PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

NDC 66993-815-30

PRASCO

Doxycycline, USP

Capsules 40mg*

*30 mg immediate release &
10 mg delayed release beads

Rx only

30 Capsules

INERT INGREDIENTS:
Hypromellose, Iron Oxide Red, Iron Oxide Yellow, Methacrylic Acid Copolymer, Polyethylene Glycol, Polysorbate 80, Sugar Spheres, Talc, Titanium Dioxide, and Triethyl Citrate

DOSAGE: ONE CAPSULE PER DAY

Store at controlled room temperature of 15°C - 30°C (59°F - 86°F).

Keep out of reach of children.

Marketed by:

Prasco Laboratories

Mason, OH 45040 USA

P52926-1
or
P55305-0

1 INDICATIONS AND USAGE

1.1 Indication

Doxycycline 40 mg is indicated for the treatment of only inflammatory lesions (papules and pustules) of rosacea in adult patients. No meaningful effect was demonstrated for generalized erythema (redness) of rosacea.

1.2 Limitations of Use

This formulation of doxycycline has not been evaluated in the treatment or prevention of infections. Do not use Doxycycline 40 mg for treating bacterial infections, providing antibacterial prophylaxis, or reducing the numbers or eliminating microorganisms associated with any bacterial disease.

To reduce the development of drug-resistant bacteria as well as to maintain the effectiveness of other antibacterial drugs, Doxycycline 40 mg should be used only as indicated.

Doxycycline 40 mg has not been evaluated for the treatment of the erythematous, telangiectatic, or ocular components of rosacea.

4 CONTRAINDICATIONS

This drug is contraindicated in persons who have shown hypersensitivity to doxycycline or any other tetracyclines.

6 ADVERSE REACTIONS

6.1 Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Adverse Reactions in Clinical Trials of Doxycycline 40 mg: In controlled clinical trials of adult subjects with mild to moderate rosacea, 537 subjects received Doxycycline 40 mg or placebo over a 16-week period. The following table summarizes selected adverse reactions that occurred in the clinical trials at a rate of ≥1% for the active arm:

Table 1. Incidence (%) of Selected Adverse Reactions in Clinical Trials of Doxycycline 40 mg (n=269) v.s. Placebo (n=268)
	Doxycycline 40 mg	Placebo
Nasopharyngitis	13 (5)	9 (3)
Pharyngolaryngeal Pain	3 (1)	2 (1)
Sinusitis	7 (3)	2 (1)
Nasal Congestion	4 (2)	2 (1)
Fungal Infection	5 (2)	1 (0)
Influenza	5 (2)	3 (1)
Diarrhea	12 (5)	7 (3)
Abdominal Pain Upper	5 (2)	1 (0)
Abdominal Distention	3 (1)	1 (0)
Abdominal Pain	3 (1)	1 (0)
Stomach Discomfort	3 (1)	2 (1)
Dry Mouth	3 (1)	0 (0)
Hypertension	8 (3)	2 (1)
Blood Pressure Increase	4 (2)	1 (0)
Aspartate Aminotransferase Increase	6 (2)	2 (1)
Blood Lactate Dehydrogenase Increase	4 (2)	1 (0)
Blood Glucose Increase	3 (1)	0 (0)
Anxiety	4 (2)	0 (0)
Pain	4 (2)	1 (0)
Back Pain	3 (1)	0 (0)
Sinus Headache	3 (1)	0 (0)

Note: Percentages based on total number of study participants in each treatment group.

Adverse Reactions for Tetracyclines: The following adverse reactions have been observed in patients receiving tetracyclines at higher, antimicrobial doses:

Gastrointestinal: anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, and inflammatory lesions (with vaginal candidiasis) in the anogenital region. Hepatotoxicity. Esophagitis and esophageal ulcerations have been reported in patients receiving the capsule forms of the drugs in the tetracycline-class. Most of the patients experiencing esophagitis and/or esophageal ulceration took their medication immediately before lying down [see Dosage and Administration (2)].

Renal toxicity: Rise in BUN has been reported and is apparently dose-related [see Warnings and Precautions (5.4)].

Skin: maculopapular and erythematous rashes. Exfoliative dermatitis. Photosensitivity is discussed above [see Warnings and Precautions (5.5)].

Hypersensitivity reactions: urticaria, angioneurotic edema, anaphylaxis, anaphylactoid purpura, serum sickness, pericarditis, and exacerbation of systemic lupus erythematosus.

Blood: Hemolytic anemia, thrombocytopenia, neutropenia, and eosinophilia.

6.2 Postmarketing Experience

Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. The following adverse reactions have been identified during post approval use of Doxycycline 40 mg. Nervous system: Pseudotumor cerebri (benign intracranial hypertension), headache.

7 DRUG INTERACTIONS

7.1 Anticoagulants

xxxBecause tetracyclines have been shown to depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage.

7.2 Penicillin

Since bacteriostatic drugs may interfere with the bactericidal action of penicillin, it is advisable to avoid giving tetracycline-class drugs in conjunction with penicillin.

7.3 Methoxyflurane

The concurrent use of tetracycline and methoxyflurane has been reported to result in fatal renal toxicity.

7.4 Antacids and Iron Preparations

Absorption of tetracyclines is impaired by bismuth subsalicylate, proton pump inhibitors, antacids containing aluminum, calcium or magnesium and iron- containing preparations.

7.5 Oral Retinoids

There have been reports of pseudotumor cerebri (benign intracranial hypertension) associated with the concomitant use of isotretinoin and tetracyclines. Since both oral retinoids, including isotretinoin and acitretin, and the tetracyclines, primarily minocycline, can cause increased intracranial pressure, the concurrent use of an oral retinoid and a tetracycline should be avoided.

7.6 Barbiturates and Anti-epileptics

Barbiturates, carbamazepine, and phenytoin decrease the half-life of doxycycline.

7.7 Drug/Laboratory Test Interactions

False elevations of urinary catecholamine levels may occur due to interference with the fluorescence test.

3 DOSAGE FORMS AND STRENGTHS

40 mg beige opaque capsule imprinted with “GLD 40”

12 CLINICAL PHARMACOLOGY

12.1 Mechanism of Action

The mechanism of action of Doxycycline 40 mg in the treatment of inflammatory lesions of rosacea is unknown.

12.3 Pharmacokinetics

Doxycycline 40 mg capsules are not bioequivalent to other doxycycline products. The pharmacokinetics of doxycycline following oral administration of Doxycycline 40 mg was investigated in 2 volunteer studies involving 61 adults. Pharmacokinetic parameters for Doxycycline 40 mg following single oral doses and at steady-state in healthy subjects are presented in Table 2.

Mean +Median #Day 7
Table 2. Pharmacokinetic Parameters [Mean (± SD)] for Doxycycline 40 mg
	N	Cmax * (ng/mL)	Tmax + (hr)	AUC 0-∞ * (ng●hr/mL)	t½ * (hr)
Single Dose 40 mg capsules	30	510 ± 220.7	3.00 (1.0 - 4.1)	9227 ± 3212.8	21.2 ± 7.6
Steady-State # 40 mg capsules	31	600 ± 194.2	2.00 (1.0 - 4.0)	7543 ± 2443.9	23.2 ± 6.2

Absorption: In a single-dose food-effect study involving administration of Doxycycline 40 mg to healthy volunteers, concomitant administration with a 1000 calorie, high-fat, high-protein meal that included dairy products, resulted in a decrease in the rate and extent of absorption (Cmax and AUC) by about 45% and 22%, respectively, compared to dosing under fasted conditions. This decrease in systemic exposure can be clinically significant, and therefore if Doxycycline 40 mg is taken close to meal times, it is recommended that it be taken at least one hour prior to or two hours after meals.

Distribution: Doxycycline is greater than 90% bound to plasma proteins.

Metabolism: Major metabolites of doxycycline have not been identified. However, enzyme inducers such as barbiturates, carbamazepine, and phenytoin decrease the half-life of doxycycline.

Excretion: Doxycycline is excreted in the urine and feces as unchanged drug. It is reported that between 29% and 55.4% of an administered dose can be accounted for in the urine by 72 hours. Terminal half-life averaged 21.2 hours in subjects receiving a single dose of Doxycycline 40 mg.

Special Populations

Geriatric: Doxycycline pharmacokinetics have not been evaluated in geriatric patients.

Pediatric: Doxycycline pharmacokinetics have not been evaluated in pediatric patients [see Warnings and Precautions (5.1)].

Gender: The pharmacokinetics of Doxycycline 40 mg were compared in 16 male and 14 female subjects under fed and fasted conditions. While female subjects had a higher Cmax and AUC than male subjects, these differences were thought to be due to differences in body weight/lean body mass.

Race: Differences in doxycycline pharmacokinetics among racial groups have not been evaluated.

Renal Insufficiency: Studies have shown no significant difference in serum half-life of doxycycline in patients with normal and severely impaired renal function. Hemodialysis does not alter the serum half-life of doxycycline.

Hepatic Insufficiency: Doxycycline pharmacokinetics have not been evaluated in patients with hepatic insufficiency.

Gastric Insufficiency: In a study in healthy volunteers (N=24) the bioavailability of doxycycline is reported to be reduced at high pH. This reduced bioavailability may be clinically significant in patients with gastrectomy, gastric bypass surgery or who are otherwise deemed achlorhydric.

Drug Interactions: [see Drug Interactions (7)].

12.4 Microbiology

Doxycycline is a member of the tetracycline-class of drugs. The plasma concentrations of doxycycline achieved with Doxycycline 40 mg during administration [see Clinical Pharmacology (12.3) and Dosage and Administration (2.2)] are less than the concentration required to treat bacterial diseases. Doxycycline 40 mg should not be used for treating bacterial infections, providing antibacterial prophylaxis, or reducing the numbers or eliminating microorganisms associated with any bacterial disease [see Indications and Usage (1.2)]. In vivo microbiological studies utilizing a similar drug exposure for up to 18 months demonstrated no detectable long term effects on bacterial flora of the oral cavity, skin, intestinal tract and vagina.

11 DESCRIPTION

Doxycycline, USP Capsules 40 mg are hard gelatin capsule shells filled with two types of doxycycline beads (30 mg immediate release and 10 mg delayed release) that together provide a dose of 40 mg of anhydrous doxycycline (C22H24N2O8). The structural formula of doxycycline, USP is:

with an empirical formula of C22H24N2O8•H2O and a molecular weight of 462.46. The chemical designation for doxycycline is 2-Naphthacenecarboxamide,4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro- 3,5,10,12,12a-pentahydroxy-6-methyl-1,11-dioxo-, [4S-(4α, 4aα, 5α, 5aα, 6α,12aα)]-, monohydrate. It is very slightly soluble in water.

Inert ingredients in the formulation are: hypromellose, iron oxide red, iron oxide yellow, methacrylic acid copolymer, polyethylene glycol, Polysorbate 80, sugar spheres, talc, titanium dioxide, and triethyl citrate.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

Doxycycline was assessed for potential to induce carcinogenesis in a study in which the compound was administered to Sprague-Dawley rats by gavage at dosages of 20, 75, and 200 mg/kg/day for two years. An increased incidence of uterine polyps was observed in female rats that received 200 mg/kg/day, a dosage that resulted in a systemic exposure to doxycycline approximately 12.2 times that observed in female humans who use Doxycycline 40 mg [exposure comparison based upon area under the curve (AUC) values]. No impact upon tumor incidence was observed in male rats up to 200 mg/kg/day, or in females at the lower dosages studied.

Doxycycline was assessed for potential to induce carcinogenesis in CD-1 mice by gavage at dosages 20, 75, and 150 mg/kg/day in males and at dosages of 20, 100, and 300 mg/kg/day in females. No impact upon tumor incidence was observed in male and female mice at systemic exposures approximately 4.2 and 8.3 times that observed in humans, respectively.

Doxycycline demonstrated no potential to cause genetic toxicity in an in vitro point mutation study with mammalian cells (CHO/HGPRT forward mutation assay) or in an in vivo micronucleus assay conducted in CD-1 mice. However, data from an in vitro mammalian chromosomal aberration assay conducted with CHO cells suggest that doxycycline is a weak clastogen. Oral administration of doxycycline to male and female Sprague-Dawley rats adversely affected fertility and reproductive performance, as evidenced by increased time for mating to occur, reduced sperm motility, velocity, and concentration, abnormal sperm morphology, and increased pre-and postimplantation losses. Doxycycline induced reproductive toxicity at all dosages that were examined in this study, as even the lowest dosage tested (50 mg/kg/day) induced a statistically significant reduction in sperm velocity. Note that 50 mg/kg/day is approximately 3.6 times the amount of doxycycline contained in the recommended daily dose of Doxycycline 40 mg when compared on the basis of AUC estimates. Although doxycycline impairs the fertility of rats when administered at sufficient dosage, the effect of Doxycycline 40 mg on human fertility is unknown.

