Best practices for taking Doxycycline
May 3, 2019 2:07 AM   Subscribe

Just got prescribed doxycycline monohydrate for a pretty clear case of lyme (tick bite + bullseye rash), which I've never taken before, and had some questions about best way to take it.

The pharmacist did warn me to stay out of the sun and to not take multivitamins too close in time to it, both of which I can do. He also said that it's more effective on an empty stomach but that I can take it with food if it makes me sick. I forgot to mention to him that I take 150 mg Zantac before bed every night.

My questions are as follows:

- How ineffective is it when taken with food? I would love to just take it with food and risk not throwing it up and wasting the dose, but I also want to get the maximum effectiveness from the drug. Is it worth it to try not taking it with food or should I just go ahead with the food?

- Should I stop taking Zantac for the 21 days? If I don't take it before bed, I feel pretty crummy the next morning, with acid reflux. I've also read that Doxy can actually cause reflux in people who didn't previously have it and that there's risk of esophagus burn, which makes me think that I'm likely to suffer even more if I can't take my Zantac.

- Should I take a probiotic during the course of Doxy or wait until after I finish the course? I'm not sure what effects probiotics have, if any, on it.

- Are there any foods to stay away from that might render it less effective? I already know about dairy.

Thank you for any help with these questions!
posted by massofintuition to Health & Fitness (12 answers total)
I've just been prescribed doxycycline hydrochloride. My instructions say take immediately after food and don't take antacids, iron or calcium within two hours of the medicine. It also states to avoid excessive exposure to sunlight.
posted by poxandplague at 2:29 AM on May 3

I am taking Doxycycline too at the moment, and my doctor and my pharmacist both said it must be taken with food. On the other hand, my pharmacist contradicted the GP about vitamins, saying they were fine to take at the same time, when the doctor had told me not to, so I'm not 100% sure I'm getting great advice here.

For what it's worth, they also said to take it with a large glass of water, and not to lie down within an hour of taking it, as you want to use gravity to insure it makes it all the way to your stomach. It can burn a pretty nasty hole in your throat if it gets stuck there.
posted by lollusc at 3:31 AM on May 3

From my own painful experience, do not take this near to bedtime as you need time to properly digest the dose before sleep.
posted by RandomInconsistencies at 3:57 AM on May 3 [1 favorite]

From reviewing WebMD and it seems like some formulations of doxycycline may have different dosing preferences, so start with what your pharmacist said. If you do have it with food, avoid things rich in calcium. For more, read the links.
posted by seanmpuckett at 4:42 AM on May 3

Be aware that Doxycycline can interfere with the effectiveness of hormonal birth control.
posted by ChuraChura at 5:26 AM on May 3

I would suggest calling your pharmacist back and asking all of this (or call any pharmacist). They'd be the best source of answers.
posted by pinochiette at 5:51 AM on May 3 [6 favorites]

This is what pharmacists are trained for. Call your pharmacist.
posted by theora55 at 6:30 AM on May 3 [3 favorites]

Hi, I'm a pharmacist!

The usual instructions are to take 1 hr before or 2 hrs after food. The purpose is to make sure you absorb the maximum amount of the drug because it can bind to calcium, magnesium, etc in food and not be fully absorbed. It's not the end of the world if you take it with food though. Try to avoid things containing aluminum, calcium, iron, magnesium, zinc, or bismuth subsalicylate -- antacids, vitamins, milk, dairy, food with calcium added. If it makes you feel nauseated to take on an empty stomach, by all means take it with food. You don't get any benefit from a dose that you throw up!

Zantac is fine, as long as you take it 2-3 hours apart.

Personally I am a huge fan of probiotics, and if it were me I'd take them. Make sure you're not taking the probiotic at the same time as the doxycycline. Otherwise the doxycycline will kill off all the good bacteria that you're trying to replenish.
posted by selfmedicating at 7:13 AM on May 3 [3 favorites]

I took doxycycline for two years as an anti-malarial, and here's what I experienced:

1. Taking it without food was very likely to cause a moderate to severe upset stomach. I never vomited, but I often dearly wished to when I made this mistake. And yet every now and again it would have no ill effect.
2. Taking it right before laying down was a universally bad idea. You are right about the acid reflux, and that combination is what did it for me.
3. Making both of those mistakes was the. worst. You are also right about the esophogeal burn, and this is what did that to me, because of the severity of the reflux. I only did this once.
4. Sun sensitivity can be mitigated with generous use of sunscreen, and your body may adapt (when I first started taking it, a five-minute bike ride could burn the backs of my hands if I didn't slather on sunscreen first, but after about three months I was back to my baseline sensitivity).

We were never advised not to take it with food (see point 1), but we were advised to avoid taking it in combination with multi-vitamins and with foods high in iron, calcium or magnesium.

Long story short, I took it in the mornings with a breakfast that was starchy and banana-free, and that worked pretty well for me.
posted by solotoro at 7:20 AM on May 3

In the course of my career I have prescribed several thousand courses of doxycycline. There are two considerations:

what is bad in theory—taking it with food or other combinations of things that may interfere with absorption—I have never seen a treatment failure from any of these;

what is bad in practice—anything that leads to it dissolving in the oesophagus (taking before lying down, not taking a big glass of water after, not taking food after)—I have seen patients with severe chest pain and indigestion that has lasted for days when this happens.
posted by FungusCassetteBicker at 8:50 AM on May 3

I washed down doxycycline one morning with a Fresca, having not had breakfast yet. Bubbliest vomit ever.
posted by lakeroon at 3:51 PM on May 3

Clear your schedule for the first 3 days or so. When I had this drug for Lyme, I needed a tremendous amount of sleep.
posted by Miko at 7:33 PM on May 3

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