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Tetracycline: Drug information

Tetracycline: Drug information
(For additional information see "Tetracycline: Patient drug information" and see "Tetracycline: Pediatric drug information")

For abbreviations and symbols that may be used in Lexicomp (show table)
Pharmacologic Category
  • Antibiotic, Tetracycline Derivative
Dosing: Adult

Usual dosage range: Oral: 250 to 500 mg 4 times daily or 500 mg twice daily.

Acne vulgaris (moderate to severe, inflammatory):

Note: Use as an adjunct to topical acne therapy.

Oral: Initial dose: 1 g daily in divided doses; reduce gradually to 125 to 500 mg/day once improvement is noted (alternate day or intermittent therapy may be adequate in some patients). Use the shortest possible duration to minimize risk of adverse effects and development of bacterial resistance; re-evaluate at 3 to 4 months (AAD [Zaenglein 2016]).

Cholera (Vibrio cholerae), treatment (adjunctive therapy for severely ill patients):

Note: Due to resistance concerns, antimicrobial therapy during an outbreak or epidemic should be guided by local isolate susceptibility (CDC 2020b).

Oral: 500 mg 4 times daily for 3 days (Seas 1996).

Helicobacter pylori eradication (off-label use):

Bismuth quadruple regimen: Oral: 500 mg 4 times daily, in combination with standard-dose proton pump inhibitor twice daily, metronidazole 250 mg 4 times daily or 500 mg 3 or 4 times daily, and either bismuth subcitrate 120 to 300 mg 4 times daily or bismuth subsalicylate 300 to 524 mg 4 times daily; continue regimen for 10 to 14 days (ACG [Chey 2017]; Fallone 2016).

Hidradenitis suppurativa (off-label use): Oral: 500 mg twice daily (Jemec 1998).

Malaria, treatment, uncomplicated (alternative agent) (off-label use): Oral: 250 mg 4 times daily for 7 days with quinine sulfate (quinine sulfate duration is region specific). Note: If used for Plasmodium vivax or Plasmodium ovale, use this regimen in combination with primaquine (CDC 2020a).

Pityriasis lichenoides chronica (off-label use): Oral: 500 mg 4 times daily until lesions subside, followed by 250 mg 4 times daily for ≥1 month (Piamphongsant 1974).

Rosacea, moderate to severe or unresponsive to topical therapy (off-label use): Oral: 250 to 500 mg twice daily (Oge' 2015).

Syphilis, penicillin-allergic patients: Note: Limited data support use of alternatives to penicillin, and close serologic and clinical follow up is warranted (CDC [Workowski 2015]).

Early syphilis (primary, secondary, and early latent): Oral: 500 mg 4 times daily for 14 days (CDC [Workowski 2015]).

Latent syphilis (late latent): Oral: 500 mg 4 times daily for 28 days (CDC [Workowski 2015]).

Tularemia (Francisella tularensis) (mild): Oral: 500 mg 4 times daily for at least 14 days (IDSA [Stevens 2014]).

Dosing: Renal Impairment: Adult

Manufacturer’s labeling: There are no specific dosage adjustments provided in the manufacturer’s labeling; decrease dose and/or extend dosing interval.

Alternative dosing (Aronoff 2007): Note: Renally adjusted dose recommendations are based on doses of 250 mg to 500 mg twice daily to 4 times daily.

GFR >50 mL/minute: Administer recommended dose based on indication every 8 to 12 hours.

GFR 10 to 50 mL/minute: Administer recommended dose based on indication every 12 to 24 hours.

GFR <10 mL/minute: Administer recommended dose based on indication every 24 hours.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Pediatric

(For additional information see "Tetracycline: Pediatric drug information")

General dosing: Children ≥8 years and Adolescents: Oral: 6.25 to 12.5 mg/kg/dose 4 times daily; maximum dose: 500 mg/dose (Red Book [AAP 2021]; manufacturer's labeling).

Acne vulgaris (moderate to severe, inflammatory): Note: Use as an adjunct to topical acne therapy (AAD [Zaenglein 2016]; Eichenfield 2013).

Children ≥8 years and Adolescents: Oral: 500 mg twice daily (Eichenfield 2013).

Balantidium coli infection: Children ≥8 years and Adolescents: Oral: 10 mg/kg/dose 4 times daily for 10 days; maximum dose: 500 mg/dose (Red Book [AAP 2021]; CDC 2020c).

