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Doxycycline

Classification: A

Drug products: Doxycyklin 2care4, Doxycyklin Ebb, Doxycyklin EQL Pharma, Doxycyklin Orifarm, Doxyferm®, Oracea, Vibramycin, Vibranord®

ATC code: J01AA02

Substances: doxycycline, doxycycline caragenate, doxycycline hyclate, doxycycline hydrochloride, doxycycline monohydrate

Summary

The effect of doxycycline has been shown to be similar in men and women in treatment of genital chlamydia infection and in papulopustular rosacea.
Women of childbearing age who are overweight or have e history of intracranial hypertension are at greater risk for developing tetracycline associated intracranial hypertension. However, few studies report about the association with doxycycline.
 
In our opinion, the described differences do not motivate differentiated dosing or treatment in men and women.

Additional information

Pharmacokinetics and dosing

The influence of sex on the pharmacokinetics of doxycycline has been investigated in Vietnamese volunteers (14 men, 14 women). Participants received a single oral dose of 100 mg doxycycline for 14 days. Except for a longer half-life in women (3.0 vs 1.5 h) no sex differences in doxycycline pharmacokinetics were observed [1]. In contrast to this, studies conducted by the manufacturer found a higher AUC and Cmax and a shorter half-life in women than men. These differences were more marked when administrated as a fasted capsule than a fasted tablet [2]. However, body weight was not reported, and since women generally have a lower body weight and thus a weight normalized analysis could have eliminated the observed differences between men and women. Although sex differences in doxycycline pharmacokinetics have been observed, the extent of the differences does not motivate any dose adjustment based on sex [1].

Effects

A meta-analysis (in total 726 men and 817 women) has shown that azithromycin and doxycycline are equally efficacious in achieving microbial cure in treatment of genital Chlamydia trachomatisinfection in both men and women [3].

The effectiveness of oral doxycycline 40 mg once daily in patients with papulopustular rosacea have been evaluated based on data from a large open-label clinical trial in 235 men and 591 women). After 12 weeks of monotherapy, a similar proportion of men and women had achieved treatment success, measured with an investigator’s global assessment scale [4].

Adverse effects

The safety of oral doxycycline 40 mg once daily has been evaluated in patients with papulopustular rosacea (343 men, 853 women) [4]. Adverse events were reported in a similar proportion of men and women [4].

A warning in the U.S. drug label of doxycycline states that women of childbearing age who are overweight or have a history of intracranial hypertension are at greater risk for developing tetracycline associated intracranial hypertension [5]. However, few studies report about the association between doxycycline and intracranial hypertension [6].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Updated: 2019-02-26

Date of litterature search: 2016-01-21

References

  1. Binh VQ, Chinh NT, Thanh NX, Cuong BT, Quang NN, Dai B et al. Sex affects the steady-state pharmacokinetics of primaquine but not doxycycline in healthy subjects. Am J Trop Med Hyg. 2009;81:747-53. PubMed
  2. Food and Drug Administration (FDA). Clinical Pharmacology and Biopharmaceutics Review - PERIOSTAT (doxycycline). Food and Drug Administration [www]. [updated 2001-02-02, cited 2016-01-21]. länk
  3. Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis. 2002;29:497-502. PubMed
  4. Del Rosso JQ, Preston NJ, Caveney SW, Gottschalk RW. Effectiveness and safety of modified-release doxycycline capsules once daily for papulopustular rosacea monotherapy results from a large community-based trial in subgroups based on gender. J Drugs Dermatol. 2012;11:703-7. PubMed
  5. Vibramycin (doxycyline). DailyMed [www]. US National Library of Medicine. [updated 2015-05-01, cited 2016-01-21]. länk
  6. Friedman DI. Medication-induced intracranial hypertension in dermatology. Am J Clin Dermatol. 2005;6:29-37. PubMed
  7. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-06-30.] Socialstyrelsens statistikdatabas

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson