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Tetracycline: Drug information

Tetracycline: Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Tetracycline: Patient drug information" and "Tetracycline: Pediatric drug information"

For abbreviations, symbols, and age group definitions 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, inflammatory, moderate to severe

Acne vulgaris, inflammatory, moderate to severe:

Note: Use in combination with topical acne therapy (Ref).

Oral: 500 mg twice daily. Treatment should ideally be limited to 3 to 4 months to minimize the risk of resistance (Ref).

Cholera, treatment

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 (Ref).

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

Helicobacter pylori eradication

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 (Ref).

Hidradenitis suppurativa

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

Malaria, treatment, uncomplicated

Malaria, treatment, uncomplicated (alternative agent) (off-label use): Oral: 250 mg 4 times daily for 7 days as part of an appropriate combination regimen. Note: If used for Plasmodium vivax or Plasmodium ovale, use this regimen in combination with primaquine (Ref).

Pityriasis lichenoides chronica

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 (Ref).

Plague

Plague ( Yersinia pestis ) (alternative agent):

Note: Consult public health officials for event-specific recommendations.

Postexposure prophylaxis: Oral: 500 mg every 6 hours for 7 days (Ref).

Treatment, bubonic or pharyngeal: Oral: 500 mg every 6 hours for 10 to 14 days and for at least a few days after clinical resolution (Ref).

Rosacea, moderate to severe or unresponsive to topical therapy

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

Syphilis

Syphilis (alternative agent for nonpregnant patients with penicillin allergy):

Note: Limited data support use of tetracycline as an alternative to penicillin, and close serologic and clinical follow-up is warranted; some experts prefer other alternative agents (eg, ceftriaxone, doxycycline) (Ref).

Early syphilis (primary, secondary, and early latent [<1-year duration]): Oral: 500 mg 4 times daily for 14 days (Ref).

Late latent syphilis (>1-year duration): Oral: 500 mg 4 times daily for 28 days (Ref).

Tularemia

Tularemia (Francisella tularensis) (mild): Oral: 500 mg 4 times daily for at least 14 days (Ref).

Dosing: Kidney 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 (Ref): 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: Older Adult

Refer to adult dosing.

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 (Ref).

Acne vulgaris

Acne vulgaris (moderate to severe, inflammatory): Note: Use as an adjunct to topical acne therapy (Ref).

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

Balantidium coli infection

Balantidium coli infection: Children ≥8 years and Adolescents: Oral: 10 mg/kg/dose 4 times daily for 10 days; maximum dose: 500 mg/dose (Ref).

Malaria, uncomplicated, treatment

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 (Ref).

Syphilis

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

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 (Ref).

Dosing: Kidney 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.

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults and pediatrics, unless otherwise noted.

Frequency not defined:

Cardiovascular: Pericarditis

Dermatologic: Erythematous rash, maculopapular rash, skin photosensitivity

Gastrointestinal: Anorexia, Clostridioides difficile-associated diarrhea, diarrhea, dysphagia, enterocolitis, epigastric discomfort, glossitis, melanoglossia, nausea, vomiting

Genitourinary: Inflammatory anogenital lesion (with monilial overgrowth)

Hematologic & oncologic: Henoch-Schonlein purpura

Hepatic: Hepatic failure, hepatotoxicity

Immunologic: Serum sickness-like reaction

Neuromuscular & skeletal: Exacerbation of systemic lupus erythematosus

Postmarketing:

Dermatologic: Exfoliative dermatitis, nail discoloration (Demers 1968), onycholysis (Demers 1968)

Endocrine & metabolic: Microscopic thyroid discoloration

Gastrointestinal: Discoloration of permanent tooth (infants, young children) (Demers 1968), dysgeusia (Syed 2016), enamel hypoplasia (infants, young children) (Demers 1968), esophageal ulcer (Channer 1981), esophagitis (Agha 1986), pancreatitis (Torosis 1987)

Genitourinary: Balanitis (Dodds 1985)