Malaria, uncomplicated; treatment: Children ≥8 years and Adolescents: Oral: 6.25 mg/kg/dose 4 times daily for 7 days; maximum dose: 250 mg/dose. Use in combination with quinine sulfate (quinine sulfate duration is region/species specific). Note: If used for Plasmodium vivax or Plasmodium ovale, use this regimen in combination with primaquine for antirelapse treatment (CDC 2020a).

Syphilis (penicillin-allergic patients): Note: Data to support the use of alternatives to penicillin are limited; close serologic and clinical follow up is warranted (CDC [Workowski 2021]).

Adolescents: Oral: 500 mg 4 times daily. Treat early syphilis (primary, secondary, and early latent) for 14 days and late latent syphilis or latent syphilis of unknown duration for 28 days (CDC [Workowski 2021]).

Dosing: Renal Impairment: Pediatric

Children ≥8 years and Adolescents: There are no specific dosage adjustments provided in the manufacturer's labeling; decrease dose and/or extend dosing interval.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Geriatric

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral, as hydrochloride:

Generic: 250 mg, 500 mg

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral, as hydrochloride:

Generic: 250 mg

Administration: Adult

Administer on an empty stomach (ie, 1 hour prior to, or 2 hours after meals) to increase total absorption and with adequate amount of fluid to reduce risk of esophageal irritation and ulceration. Administer at least 1 to 2 hours prior to, or 4 hours after antacid because aluminum and magnesium cations may chelate with tetracycline and reduce its total absorption.

Administration: Pediatric

Oral: Administer on an empty stomach (ie, 1 hour before or 2 hours after meals) to increase total absorption; give with adequate amounts of fluid to reduce risk of esophageal irritation and ulceration.

Use: Labeled Indications

Acne: Adjunctive therapy for the treatment of severe acne.

Actinomycosis: Treatment of actinomycosis caused by Actinomyces species when penicillin is contraindicated.

Anthrax: Treatment of anthrax due to Bacillus anthracis when penicillin is contraindicated.

Campylobacter: Treatment of infections caused by Campylobacter fetus.

Cholera: Treatment of cholera caused by Vibrio cholerae.

Clostridium: Treatment of infections caused by Clostridium spp. when penicillin is contraindicated.

Gram-negative infections: Treatment of infections caused by susceptible Escherichia coli, Klebsiella aerogenes (formerly Enterobacter aerogenes), Shigella spp., Acinetobacter spp., Klebsiella spp., and Bacteroides spp.

Intestinal amebiasis: Adjunctive therapy in intestinal amebiasis caused by Entamoeba histolytica.

Listeriosis: Treatment of listeriosis due to Listeria monocytogenes when penicillin is contraindicated.

Ophthalmic infections: Treatment of inclusion conjunctivitis or trachoma caused by Chlamydia trachomatis.

Relapsing fever: Treatment of relapsing fever due to Borrelia spp.

Respiratory tract infection: Treatment of respiratory tract infections caused by susceptible Haemophilus influenzae (upper respiratory tract only), Klebsiella spp. (lower respiratory tract only), Mycoplasma pneumoniae (lower respiratory tract only), Streptococcus pneumoniae, or Streptococcus pyogenes.

Rickettsial infections: Treatment of Rocky Mountain spotted fever, typhus group infections, Q fever, and rickettsialpox caused by Rickettsiae.

Sexually transmitted diseases: Treatment of lymphogranuloma venereum or uncomplicated urethral, endocervical, or rectal infections caused by C. trachomatis; chancroid caused by Haemophilus ducreyi; granuloma inguinale (donovanosis) caused by Klebsiella granulomatis; syphilis caused by Treponema pallidum, when penicillin is contraindicated.

Skin and skin structure infections: Treatment of skin and skin structure infections caused by Staphylococcus aureus or S. pyogenes.

Urinary tract infections: Treatment of urinary tract infections caused by susceptible gram-negative organisms (eg, E. coli, Klebsiella spp.).

Vincent infection: Treatment of Vincent infection caused by Fusobacterium fusiforme when penicillin is contraindicated.

Yaws: Treatment of yaws caused by Treponema pertenue when penicillin is contraindicated.

Zoonotic infections: Treatment of psittacosis (ornithosis) due to Chlamydophila psittaci; plague due to Yersinia pestis; tularemia due to Francisella tularensis; brucellosis due to Brucella spp. (in conjunction with an aminoglycoside); bartonellosis due to Bartonella bacilliformis.

