6 Interactions found for:
Drug Interactions
No drug interactions were found for selected drugs: doxycycline, Vitamin C.
This does not necessarily mean no interactions exist. Always consult your healthcare provider.
Drug and Food Interactions
Moderate
Doxycycline
+ Food
The following applies to the ingredients: Doxycycline
Iron can bind to doxycycline in the gastrointestinal tract, which may prevent their absorption into the bloodstream and possibly reduce their effectiveness. To avoid or minimize the interaction, iron-containing medications and doxycycline should preferably be taken at least three to four hours apart in most cases. Talk to your doctor if you have any questions or concerns, or if you have trouble separating the dosing times. Your doctor may be able to prescribe alternatives that do not interact. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Minor
Doxycycline
+ Food
The following applies to the ingredients: Doxycycline
Professional Content
Chronic alcohol consumption may enhance the elimination of doxycycline. The mechanism is induction of hepatic microsomal enzymes by alcohol. In one study, the half-life of doxycycline in six alcoholics was 10.5 hours, compared with 14.7 hours in six control patients. In addition, half the alcoholic patients had serum concentrations below what is generally considered the minimum therapeutic concentration (0.5 mcg/mL) at 12 to 24 hours after the dose. The investigators suggest that twice-a-day dosing may be indicated in these patients, especially if additional inducing drugs are used. The elimination of other tetracyclines probably is not affected by alcohol consumption.
References
- Neuvonen PJ, Penttila O, Roos M, Tirkkonen J "Effect of long-term alcohol consumption on the half-life of tetracycline and doxycycline in man." Int J Clin Pharmacol Biopharm 14 (1976): 303-7
Drug and Pregnancy Interactions
Major
Doxycycline
+ Pregnancy
The following applies to the ingredients: Doxycycline
Professional Content
AU: Tetracyclines are considered safe for use during the first 18 weeks of pregnancy (16 weeks postconception); use should be avoided during the second and third trimesters of pregnancy.
UK: Use of most oral formulations is contraindicated; use of the 40 mg capsule formulation is contraindicated during the second and third trimesters.
US: Use of the IV formulation is not recommended unless considered essential for patient welfare. Most oral formulations of this drug should not be used during pregnancy unless the benefit outweighs the risk; use of the 40 mg capsule formulation is not recommended.
AU TGA pregnancy category: D
US FDA pregnancy category:
-Most products: D
-Doryx(R) MPC, Vibramycin(R), Vibra-Tabs(R): Not assigned.
Risk summary: Use of this drug in pregnant women may cause fetal harm.
Comments:
-Use of tetracyclines after the first 18 weeks of pregnancy may affect the formation of the baby's teeth and cause discoloration.
-According to some authorities, this drug should be used during tooth development (e.g., last half of pregnancy) only if benefits are expected to outweigh risks in severe or life-threatening conditions (e.g., anthrax, Rocky Mountain spotted fever), especially if alternative therapies are unavailable.
-If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.
-According to some authorities, the 40 mg capsule formulation should be stopped at once if the patient becomes pregnant.
Animal studies have revealed evidence of embryofetal toxicity, including toxic effects on skeletal formation. Animal studies indicate this drug crosses the placenta and is found in fetal tissues. There are no controlled data in human pregnancy; most reported human experience was short-term, first trimester exposure but no human data are available assessing long-term therapy during pregnancy (e.g., regimen for anthrax exposure).
Congenital defects have been reported with tetracyclines; large doses have caused acute fatty liver necrosis in pregnant women (particularly those with pyelonephritis). Fetal effects may be dose-related. When used during tooth development (second half of pregnancy), tetracyclines may cause permanent yellow-grey-brown discoloration of the teeth; this side effect is more common during prolonged use but has been seen after short-term therapy. Enamel hypoplasia has also been reported.
An expert review of data regarding use of this drug during pregnancy by the Teratogen Information System (TERIS) concluded that substantial teratogenic risk from therapeutic doses during pregnancy is unlikely (data quantity and quality limited to fair); insufficient data to state there is no risk.