14 CLINICAL STUDIES

The safety and efficacy of Doxycycline 40 mg in the treatment of only inflammatory lesions (papules and pustules) of rosacea was evaluated in two randomized, placebo-controlled, multi-centered, double-blind, 16-week Phase 3 trials involving 537 subjects (total of 269 subjects on Doxycycline 40 mg from the two trials) with rosacea (10 to 40 papules and pustules and two or fewer nodules). Mean baseline lesion counts were 20 and 21 for Doxycycline 40 mg and placebo subject groups respectively. Pregnant and nursing women, subjects <18 years of age, and subjects with ocular rosacea and/or blepharitis/meibomianitis who require ophthalmologic treatment were excluded from trials.

At Week 16, subjects in the Doxycycline 40 mg group were evaluated using co- primary endpoints of mean reduction in lesion counts and a dichotomized static Investigator’s Global Assessment of Clear or Almost Clear (defined as 1 to 2 small papules or pustules) when compared to the placebo group in both Phase 3 trials.

*Investigator's Global Assessment
Table 3: Clinical Results of Doxycycline 40 mg versus Placebo
	Study 1	Study 2
	Doxycycline 40 mg	Placebo	Doxycycline 40 mg	Placebo
	40 mg N=127	N=124	40 mg N=142	N=144
Mean Change in Lesion Count from Baseline	-11.8	-5.9	-9.5	-4.3
No. (%) of Subjects Clear or Almost Clear in the IGA*	39 (30.7%)	24 (19.4%)	21 (14.8%)	9 (6.3%)

Subjects treated with Doxycycline 40 mg did not demonstrate significant improvement in erythema when compared to those treated with placebo.

16 HOW SUPPLIED/STORAGE AND HANDLING

Doxycycline 40 mg (beige opaque capsule imprinted with “GLD 40”) containing doxycycline, USP in an amount equivalent to 40 mg of anhydrous doxycycline.

Bottle of 30 (NDC 66993-815-30).

Storage:

All products are to be stored at controlled room temperatures of 59°F - 86°F (15°C - 30°C) and dispensed in tight, light-resistant containers (USP).

Keep out of reach of children.

17 PATIENT COUNSELING INFORMATION

See FDA-approved patient labeling (Patient Information)

Patients taking Doxycycline Capsules 40 mg should receive the following information and instructions:

• Advise pregnant women that doxycycline, like other tetracycline-class drugs, may cause permanent discoloration of deciduous teeth and reversible inhibition of bone growth when administered during the second and third trimesters of pregnancy [see Warnings and Precautions (5.1 and 5.2) and Use in Specific Populations (8.1)].
• Advise women not to breastfeed during treatment with Doxycycline 40 mg and for 5 days after the last dose [see Use in Specific Populations (8.2)].
• Advise patients that use of tetracycline class drugs orally during tooth development (infancy and childhood up to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown).
• Advise patients that use of doxycycline, like other tetracycline-class drugs, may cause inhibition of bone growth when administered during infancy and childhood.
• Advise patients that pseudomembranous colitis can occur with doxycycline therapy. If patients develop watery or bloody stools, they should seek medical attention.
• Advise patients that pseudotumor cerebri can occur with doxycycline therapy. If patients experience headache or blurred vision they should seek medical attention.
• Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines, including doxycycline. Patients should minimize or avoid exposure to natural or artificial sunlight (tanning beds or UVA/B treatment) while using doxycycline. If patients need to be outdoors while using doxycycline, they should wear loose-fitting clothes that protect skin from sun exposure and discuss other sun protection measures with their physician. Treatment should be discontinued at the first evidence of sunburn.
• Autoimmune syndromes, including drug-induced lupus-like syndrome, autoimmune hepatitis, vasculitis and serum sickness have been observed with tetracycline-class drugs, including doxycycline. Symptoms may be manifested by arthralgia, fever, rash and malaise. Patients who experience such symptoms should be cautioned to stop the drug immediately and seek medical help.
• Counsel patients about discoloration of skin, scars, teeth or gums that can arise from doxycycline therapy.
• Advise patients to take Doxycycline 40 mg exactly as directed. Increasing doses beyond 40 mg every morning may increase the likelihood that bacteria will develop resistance and will not be treatable by other antibacterial drugs in the future.

PATIENT INFORMATION

Doxycycline, USP, 40 mg Capsules
(daak-suh-sai-kleen)

Read this Patient Information before you start taking Doxycycline 40 mg and each time you get a refill. There may be new information. This information does not take the place of talking to your doctor about your medical condition or treatment.

What is Doxycycline 40 mg?

Doxycycline 40 mg is a tetracycline-class medicine. Doxycycline 40 mg is a prescription medicine used in adults to treat only pimples or bumps (papules and pustules) caused by a condition called rosacea. Doxycycline 40 mg does not lessen redness caused by rosacea.

