Dr. Murai Éva szerk.: Parasitologia Hungarica 26. (Budapest, 1993)

In case of infections caused by Streptococcus haemolyticus treatment should be continued for 10 days. To avoid oesophageal irritation and ulceration the capsule should be taken with ample fluid. In case of gastric irritation, the drug should be taken with food or with milk. Side-effects: - gastrointestinal symptoms: (occur relatively rarely because of complete absorption) loss of appetite, nausea, vomiting, diarrhoea, glossitis, dysphagia, enterocolitis, rarely oesophageal ulcer (mainly when the drug is taken immediately before going to bed); - dermatological symptoms: maculopapular and erythematous alterations, photodermatosis; - allergic reaction: urticaria, angioneurotic edema, anaphylactic shock, exacerbation of systemic lupus erythematosus; - haemopoietic side-effects: haemolytic anaemia , leukopenia, thrombocytopenia, eosinophilia, - decreased plasma prothrombin level - liver impairment ( mainly in the case of hepatic or renal insufficiency and in pregnant women with renal disease); - secondary infection due to the overgrowth of resistant pathogenic microorganisms (primarily fungi); - doxycycline gets built in the developing bone system and inhibits bone development, during tooth development causes yellowish discoloration of the teeth and may lead to enamel hypoplasia (in case of prolonged or repeated treatment caries becomes more frequent). Drug interactions Simultaneous administration is contraindicated with - aluminum-,calcium-, or magnesium-containing antacids, oral iron preparations cholestyramine and cholestirol (they decrease the absorption of doxycycline, if the usage of these drugs cannot be avoided, they should be administered at least 3 hours after doxycycline). - Methoxyflurane narcotic (severe, sometimes fatal renal impairment may develop). - Carbamazepine, Phenytoin, Primidone and barbiturates (desrease the half-life of doxycycline by 50%). Simultaneous administration with hepatotoxic agents and penicillin and cephalosporin preparations should be avoided (their effects are decreased by doxycycline). It can be administered with caution with oral anticoagulants and oral antidiabetics (doxycycline increases their effect mainly in case of prolonged administration). Warning. Due to its bone and tooth damaging effect, doxycycline should not be used in the second half of pregnancy and if possible should not be given to children below the age of 8 years unless other antibiotic is ineffective or contraindicated. Doxycycline gets into the placental circulation and delays fetal bone formation. Since it has been found to be embryotoxic in animal experiments, it can only be administered in the first half of pregnancy in case of vital indication for the mother. When taken during lactation it gets into the mother's milk. In long-term therapy control of the haemopoietic system, of the renal and liver functions is necessary (particularly in elderly patients and in those suffering from hepatic or renal diseases, although the nephrotoxicity of doxycycline is mild and the drug does not accumulate in the blood upon renal insufficiency). During doxycycline treatment the urine glucose and urobilinogen tests may yield false positive results. Administration of the drug may disturb the determination of clinical laboratory values of proteins and catecholamines. In case the simultaneous occurrence of gonococcal infection and syphilis is suspected the suitable diagnostic tests should be performed: monthly serologic control over 4 months is necessary. Photosensitive patients should be protected from sunlight and UV radiation and treatment should be discontinued if erythema appears. Note: Keep at temperature below 25 C, protected from light. Package: 8 or 100 capsules of 100 mg Manufacturer: CHINOIN Pharmaceutical and Chemical Works Co. Ltd. BUDAPEST - HUNGARY