Population-based data from the Hungarian Case-Control Surveillance of Congenital Abnormalities revealed that of 32,804 women who had infants with no defects, 63 (0.19%) were treated with this drug during pregnancy. Of 18,515 women who had infants with congenital abnormalities, 56 (0.3%) were treated with this drug. This study showed a weak but marginally statistically significant association with total malformations and use of this drug anytime during pregnancy. This association was not seen when analysis was limited to maternal therapy during organogenesis (i.e., second and third months of gestation), except for a marginal association with neural tube defect based on 2 exposed cases. Data were based on retrospective recall and did not include alcohol or tobacco usage.
In a small prospective study (81 pregnancies), 43 pregnant women were treated with this drug for 10 days during early first trimester. All mothers reported their exposed infants were normal at 1 year of age.
In mass casualty settings after release of biological weapons, the Working Group on Civilian Biodefense has recommended this drug as an alternative drug for prophylaxis and treatment of anthrax, tularemia, and plague. The risk of using this drug during pregnancy is outweighed by the high fatality rates from these infections.
AU TGA pregnancy category D: Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details.
US FDA pregnancy category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.
References
- "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals PROD (2002):
- Czeizel AE, Rockenbauer M "Teratogenic study of doxycycline." Obstet Gynecol 89 (1997): 524-8
- "Product Information. Periostat (doxycycline)." Collagenex Pharmaceuticals PROD (2001):
- Inglesby TV, Dennis DT, Henderson DA, et al. "Plague as a biological weapon: medical and public health management. Working Group on Civilian Biodefense." JAMA 283 (2000): 2281-90
- Dennis DT, Inglesby TV, Henderson DA, et al. "Tularemia as a biological weapon: medical and public health management." JAMA 285 (2001): 2763-73
- Inglesby TV, O'Toole T, Henderson DA, et al. "Anthrax as a biological weapon, 2002: updated recommendations for management." JAMA 287 (2002): 2236-52
- "Product Information. Adoxa (doxycycline)." Doak Dermatologics Division (2005):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- "Product Information. Oracea (doxycycline)." Collagenex Pharmaceuticals (2006):
- "Low-Dose Doxycycline (Oracea) for Rosacea." Med Lett Drugs Ther 49 (2007): 5-6
- Cerner Multum, Inc. "Australian Product Information." O 0
- Freedman DO "Clinical practice. Malaria prevention in short-term travelers." N Engl J Med 359 (2008): 603-12
- "Product Information. Acticlate (doxycycline)." Aqua Pharmaceuticals LLC (2014):
- Melbourne: Therapeutic Guidelines Limited "eTG complete [Online] http://online.tg.org.au/complete/desktop/tgc.htm" (2015):
Minor
Vitamin C
+ Pregnancy
The following applies to the ingredients: Ascorbic Acid (found in Vitamin C)
Professional Content
Ascorbic acid has been assigned to pregnancy category A by the FDA when used in doses that are advocated by the FDA. Doses exceeding the recommended dietary allowance (RDA) have been assigned to pregnancy category C. Animal studies have not been reported. There are no controlled data in human pregnancy. Ascorbic acid is only recommended for use during pregnancy when benefit outweighs risk.
High doses of ascorbic acid taken during pregnancy have been reported to cause conditional scurvy in infants following birth.
References
- "Product Information. Cemill 500 (ascorbic acid)." Abbott Pharmaceutical PROD
- Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation." Philadelphia, PA: Lippincott Williams & Wilkins (2002):
Drug and Breastfeeding Interactions
Major
Doxycycline
+ Breastfeeding
The following applies to the ingredients: Doxycycline
Professional Content
LactMed: Short-term use is considered acceptable; as a precaution (theoretical), prolonged or repeat courses should be avoided throughout breastfeeding.
-IV: The manufacturer makes no recommendation regarding use during lactation.
-Oral: According to some authorities and manufacturers, a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother; according to other authorities and manufacturers, use is contraindicated. Use of the 40 mg capsule formulation is not recommended.
Excreted into human milk: Yes
Comments:
-According to at least 1 manufacturer: Developmental and health benefits of breastfeeding should be considered as well as the mother's clinical need for the drug; potential side effects in the breastfed child due to the drug or the mother's underlying condition should be considered.
-The effects in the nursing infant are unknown; the infant should be monitored for rash and possible effects on the gastrointestinal flora (e.g., diarrhea or candidiasis [thrush, diaper rash]).
-Tetracycline, a related drug, is considered compatible with breastfeeding by the American Academy of Pediatrics.