Hematologic & oncologic: Aplastic anemia (Lehrner 1979), eosinophilia, hemolytic anemia, immune thrombocytopenia, neutropenia, thrombocytopenia

Hypersensitivity: Hypersensitivity reaction (including anaphylaxis and angioedema) (Ogita 2011; Steinbruegge 1980), nonimmune anaphylaxis (Barnett 1967)

Nervous system: Intracranial hypertension (Walters 1981)

Neuromuscular & skeletal: Abnormal bone growth (fibula; premature infants) (Demers 1968), lupus-like syndrome (Lee 2013)

Ophthalmic: Conjunctival discoloration (bulbar pigment deposits) (Morrison 2005)

Renal: Increased blood urea nitrogen (Pothier 1966)

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).

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

Tablet, Oral, as hydrochloride:

Generic: 250 mg, 500 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Tetracycline HCl Oral)

250 mg (per each): $7.88

500 mg (per each): $15.75

Tablets (Tetracycline HCl Oral)

250 mg (per each): $50.00

500 mg (per each): $50.00

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.

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

Oral: 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 vulgaris, inflammatory, moderate to severe: 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 infections: 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, treatment; 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]).

Metabolism/Transport Effects

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

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

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

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

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

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

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 2 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

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

Mycophenolate: Antibiotics may decrease serum concentrations of the active metabolite(s) of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor therapy

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

Polyethylene Glycol-Electrolyte Solution: May decrease the absorption of Tetracyclines. Management: Give oral tetracyclines at least 2 hours before or at least 6 hours after polyethylene glycol-electrolyte solutions that contain magnesium sulfate (Suflave brand). Other products without magnesium do not require dose separation. Risk D: Consider therapy modification

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 Bicarbonate (Systemic): May decrease the serum concentration of Tetracyclines. Risk C: Monitor therapy

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 patients 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 patients 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 patients if other agents are available and appropriate for use (CDC 2023; CDC [Anderson 2013]; IDSA [Stevens 2014]). When systemic antibiotics are needed for acne or dermatologic conditions in pregnant patients, other agents are preferred (AAD [Zaenglein 2016]; Murase 2014). Tetracycline may be used as an alternative antibiotic for pre- and post-exposure prophylaxis in pregnant patients exposed to Y. pestis (CDC [Nelson 2021]).

Breastfeeding Considerations

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

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). The calcium in the maternal milk is expected to decrease the amount of tetracycline absorbed by the breastfeeding infant (Chung 2002).

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. As a class, tetracyclines have generally been avoided in nursing patients 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]).

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

Pharmacokinetics (Adult Data Unless Noted)

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)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