Use: Off-Label: Adult

Helicobacter pylori eradication; Hidradenitis suppurativa; Malaria; Pityriasis lichenoides chronica; Rosacea

Medication Safety Issues
Sound-alike/look-alike issues:

Tetracycline may be confused with tetradecyl sulfate

Achromycin may be confused with actinomycin, Adriamycin

Pediatric patients: High-risk medication:

KIDs List: Tetracycline, when used in neonates, infants, and children <8 years of age, is identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list. In neonates, tetracycline should be used with caution due to risk of retardation of skeletal development and bone growth in premature neonates (strong recommendation; moderate quality of evidence); in infants and children <8 years of age, it should be used with caution due to risk of tooth discoloration and enamel hypoplasia (strong recommendation; high quality of evidence) (PPA [Meyers 2020]).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Pericarditis

Central nervous system: Bulging fontanel, idiopathic intracranial hypertension

Dermatologic: Erythematous rash, maculopapular rash, skin photosensitivity, urticaria

Endocrine & metabolic: Growth retardation (fibula)

Gastrointestinal: Anorexia, diarrhea, dysphagia, enterocolitis, epigastric distress, glossitis, melanoglossia, nausea, vomiting

Genitourinary: Inflammatory anogenital lesion (with monilial overgrowth)

Hematologic & oncologic: Henoch-Schonlein purpura

Hepatic: Hepatic failure, hepatotoxicity

Hypersensitivity: Anaphylaxis, angioedema, hypersensitivity reaction

Immunologic: Serum sickness-like reaction

Neuromuscular & skeletal: Exacerbation of systemic lupus erythematosus

Postmarketing: Discoloration of permanent tooth, dysgeusia (Syed 2016), enamel hypoplasia (infants, young children), eosinophilia, esophageal ulcer, esophagitis, exfoliative dermatitis, hemolytic anemia, immune thrombocytopenia, increased blood urea nitrogen, lupus-like syndrome (Lee 2013), microscopic thyroid discoloration, nail discoloration, neutropenia, onycholysis, staining of tooth (infants, young children), thrombocytopenia

Contraindications

Hypersensitivity to any of the tetracyclines or any component of the formulation.

Canadian labeling: Additional contraindications (not in US labeling): Severe liver disease; severe renal disease; use in children <12 years of age for therapy of common infections or conditions where bactericidal effect is essential (bacterial endocarditis); surgical prophylaxis; pregnancy; breastfeeding.

Warnings/Precautions

Concerns related to adverse effects:

• Increased BUN: May be associated with increases in serum urea nitrogen (BUN) secondary to antianabolic effects; use caution in patients with renal impairment.

• Intracranial hypertension (eg, pseudotumor cerebri): Intracranial hypertension (headache, blurred vision, diplopia, vision loss, and/or papilledema) has been associated with use. Women of childbearing age who are overweight or have a history of intracranial hypertension are at greater risk. Concomitant use of isotretinoin (known to cause pseudotumor cerebri [PTC]) and tetracycline should be avoided. Intracranial hypertension typically resolves after discontinuation of treatment; however, permanent visual loss is possible. If visual symptoms develop during treatment, prompt ophthalmologic evaluation is warranted. Intracranial pressure can remain elevated for weeks after drug discontinuation; monitor patients until they stabilize.

• Photosensitivity: May cause photosensitivity; discontinue if skin erythema occurs. Use skin protection and avoid prolonged exposure to sunlight; do not use tanning equipment.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including Clostridioides difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

Disease-related concerns:

• Hepatic impairment: Hepatotoxicity has been reported rarely; risk may be increased in patients with preexisting hepatic or renal impairment.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment recommended.

Special populations:

• Pediatric: May cause tissue hyperpigmentation, enamel hypoplasia, or permanent tooth discoloration; use of tetracyclines should be avoided during tooth development (children <8 years of age) unless other drugs are not likely to be effective or are contraindicated.

Other warnings/precautions:

• Appropriate use: Acne: The American Academy of Dermatology acne guidelines recommend tetracycline as adjunctive treatment for moderate and severe acne and forms of inflammatory acne that are resistant to topical treatments. Concomitant topical therapy with benzoyl peroxide or a retinoid should be administered with systemic antibiotic therapy (eg, tetracycline) and continued for maintenance after antibiotic course is completed (AAD [Zaenglein 2016]).

Warnings: Additional Pediatric Considerations

Do not use in patients <8 years of age, unless other drugs are not likely to be effective or are contraindicated, due to potential for permanent discoloration of teeth (yellow, gray, or brown); enamel hypoplasia has also been reported. Effects are more common with long-term use, but may be observed with repeated, short courses.