Tetracyclines have been considered contraindicated during breastfeeding due to possible staining of infants' dental enamel or bone deposition of tetracyclines; however, a close review of available literature suggests harmful effects are unlikely with short-term use of this drug during lactation as milk levels are low and infant absorption is inhibited by the calcium in breast milk.
According to some experts, this drug is compatible for short courses (e.g., 10 days) if alternative therapy is not appropriate; diarrhea may occur in the nursing infant.
The extent of drug absorption by breastfed infants is unknown. Short-term use in lactating women is not explicitly contraindicated by most manufacturers, but the effects of prolonged drug exposure via breast milk are unknown. Long-term or repeat courses are not recommended during nursing as a theoretical precaution. Theoretical risks of dental staining and inhibition of bone growth in nursing infants are considered unlikely by most experts.
After 2 oral doses (200 mg followed by 100 mg 12 hours later) in 15 nursing mothers, milk drug levels 3 and 24 hours after dosing averaged 0.77 mg/L (range: 0.4 to 1.4 mg/L) and 0.38 mg/L (range: 0.12 to 0.85 mg/L), respectively.
This drug (100 mg/day) was given orally to 10 mothers. On day 2, milk drug levels 3 and 24 hours after dosing averaged 0.82 mg/L (range: 0.37 to 1.24 mg/L) and 0.46 mg/L (range: 0.3 to 0.91 mg/L), respectively. Using peak and trough milk level averages in this study, the estimated intake of an infant only fed breast milk averaged about 6% of the maternal weight-adjusted dose.
Peak milk levels averaged 0.96 mg/L after a single 100 mg dose (n=3) and 1.8 mg/L after a single 200 mg dose (n=3). After 100 mg orally twice a day for 5 days, milk drug levels were about 3.6 mg/L.
In another study, in the immediate postpartum period, peak milk levels were 0.6 mg/L after oral doses of 100 mg (n=3) and averaged 1.1 mg/L after 200 mg (n=11).
After a single 200 mg dose (n=2), milk levels 2, 4, and 6 hours after dosing averaged 0.8, 0.7, and 0.4 mg/L, respectively.
References
- Roberts RJ, Blumer JL, Gorman RL, et al. "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk." Pediatrics 84 (1989): 924-36
- "Product Information. Vibramycin (doxycycline)." Pfizer U.S. Pharmaceuticals PROD (2002):
- Briggs GG, Freeman RK, Yaffe SJ.. "Drugs in Pregnancy and Lactation." Baltimore, MD: Williams & Wilkins (1998):
- "Product Information. Periostat (doxycycline)." Collagenex Pharmaceuticals PROD (2001):
- "Product Information. Adoxa (doxycycline)." Doak Dermatologics Division (2005):
- Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
- "Product Information. Oracea (doxycycline)." Collagenex Pharmaceuticals (2006):
- Cerner Multum, Inc. "Australian Product Information." O 0
- Tan KR, Magill AJ, Parise ME, Arguin PM "Doxycycline for malaria chemoprophylaxis and treatment: report from the CDC expert meeting on malaria chemoprophylaxis." Am J Trop Med Hyg 84 (2011): 517-31
- United States National Library of Medicine "Toxnet. Toxicology Data Network. http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT" (2013):
- Sachs HC; Committee on Drugs, Frattarelli DAC, et al. "The transfer of drugs and therapeutics into human breast milk: an update on selected topics." Pediatrics 132 (2013): e796-e809
- "Product Information. Acticlate (doxycycline)." Aqua Pharmaceuticals LLC (2014):
- Melbourne: Therapeutic Guidelines Limited "eTG complete [Online] http://online.tg.org.au/complete/desktop/tgc.htm" (2015):
Minor
Vitamin C
+ Breastfeeding
The following applies to the ingredients: Ascorbic Acid (found in Vitamin C)
Professional Content
Ascorbic acid is excreted into human breast milk. The effects in the nursing infant are unknown. The manufacturer recommends that caution be used when administering ascorbic acid to nursing women.
References
- "Product Information. Cemill 500 (ascorbic acid)." Abbott Pharmaceutical PROD
Therapeutic Duplication Warnings
No warnings were found for your selected drugs.Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
Switch to: Professional Interactions
Drug Interaction Classification | |
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These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication. |
|
Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Unknown | No interaction information available. |
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