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

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Achromycin | Achromycin v | Ambramycin | Dumocycline | Grocycline | Ibicyn | Micycline | Servitet | Tetracycline Julphar | Tetradar | Tetrarco | Tetrex;
  • (AR) Argentina: Tetraciclina omega;
  • (AU) Australia: Achromycin | Achromycin v | Mysteclin | Tetracycline | Tetrex;
  • (BD) Bangladesh: A-Tetra | Aristodox | Atron | Capta | Cremycin | Decacycline | Hostacycline | Jmycin | Jp tetra | Minocin | Monatrex | Omnimycin | S-tetracycline | Taracycline | Tc | Teracilin | Tetclin | Tetrac | Tetracal | Tetracil | Tetracin | Tetracline | Tetracycline | Tetracycline-H | Tetracyn | Tetrafen | Tetragen | Tetram | Tetramed | Tetramet | Tetramycin | Tetrasina | Tetrasis | Tetraskylin | Tetrax;
  • (BG) Bulgaria: Tetracyclin;
  • (BR) Brazil: Aureciclina | Cloridrato de tetraciclina | Infex | Multigram | Parenzyme tetraciclina | Statinclyne | Telexin | Teraciton | Tetracaps | Tetraciclina | Tetracilil | Tetracina | Tetraclin | Tetraklin | Tetramax | Tetramed | Tetramicin | Tetraspis | Tetraxil | Tetrex | Treciclin;
  • (CI) Côte d'Ivoire: Apo-tetra;
  • (CL) Chile: Acromicina | Hostaciclina | Tetraciclina;
  • (CN) China: Jin jing kang | Tetracycline | Tetyacycline hydrochloride;
  • (CO) Colombia: Ambramicina | Pirocyclina | Servitet | Tetraciclina;
  • (CZ) Czech Republic: Rimatet | Tetracyclin;
  • (DE) Germany: Achromycin | Hostacyclin | Tefilin | Tetracyclin | Tetralution;
  • (DO) Dominican Republic: Tetraciclina | Tetrafarma;
  • (EC) Ecuador: Tetrabiotico | Tetraciclina | Tetraciclina ariston | Tetraciclina clorhidrato | Tetraciclina MK | Tetrecu | Tetrex;
  • (EE) Estonia: Apo-tetra | Panmycin | Tetraciclina atb | Tetracyclin | Tetracyklin;
  • (EG) Egypt: Micycline | Tetracid | Tetracycline;
  • (ES) Spain: Quimpe antibiotico;
  • (FI) Finland: Medicyclin | Salcyclin | Tesyklin | Tetracyclin;
  • (GB) United Kingdom: Economycin | Steclin | Sustamycin | Tetrabid | Tetracycline berk | Tetracycline sus | Tetracyn | Totomycin;
  • (HK) Hong Kong: Achromycin | Akotid | Apo-tetra | Medocycline | Meyercycline | Qualitetra | Setrocin | Tetracin | Tetracline | Tetracycline | Tetracycline HCL;
  • (HU) Hungary: Tetracyclin Wolff;
  • (ID) Indonesia: Achromycin | Altetra | Arsilin | Bimatra | Bufacyn | Camicycline | Centraclin | Citocycline | Combicyclin | Conmycin | Corocyclin | Dantetra | Decacycline | Decycline | Dumocycline | Enkacyclin | Erlacycline | Farsyclin | Gametra | Hitetra | Hufacyclin | Ikacyclin | Itracycline | Kalcyclin | Kemoclin | Lanacycline | Librocyn | Licoklin | Megacycline | Novabiotic | Ottocyclin | Pharocycline | Ramatetra | S-meprotetra | Sakacyclin | Samtetra | Sanlin | Scantetra | Sinacyclin | Soltralin | Steclin | Super tetra | Suprabiotic | Tetra | Tetrabiotic | Tetracycline | Tetradex | Tetramet | Tetraped | Tetrarco | Tetrin | Trifamycetin | Unicycline | Varcycline | Wiclin | Xepacyclin | Zenicyclin;
  • (IE) Ireland: Achromycin;
  • (IL) Israel: Tevacycline;
  • (IN) India: Achromycin | Acrocycline | Dicicyclin | Getra | Hostacycline | Larcyclin | Lupiterra | Lykaclin | Rancyclin | Rancycline | Resteclin | Subamycin | Tera-Cap | Teralin | Terapal | Tetlin | Tetrabact | Tetrac | Tetracycline | Tetracycline HCL | Tetrakem | Tetrasain | Tetrastar | Tritetra | Wocycline;
  • (IQ) Iraq: Samacycline;