Bone growth suppression, as evidenced by a decrease in the fibular growth rate, has been reported in premature infants treated with tetracycline; growth restriction up to 40% has been associated with oral tetracycline therapy but is reversible when short-term treatment is discontinued. Tetracycline binds to calcium in growing bones and negatively affects calcium orthophosphate metabolism; doses of 25 mg/kg/dose every 6 hours have resulted in restricted bone growth in premature infants. Upon discontinuation of tetracycline, rapid compensatory bone growth is observed (Cohlan 1963; Cross 2016; Wormser 2019).

Metabolism/Transport Effects

Substrate of CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Antacids: May decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Monitor for decreased therapeutic effects of tetracyclines. Risk D: Consider therapy modification

Atovaquone: Tetracycline (Systemic) may decrease the serum concentration of Atovaquone. Risk C: Monitor therapy

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Bile Acid Sequestrants: May decrease the absorption of Tetracyclines. Risk C: Monitor therapy

Bismuth Subcitrate: May decrease the serum concentration of Tetracyclines. Management: Avoid administration of oral tetracyclines within 30 minutes of bismuth subcitrate administration. This is of questionable significance for at least some regimens intended to treat H. pylori infections. Risk D: Consider therapy modification

Bismuth Subsalicylate: May decrease the serum concentration of Tetracyclines. Management: Consider dosing tetracyclines 2 hours before or 6 hours after bismuth. The need to separate doses during Helicobacter pylori eradication regimens is questionable. Risk D: Consider therapy modification

Calcium Salts: May decrease the serum concentration of Tetracyclines. Management: If coadministration of oral calcium with oral tetracyclines cannot be avoided, consider separating administration of each agent by several hours. Risk D: Consider therapy modification

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Iron Preparations: Tetracyclines may decrease the absorption of Iron Preparations. Iron Preparations may decrease the serum concentration of Tetracyclines. Management: Avoid this combination if possible. Administer oral iron preparations at least 2 hours before, or 4 hours after, the dose of the oral tetracycline derivative. Monitor for decreased therapeutic effect of oral tetracycline derivatives. Risk D: Consider therapy modification

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Lanthanum: May decrease the serum concentration of Tetracyclines. Management: Administer oral tetracycline antibiotics at least two hours before or after lanthanum. Risk D: Consider therapy modification

Lithium: Tetracyclines may increase the serum concentration of Lithium. Risk C: Monitor therapy

Magnesium Dimecrotate: May interact via an unknown mechanism with Tetracyclines. Risk C: Monitor therapy

Magnesium Salts: May decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Risk D: Consider therapy modification

Mecamylamine: Tetracyclines may enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination

Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy

Methoxyflurane: Tetracyclines may enhance the nephrotoxic effect of Methoxyflurane. Risk X: Avoid combination

Mipomersen: Tetracyclines may enhance the hepatotoxic effect of Mipomersen. Risk C: Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease the serum concentration of Tetracyclines. Management: Avoid this combination if possible. If coadministration cannot be avoided, administer the polyvalent cation-containing multivitamin at least 2 hours before or 4 hours after the tetracycline derivative. Monitor for decreased tetracycline effects. Risk D: Consider therapy modification

Multivitamins/Minerals (with AE, No Iron): May decrease the serum concentration of Tetracyclines. Management: If coadministration of a polyvalent cation-containing multivitamin with oral tetracyclines cannot be avoided, administer the polyvalent cation-containing multivitamin either 2 hours before or 4 hours after the tetracycline product. Risk D: Consider therapy modification

Neuromuscular-Blocking Agents: Tetracyclines may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Penicillins: Tetracyclines may diminish the therapeutic effect of Penicillins. Risk C: Monitor therapy

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Quinapril: May decrease the serum concentration of Tetracyclines. Risk C: Monitor therapy

QuiNINE: Tetracycline (Systemic) may increase the serum concentration of QuiNINE. Risk C: Monitor therapy

Retinoic Acid Derivatives: Tetracyclines may enhance the adverse/toxic effect of Retinoic Acid Derivatives. The development of pseudotumor cerebri is of particular concern. Risk X: Avoid combination

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Strontium Ranelate: May decrease the serum concentration of Tetracyclines. Management: In order to minimize any potential impact of strontium ranelate on tetracycline antibiotic concentrations, it is recommended that strontium ranelate treatment be interrupted during tetracycline therapy. Risk X: Avoid combination

Sucralfate: May decrease the absorption of Tetracyclines. Management: Administer most tetracycline derivatives at least 2 hours prior to sucralfate in order to minimize the impact of this interaction. Administer oral omadacycline 4 hours prior to sucralfate. Risk D: Consider therapy modification

