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Haemodialysis does not alter the serum half-life of doxycycline. Studies to date indicate that this anti-anabolic effect does not occur with the use of Doxycycline in patients with impaired renal function. The use of antibiotics may occasionally result in overgrowth of non-susceptible organisms including Candida. If a resistant organism appears, the antibiotic should be discontinued and appropriate therapy instituted. It is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents.

Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C difficile. Hypertoxin producing strains of C. CDAD should be considered in all patients who present with diarrhoea after antibiotic treatment. Most of these patients took medications immediately before going to bed or with inadequate amounts of fluid. These conditions disappeared rapidly when the drug was discontinued. When treating venereal disease, where co-existent syphilis is suspected, proper diagnostic procedures, including dark-field examinations, should be utilised.

Due to a potential for weak neuromuscular blockade, care should be taken in administering tetracyclines to patients with myasthenia gravis. Patients should be reassured that this is a usually self-limiting consequence of antibiotic treatment of spirochete infections. Tetracyclines depress plasma prothrombin activity and reduced dosage of concomitant anti-coagulants may be necessary. The absorption of doxycycline may be impaired by concurrently administered antacids containing aluminium, calcium, magnesium or other drugs containing these cations; oral zinc, iron salts or bismuth preparations.

Dosages should be maximally separated. Phenobarbital, carbamazepine, primidone and phenytoin may increase the metabolism of doxycycline reduced half-life. An increase in the daily dosage of doxycycline should be considered. Doxycycline may increase the plasma concentration of ciclosporin. Co-administration should only be undertaken with appropriate monitoring.

Drugs that induce hepatic enzymes such as rifampicin may accelerate the decomposition of doxycycline, thereby decreasing its half-life. Sub-therapeutic doxycycline concentrations may result. Monitoring concurrent use is advised and an increase in doxycycline dose may be required. There is a possible increased risk of benign intra-cranial hypertension when doxycycline given with retinoids. Concomitant use should be avoided. Antibacterials inactivate oral typhoid vaccines.

Avoid administration of vaccine during treatment with doxycycline.

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