  • (IT) Italy: Ambramicina;
  • (JO) Jordan: Dumocycline | Tetradar;
  • (JP) Japan: Achromycin | Achromycin v | Brisai tx | Cytome | Junmycin v | Neocycline | Panmycin p | Tetracycline hcl organon | Tetracycline hcl taisho | Tetracycline v daiichi | Tetralysal;
  • (KE) Kenya: Biotet | Probax | Racycline | Tetracin | Tetracycline | Tetraline | Tetramed;
  • (KR) Korea, Republic of: Teracyclin | Tetracycline;
  • (LB) Lebanon: Mephicycline | Tetracycline | Tetramed;
  • (LT) Lithuania: Tetracyclin | Tetracyclin Wolff;
  • (LV) Latvia: Tetracyclin | Tevacycline;
  • (MX) Mexico: Ambotetra | Educiclina | Erifor | Livitex | Oxi-t | Quimocyclar | Senociclin | Tetra atlantis | Tetra Zil | Tetraciclina Arlex | Tetraciclina gi se | Tetrerba | Tetrex | Tromicol;
  • (MY) Malaysia: Axcel tetracycline | Beatacycline | Dhatracin | Latycin | Panmycin | Pharmycin | Setrocin | Super tetra | Tetra | Tetracap | Tetracin | Tetracycla | Tetracycline | Tracyne | Triomycin | Vemyclin | Xepacycline;
  • (NG) Nigeria: Maxcyclin | Naptrene | Vadicycllin;
  • (NL) Netherlands: Tetracycline HCL;
  • (NO) Norway: Tetracyclin | Tetracycline HCL;
  • (NZ) New Zealand: Panmycin;
  • (PE) Peru: Hostaciclina | Orencyclin f-500 | Quemiciclina-s | Tetraciclina | Tetralan | Tetranase;
  • (PH) Philippines: Cherrylex | Dli-tetracycline hcl | Gli-tetracycline | Moncycline | Tetracycline | Traxetrine | Tricor | Unimycin | Zetra;
  • (PK) Pakistan: Achromycin | Dosamycin | Novocin | Tetracycline | Tetramaz;
  • (PR) Puerto Rico: Achromycin | Achromycin v | Ala-tet | Sumycin | Tetracycline HCL;
  • (PT) Portugal: Ambramicina | Neociclina | Neociclina vitamin | Tetraciclina;
  • (PY) Paraguay: Tetraciclina | Tetracilin;
  • (QA) Qatar: Cyclovin;
  • (RO) Romania: Tetracyclin k;
  • (RU) Russian Federation: Tetracyclin;
  • (SA) Saudi Arabia: Dumocycline | Tetracyclin;
  • (SG) Singapore: Beatacycline | Dhatracin | Erlimycin | Hostacycline | Latycin | Pharmycin | Super tetra | Tetracycline | Tetracycline HCL | Vemyclin | Xepacycline;
  • (SK) Slovakia: Tetracyclin k;
  • (TH) Thailand: A.d.mycin | Acnicin | Acnicin t1 | Acnicin T9 | Ambritrex | Amtrax | Bomcin | Boramycin Phosphate | Cotrex | Dada mycin | Detra | Forbiotin | Forcycline | Gano | Ganospec | Hawkmycin | Heromycin | Kentra | Lenocin | Liwinnermycin | Macmycin | Manocycline | Medicline | Moderncycline | N.L.Mycin | Naptrax | Nidacycline | Pannacycline | Pantocycline | Piccomycin | Pincycline | Pondnatrex | Servitet | Starmycin | Tc-mycin | Tephos | Tetexcin | Tetra | Tetra central | Tetracin | Tetracycline | Tetracyline hcl | Tetrafet | Tetralim | Tetraman | Tetrano | Tetraphos | Tilan mycin | Trex | Utomycin;
  • (TR) Turkey: Tetra | Tetramin;
  • (TW) Taiwan: Achromycin | Bilimycin | Bocycline | Bristacycline | Diocyclin | Paromycine | Servitet | Suncycline V | Teralin | Tetocyn | Tetra | Tetracin | Tetracycline | Tetracycline HCL | Tetralow | Ttmycin | Weile | Wintel | Wintellin;
  • (UA) Ukraine: Tetracyclin;
  • (UG) Uganda: Agotetra | Tetracycline | Tetraren | Tetras;
  • (UY) Uruguay: Tetraciclina;
  • (VE) Venezuela, Bolivarian Republic of: Ambramicina | Tetraciclina;
  • (ZA) South Africa: Hostacycline | Hostacycline-p | Rolab-tetracycline | Tetrex;
  • (ZM) Zambia: Elytetra | Emcycline | Fidemycin | Tetracap | Tetrakant | Tetret
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