Sucroferric Oxyhydroxide: May decrease the serum concentration of Tetracyclines. Management: Administer oral/enteral doxycycline at least 1 hour before sucroferric oxyhydroxide. Specific dose separation guidelines for other tetracyclines are not presently available. No interaction is anticipated with parenteral administration of tetracyclines. Risk D: Consider therapy modification

Sulfonylureas: Tetracyclines may enhance the hypoglycemic effect of Sulfonylureas. Risk C: Monitor therapy

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Tetracyclines may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Zinc Salts: May decrease the absorption of Tetracyclines. Only a concern when both products are administered orally. Management: Separate administration of oral tetracycline derivatives and oral zinc salts by at least 2 hours to minimize this interaction. Risk D: Consider therapy modification

Food Interactions

Serum concentrations may be decreased if taken with dairy products. Management: Take on an empty stomach 1 hour before or 2 hours after meals to increase total absorption. Administer around-the-clock to promote less variation in peak and trough serum levels.

Pregnancy Considerations

Tetracycline crosses the placenta (Leblanc 1967). Tetracyclines accumulate in developing teeth and long tubular bones (Mylonas 2011). Permanent discoloration of teeth (yellow, gray, brown) can occur following in utero exposure and is more likely to occur following long-term or repeated exposure. The pharmacokinetics of tetracycline are not altered in pregnant patients with normal renal function (Whalley 1966; Whalley 1970). Hepatic toxicity during pregnancy, potentially associated with tetracycline use, has been reported. Pregnant women with renal disease may be more likely to develop hepatic failure with tetracycline use.

As a class, tetracyclines are generally considered second-line antibiotics in pregnant women and their use should be avoided (Mylonas 2011). Many guidelines consider use of tetracycline to be contraindicated during pregnancy, or to be a relative contraindication in pregnant women if other agents are available and appropriate for use (CDC 2020a; CDC [Anderson 2013]; CDC [Workowski 2015]; HHS [OI adult 2020]; IDSA [Stevens 2014]). When systemic antibiotics are needed for acne or dermatologic conditions in pregnant women, other agents are preferred (AAD [Zaenglein 2016]; Murase 2014).

Breast-Feeding Considerations

Tetracycline is excreted into breast milk (Knowles 1965; Matsuda 1984).

According to the manufacturer, the decision to continue or discontinue breastfeeding during therapy should consider the risk of exposure to the infant and the benefits of treatment to the mother. The calcium in the maternal milk is expected to decrease the amount of tetracycline absorbed by the breastfeeding infant (Chung 2002).

As a class, tetracyclines have generally been avoided in nursing women due to theoretical concerns that they may permanently stain the teeth of the breastfeeding infant (Chung 2002). Some sources note that breastfeeding can continue during tetracycline therapy (Chung 2002; WHO 2002) but recommend use of alternative medications when possible (WHO 2002). Breastfeeding is not recommended when tetracycline is being used for maternal treatment of acne (AAD [Zaenglein 2016]. In general, antibiotics that are present in breast milk may cause nondose-related modification of bowel flora. Monitor infants for GI disturbances (Chung 2002; WHO 2002).

Dietary Considerations

Take on an empty stomach (ie, 1 hour prior to, or 2 hours after meals). Take at least 1-2 hours prior to, or 4 hours after antacid.

Monitoring Parameters

Renal, hepatic, and hematologic function test, temperature, WBC, cultures and sensitivity, appetite, mental status

Mechanism of Action

Inhibits bacterial protein synthesis by binding with the 30S and possibly the 50S ribosomal subunit(s) of susceptible bacteria; may also cause alterations in the cytoplasmic membrane

Pharmacodynamics and Pharmacokinetics

Absorption: Oral: 77% to 88% (Agwuh 2006); IM: Poor, with less than 60% of dose absorbed

Distribution: Widely distributed to most body fluids and tissues including ascitic, synovial and pleural fluids; bronchial secretions; poor penetration into CSF

Protein binding: 55% to 64% (Agwuh 2006)

Half-life elimination: 6 to 11 hours (Agwuh 2006)

Time to peak, serum: Oral: 2 to 4 hours (Agwuh 2006)

Excretion: Urine (30%); feces (20% to 60%) (Agwuh 2006)

Pharmacodynamics and Pharmacokinetics: Additional Considerations

Renal function impairment: Because renal Cl is by glomerular filtration, excretion is significantly affected by the state of renal function.

