy (16 weeks post conception) and use in lactation are contraindicated (see section 4.4 SPECIAL WARNINGS AND PRECAUTIONS FOR USE). Rare cases of benign intracranial hypertension have been reported after tetracyclines and oral retinoids, such as isotretinoin or etretinate, and vitamin A. Concomitant treatment is therefore contraindicated (see section 4.8 ADVERSE EFFECTS (UNDESIRABLE EFFECTS)) . The concurrent use of tetracycline and methoxyflurane has been reported to result in fatal renal toxicity (see section 4.5 INTERACTIONS WITH OTHER MEDICINES AND OTHER FORMS OF
Precautions & warningsPI §4.4
Photosensitivity Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines. Patients taking tetracycline drugs should be advised against exposure to direct sunlight or ultra- violet light, and treatment should be discontinued at the first sign of skin erythema. Severe Skin Reactions Severe skin reactions, such as exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms (DRESS) have been reported in patients receiving doxycycline. Fixed drug eruptions have occurred with doxycycline and have been associated with worsening severity upon subsequent administrations, including generalized bullous fixed drug eruption (see section 4.8 ADVERSE EFFECTS (UNDESIRABLE EFFECTS)). If severe skin reactions occur, discontinue DOXYLIN immediately and institute appropriate therapy. Increased Serum Urea The anti-anabolic action of the …
InteractionsPI §4.5
Anticoagulants There have been reports of prolonged prothrombin time in patients taking warfarin and doxycycline. Patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage, as tetracyclines have been shown to depress plasma prothrombin activity. Antacids Antacids containing aluminium, calcium or magnesium, or other drugs containing these cations, bismuth salts and preparations containing iron impair absorption and should not be given to patients taking DOXYLIN. Penicillin It is advisable to avoid giving tetracyclines concomitantly with penicillin as bacteriostatic drugs may interfere with the bactericidal action of penicillin. Drugs that Reduce Plasma Levels of Doxycycline Plasma levels of doxycycline are reduced by the ingestion of alcohol or the administration of barbiturates, anticonvulsants (phenytoin, carbamazepine), disodium hydrogen citrate, sodium bicarbonate, sodium lactate, acetazolamide and ethoxzolamide. Oral …
Adverse effectsPI §4.8
Doxycycline is generally well tolerated. Cases of benign intracranial hypertension have been reported with tetracyclines. It has also occurred with concomitant vitamin A or retinoids such as isotretinoin and etretinate (see Section 4.3 CONTRAINDICATIONS). Due to doxycycline’s virtually complete absorption, side effects of the lower bowel, particularly diarrhoea, have been infrequent. The following adverse reactions have been observed in patients receiving doxycycline. More Common Reactions Dermatological Photosensitive dermatitis, (see section 4.4 SPECIAL WARNINGS AND PRECAUTIONS FOR USE), erythematous rash, maculopapular rash, morbilliform rash, pustular rash, urticaria, photo-onycholysis and discolouration of the nails. Gastrointestinal Nausea, anorexia, vomiting, dysphagia, diarrhoea, oesophagitis, oesophageal ulceration, abdominal pain, glossitis, black hairy tongue. Hypersensitivity Reactions Urticaria, exacerbation of systemic lupus erythematosus and Jarisch-Herxheimer reaction …
OverdosePI §4.9
Signs and Symptoms Tetracyclines, including doxycycline, generally have low toxicity. Severe toxicity following acute overdosage is unlikely, with nausea and vomiting being the most common effects after ingestion of therapeutic and overdose amounts. Treatment Treatment may include immediate discontinuation of medication, dilution with water or milk and general supportive care. Antacids may be useful in managing gastric irritation. In most cases, gastrointestinal decontamination is not required. Plasma levels are not clinically useful and specific laboratory monitoring is not needed unless otherwise indicated. For information on the management of overdose, contact the Poisons Information Centre on 13 11
Pregnancy & lactationPI §4.6
Effects on Fertility No data available. Use in Pregnancy Pregnancy Category: D Tetracyclines are safe for use during the first 18 weeks of pregnancy, after which they cause discolouration of the baby’s teeth (see section 4.4 SPECIAL WARNINGS AND PRECAUTIONS FOR USE – Paediatric Use). During the period of mineralisation of a child’s teeth (the last half of pregnancy, the neonatal period and the first 8 years of life) tetracyclines may induce hypoplasia of the enamel and discolouration of the teeth. Tetracyclines also accumulate in the growing skeleton. These products should be avoided during the latter half of pregnancy. Large doses of tetracyclines have caused acute fatty necrosis of the liver in pregnant women, especially those with pyelonephritis. Use in Lactation Doxycycline is present in the milk of lactating women. It forms a stable calcium complex in bone-forming tissue and a decrease in the fibula growth has been observed in prematures. The use of medicines of the tetracycline …
Faded = flagged by a single source only (lower confidence).