Pricing: US

Capsules (Tetracycline HCl Oral)

250 mg (per each): $7.88

500 mg (per each): $15.75 - $15.76

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • A tetra (BD);
  • Achromycin (AE, CY, IN, IQ, IR, JO, JP, KW, LY, OM, PK, SA, SY, YE, ZA);
  • Achromycin V (AE, CY, IQ, IR, JO, JP, KW, LY, OM, SA, SY, YE);
  • Aclocin (BD);
  • Acromicina (CR, DO, GT, HN, MX, NI, PA, SV);
  • Alexcyclin (EG);
  • Ambramicina (CO, IT);
  • Apocyclin (FI);
  • Atron (BD);
  • Beatacycline (MY, SG);
  • Berciclina (MX);
  • Biotine (SG);
  • Bocycline (TW);
  • Cadicycline (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW);
  • Ciclotetryl (AR);
  • Cinatrex (BR);
  • Clincor (VE);
  • Cyclabid (ZA);
  • Dhatracin (SG);
  • Dicyclin Forte (IN);
  • Dumocycline (SA);
  • Eapatet (ET);
  • Emcycline (LK);
  • Erifor (MX);
  • Hostacyclin (GR);
  • Hostacycline (IN, ZA);
  • Hostacycline-P (ZA);
  • Hydromycin (TH);
  • Ibicyn (TW);
  • Imex (BG, DE, EE, GR, KR, LT, TR, TW);
  • Latycin (AE, CY, IQ, IR, JO, KW, LY, OM, SA, SY, YE);
  • Lenocin (TH);
  • Medocycline (HK);
  • Mephicycline (LB);
  • Metacycline (LK);
  • Ophth-tetracil (PK);
  • Opticyclin (AE);
  • Oricyclin (FI);
  • Panmycin (AE, CY, IQ, IR, JO, KW, LY, MY, OM, SA, SY, YE);
  • Pantocycline (TH);
  • Quemiciclina-S (PE);
  • Recycline (IL);
  • Resteclin (IN);
  • Rimatet (AE, BB, BF, BJ, BM, BS, BZ, CI, CY, ET, GH, GM, GN, GY, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, PR, QA, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, YE, ZM, ZW);
  • Servitet (MY);
  • Steclin V (ZA);
  • Subamycin (IN);
  • Tc (PL);
  • Tefilin (DE);
  • Teracin (AE, QA);
  • Tetrabiotico (EC);
  • Tetrachem (LK);
  • Tetracid (EG);
  • Tetraciklins (LV);
  • Tetracilin (PY);
  • Tetracin (BD);
  • Tetracyclinum (PL);
  • Tetradar (SA);
  • Tetralan (PE);
  • Tetramed (LB);
  • Tetramin (BD);
  • Tetran (LB);
  • Tetrana (TH);
  • Tetrarco (AE, NL);
  • Tetras (ET);
  • Tetraseptin (CH);
  • Tetrasuiss (AE, BB, BF, BJ, BM, BS, BZ, CI, CY, ET, GH, GM, GN, GY, IQ, IR, JM, JO, KE, KW, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, PR, SA, SC, SD, SL, SN, SR, SY, TN, TT, TZ, UG, YE, ZM, ZW);
  • Tetrecu (EC);
  • Tetret-250 (LK);
  • Tetrex (AE, BH, BR, CR, CY, DO, GT, HN, IQ, IR, JO, JP, KW, LY, MX, NI, OM, PA, SA, SV, SY, YE, ZA);
  • Tetrm (BD);
  • Tetrop (LK);
  • Tevacycline (IL);
  • Traxetrine (PH);
  • Ttmycin (TW);
  • Wintel (TW);
  • Xepacycline (SG)


For country abbreviations used in Lexicomp (show table)