US/UK reference sections (Lexicomp, Mosby's) — superseded by the Australian guidance and Product Information above. Retained for audit; click to expand.
Effects on dental treatment
Glossitis and tooth discoloration in children are reported. Tetracyclines may cause Candida superinfection and are not recommended during pregnancy or in children younger than 8 years because of enamel hypoplasia and permanent tooth discoloration unless alternatives are contraindicated or ineffective. (lexicomp-2260 p.579)
LA / vasoconstrictor precautions
No information available to require special precautions. (lexicomp-2260 p.579)
Drug interactions of concern in dentistry
SYSTEMIC FORM • Decreased absorption: NaHCO, other antacids • Increased rate of metabolism: barbiturates, carbamazepine, hydantoins • Decreased effect of penicillins, cephalosporins • May increase the effectiveness of anticoagulants, methotrexate, digoxin • Contraindicated with isotretinoin (Accutane) (mosbys-2015 p.464)
Oral adverse effects
glossitis; tooth discoloration; oral mucosal pigmentation; xerostomia; dysphagia; esophagitis; esophageal ulceration; oral candidiasis risk; thrombocytopenia (lexicomp-2260 p.579)
Dental considerations
• Doxycycline Hyclate (Dental-Systemic) General: • Examine for oral manifestation of opportunistic infection. • Should be administered at least 1 hr before or 2 hr after morning or evening meals. Teach Patient/Family to: • Avoid using ingestible sodium bicarbonate products, such as the Prophy-Jet air polishing system, within 2 hr of drug use. • Doxycycline Hyclate/Doxycycline Calcium (Systemic Form) General: • Determine why the patient is taking tetracycline. • Broad-spectrum antibiotics may promote oral or vaginal fungal infection. • Dental staining or enamel hypoplasia may be associated with exposure to this drug before birth or up to the age of 8. Tetracycline stains may be extremely resistant to ordinary tooth-whitening procedures. Consultations: • Medical consultation may be required to assess disease control. Teach Patient/Family: • That tetracycline can be taken with milk, food; take with a full glass of water. • To take tetracycline doses | hr before or 2 hr after air polishing device (Prophy-Jet), if used. • When used for dental infection, advise patient: • To report sore throat, oral burning sensation, fever, and fatigue, any of which could indicate superinfection. • To take at prescribed intervals and complete dosage regimen. • To immediately notify the dentist if signs or symptoms of infection increase. doxycycline hyclate (dental-systemic) (mosbys-2015 p.464)
Dental dosing
Adults: treatment of refractory periodontitis, 100-200 mg once daily for 21 days. Periostat 20 mg twice daily is used as an adjunct after scaling and root planing; doxycycline gel is available for subgingival application. (lexicomp-2260 p.579)
Precautions / contraindications
Children 8 yr and younger, hypersensitivity to tetracyclines or sulfites, last half of pregnancy, severe hepatic dysfunction. The use of tetracycline drugs during tooth development (last half of pregnancy, infancy and childhood up to the age of 8 may cause permanent discoloration of the teeth (yellowgray-brown). Enamel hypoplasia has also been reported. May also cause retardation of skeletal development and deformations. Caution: Hepatic disease, lactation (mosbys-2015 p.464)
Serious reactions
• Superinfection (especially fungal) and benign intracranial hypertension (headache, visual changes) may occur. • Hepatotoxicity, fatty degeneration of the liver, and pancreatitis occur rarely. (mosbys-2015 p.464)