REFERENCES

  1. Agwuh K, MacGowan A. Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines. J Antimicrob Chemother. 2006;58(2):256-265. [PubMed 16816396]
  2. American Academy of Pediatrics (AAP). In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021.
  3. American Academy of Pediatrics, Committee on Drugs. Requiem for Tetracyclines. Pediatrics. 1975;55(1):142-143. [PubMed 122864]
  4. Anderson A, Bijlmer H, Fournier PE, et al. Diagnosis and management of Q fever--United States, 2013: recommendations from CDC and the Q Fever Working Group. MMWR Recomm Rep. 2013;62(RR-03):1-30. [PubMed 23535757]
  5. Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. American College of Physicians; 2007.
  6. Centers for Disease Control and Prevention (CDC). Parasites - balantidiasis (also known as Balantidium coli infection): resources for health professionals. https://www.cdc.gov/parasites/balantidium/health_professionals/index.html. Last reviewed May 20, 2020c. Accessed September 10, 2021.
  7. Centers for Disease Control and Prevention (CDC). Treatment of malaria: guidelines for clinicians (United States). https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html. Updated May 29, 2020a. Accessed June 8, 2020.
  8. Centers for Disease Control and Prevention (CDC). Treatment of malaria: guidelines for clinicians (United States). https://www.cdc.gov/cholera/treatment/antibiotic-treatment.html. Updated October 2, 2020b. Accessed May 10, 2021.
  9. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212-239. doi:10.1038/ajg.2016.563 [PubMed 28071659]
  10. Chey WD, Wong BC; Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102(8):1808-1825. doi:10.1111/j.1572-0241.2007.01393.x [PubMed 17608775]
  11. Chung AM, Reed MD, Blumer JL. Antibiotics and breast-feeding: a critical review of the literature. Paediatr Drugs. 2002;4(12):817-837. [PubMed 12431134]
  12. Cohlan SQ, Bevelander G, Tiamsic T. Growth inhibition of prematures receiving tetracycline: a clinical and laboratory investigation of tetracycline-induced bone fluorescence. AMA Am J Dis Child. 1963;105:453-461.
  13. Coronado BE, Opal SM, Yoburn DC. Antibiotic-Induced D-Lactic Acidosis. Ann Intern Med. 1995;122(11):839-842. [PubMed 7741368]
  14. Cross R, Ling C, Day NP, McGready R, Paris DH. Revisiting doxycycline in pregnancy and early childhood--time to rebuild its reputation?. Expert Opin Drug Saf. 2016;15(3):367-382. doi:10.1517/14740338.2016.1133584 [PubMed 26680308]
  15. Cuddihy J. Case Report of Benign Intra-cranial Hypertension Secondary to Tetracycline. Ir Med J. 1994;87(3):90. [PubMed 8056550]
  16. Del Rosso JQ, Tanghetti E, Webster G, Stein Gold L, Thiboutot D, Gallo RL. Update on the management of rosacea from the American Acne & Rosacea Society (AARS). J Clin Aesthet Dermatol. 2019;12(6):17-24. [PubMed 31360284]
  17. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131(suppl 3):S163-186. [PubMed 23637225]
  18. Fox SA, Berenyi MR, Straus B. Tetracycline Toxicity Presenting as a Multisystem Disease. Mt Sinai J Med. 1976;43(2):129-135. [PubMed 130551]
  19. Gardner K, Cox T, Digre KB. Idiopathic Intracranial Hypertension Associated With Tetracycline Use in Fraternal Twins: Case Reports and Review. Neurology. 1995;45(1):6-10. [PubMed 7824136]
  20. Gordon JM, Walker CB. Current Status of Systemic Antibiotic Usage in Destructive Periodontal Disease. J Periodontol. 1993;64(8)(suppl):760-771. [PubMed 8410616]
  21. Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 1998;39(6):971-974. doi:10.1016/s0190-9622(98)70272-5 [PubMed 9843011]
  22. Knowles JA. Excretion of drugs in milk – a review. J Pediatr. 1965;66(6):1068-1082. [PubMed 14288461]
  23. Leblanc AL, Perry JE. Transfer of Tetracycline Across the Human Placenta. Tex Rep Biol Med. 1967;25(4):541-545. [PubMed 5625449]
  24. Lee AG. Pseudotumor Cerebri After Treatment With Tetracycline and Isotretinoin for Acne. Cutis. 1995;55(3):165-168. [PubMed 7634848]
  25. Lee SH, Yoon J, Kim TH, Um SH, Yoon TJ. Systemic lupus erythematosus induced by tetracycline. Int J Dermatol. 2013;52(2):257-258. [PubMed 22171784]
  26. Maroon JC, Mealy J Jr. Benign Intracranial Hypertension. Sequel to Tetracycline Therapy in a Child. JAMA. 1979;216(9):1479-1480. [PubMed 5108523]
  27. Matsuda S. Transfer of Antibiotics Into Maternal Milk. Biol Res Pregnancy Perinatol. 1984;5(2):57-60. [PubMed 6743732]
  28. Meyers RS, Thackray J, Matson KL, et al. Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List. J Pediatr Pharmacol Ther. 2020;25(3):175-191. [PubMed 32265601]
  29. Mitrano JA, Spooner LM, Belliveau P. Excretion of Antimicrobials Used to Treat Methicillin-Resistant Staphylococcus aureus Infections During Lactation: Safety in Breastfeeding Infants. Pharmacotherapy. 2009;29(9):1103-1109. [PubMed 19698015]
  30. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: part I. Pregnancy. J Am Acad Dermatol. 2014;70(3):1-14. [PubMed 24528911]
  31. Mylonas I. Antibiotic Chemotherapy During Pregnancy and Lactation Period: Aspects for Consideration. Arch Gynecol Obstet. 2011;283(1):7-18. [PubMed 20814687]
  32. Oge' LK, Muncie HL, Phillips-Savoy AR. Rosacea: diagnosis and treatment. Am Fam Physician. 2015;92(3):187-196. [PubMed 26280139]
  33. Piamphongsant T. Tetracycline for the treatment of pityriasis lichenoides. Br J Dermatol. 1974;91(3):319-322. doi:10.1111/j.1365-2133.1974.tb12902.x [PubMed 4154770]
  34. Rams TE, Slots J. Antibiotics in periodontal therapy: an update. Compendium. 1992;13(12):1130, 1132, 1134. [PubMed 1298559]
  35. Sargent E. Tetracycline for Seal Finger. JAMA. 1980;244(5):437.
  36. Seas C, DuPont HL, Valdez LM, Gotuzzo E. Practical guidelines for the treatment of cholera. Drugs. 1996;51(6):966-973. [PubMed 8736618]
  37. Seymour RA, Heasman PA. Pharmacological Control of Periodontal Disease. II. Antimicrobial Agents. J Dent. 1995;23(1):5-14 [PubMed 7876417]
  38. Seymour RA, Heasman PA. Tetracyclines in the Management of Periodontal Diseases. A Review. J Clin Periodontol. 1995;22(1):22-35. [PubMed 7706536]
  39. Smilack JD, Wilson WR, Cockerill FR 3rd. Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole. Mayo Clin Proc. 1991;66(12):1270-1280. [PubMed 1749296]
  40. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-e52. doi:10.1093/cid/ciu444 [PubMed 24973422]
  41. Syed Q, Hendler KT, Koncilja K. The impact of aging and medical status on dysgeusia. Am J Med. 2016;129(7):753. [PubMed 26899755]
  42. Tetracycline hydrochloride [prescribing information]. Congers, NY: Chartwell Pharmaceuticals LLC; February 2021.
  43. Tetracycline hydrochloride capsules [prescribing information]. Bridgewater, NJ: Amneal Pharmaceuticals LLC; March 2018.
  44. Tetracycline hydrochloride capsules [product monograph]. Vaughan, Ontario, Canada: AA Pharma Inc; January 2019.
  45. US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed May 5, 2020.
  46. Walters BN, Gubbay SS. Tetracycline and Benign Intracranial Hypertension: Report of Five Cases. Br Med J (Clin Res Ed). 1981;282(6257):19-20.
  47. Wandstrat TL, Phillips J. Pseudotumor Cerebri Responsive to Acetazolamide. Ann Pharmacother. 1995;29(3):318.
  48. Whalley PJ, Adams RH, Combes B. Tetracycline Toxicity in Pregnancy. Liver and Pancreatic Dysfunction. JAMA. 1964;189:357-362. [PubMed 14160508]
  49. Whalley PJ, Martin FG, Adams RH, et al. Disposition of Tetracycline By Pregnant Women With Acute Pyelonephritis. Obstet Gynecol. 1970;36(6):821-826. [PubMed 5487732]
  50. Whalley PJ, Martin FG, Adams RH, et al. Tetracycline Disposition in Normal Pregnancy. Obstet Gynecol. 1966;28(1):103-111. [PubMed 5940450]
  51. Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137. [PubMed 26042815]
  52. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]
  53. World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the Eleventh WHO Model List of Essential Drugs. 2002. http://www.who.int/maternal_child_adolescent/documents/55732/en/
  54. Wormser GP, Wormser RP, Strle F, Myers R, Cunha BA. How safe is doxycycline for young children or for pregnant or breastfeeding women? Diagn Microbiol Infect Dis. 2019;93(3):238-242. doi:10.1016/j.diagmicrobio.2018.09.015 [PubMed 30442509]
  55. Yoshikawa TT. Antimicrobial Therapy for the Elderly Patient. J Am Geriatr Soc. 1990;38(12):1353-1372. [PubMed 2254575]
  56. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.e33. http://www.jaad.org/article/S0190-9622(15)02614-6/pdf. Accessed June 13, 2016. [PubMed 26897386]
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