Doxycycline 40 mg should not be used for the treatment or prevention of infections.

It is not known if Doxycycline 40 mg is:

• effective for use for longer than 16 weeks.
• safe for use longer than 9 months.
• safe and effective in children. Doxycycline 40 mg should not be used in infants and children less than 8 years of age because it may cause stained teeth in infants and children.

Who should not take Doxycycline 40 mg?

Do not take Doxycycline 40 mg if you are allergic to doxycycline or other medicines in the tetracycline-class. Ask your doctor or pharmacist for a list of these medicines if you are not sure.

What should I tell my doctor before taking Doxycycline 40 mg?

Before you take Doxycycline 40 mg tell your doctor if you:

• have kidney problems.
• have liver problems.
• have diarrhea or watery stools.
• have vision problems.
• have had surgery on your stomach (gastric surgery).
• have or had a yeast or fungal infection in your mouth or vagina.
• have any other medical condition.
• are pregnant or plan to become pregnant. Doxycycline 40 mg may harm your unborn baby. Taking Doxycycline 40 mg while you are pregnant may cause serious side effects on the growth of bone and teeth of your baby. Stop taking Doxycycline 40 mg and call your doctor right away if you become pregnant while taking Doxycycline 40 mg.
• are breastfeeding or plan to breastfeed. Doxycycline 40 mg can pass into your breast milk and may harm your baby. Talk to your doctor about the best way to feed your baby if you take Doxycycline 40 mg. You and your doctor should decide if you will take Doxycycline 40 mg or breastfeed. You should not do both.

Tell your doctor about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Doxycycline 40 mg and other medicines can affect each other causing serious side effects.

Especially tell your doctor if you take:

• a blood thinner medicine.
• a penicillin (antibacterial medicine).
• proton pump inhibitors or antacids that contain aluminum, calcium, or magnesium.
• products containing iron or bismuth subsalicylate.
• a medicine taken by mouth that contains isotretinoin or acitretin.
• a medicine to treat seizures, such as carbamazepine or phenytoin.

Ask your doctor or pharmacist for a full list of your medicines, if you are not sure.

Know the medicines you take. Keep a list of your medicines and show it to your doctor and pharmacist when you get a new medicine.

How should I take Doxycycline 40 mg?

• Take Doxycycline 40 mg exactly as prescribed by your doctor. Taking more than your prescribed dose may increase your chance of side effects, including the chance that bacteria will become resistant to Doxycycline 40 mg.
• Take Doxycycline 40 mg 1 time a day in the morning on an empty stomach.
• You should take Doxycycline 40 mg at least one hour before or two hours after a meal.
• Take Doxycycline 40 mg with enough fluid to completely swallow the capsule and to lower your risk of getting irritation or ulcer in your esophagus. Your esophagus is the tube that connects your mouth to your stomach.
• If you took too much Doxycycline 40 mg call your doctor right away.
• Your doctor may do blood tests during treatment with Doxycycline 40 mg to check for side effects.

What should I avoid while taking Doxycycline 40 mg?

Avoid sunlight or artificial sunlight, such as tanning booth or sunlamp. You could get severe sunburn. Use sunscreen and wear clothes that cover your skin while out in sunlight.

What are the possible side effects of Doxycycline 40 mg?

Doxycycline 40 mg may cause serious side effects, including:

*Harm to an unborn baby.See “What should I tell my doctor before taking Doxycycline 40 mg?” *Permanent teeth discoloration. Doxycycline 40 mg may permanently turn a baby or child’s teeth yellow-grey-brown during tooth development. Doxycycline 40 mg should not be used during tooth development. Tooth development happens in the last half of pregnancy, and from birth to 8 years of age. See “What should I tell my doctor before taking Doxycycline 40 mg?” *Intestine infection (pseudomembranous colitis). Pseudomembranous colitis can happen with most antibiotics, including Doxycycline 40 mg. Call your doctor right away if you get diarrhea or bloody stools. *Immune system reactions including a lupus-like syndrome, hepatitis, and inflammation of blood or lymph vessels (vasculitis). Stop taking Doxycycline 40 mg and tell your doctor right away if you get joint pain, fever, rash, or body weakness. *Discoloration (hyperpigmentation). Doxycycline 40 mg can cause darkening of your skin, scars, teeth, gums, nails, and whites of your eyes. *Benign intracranial hypertension, also called pseudotumor cerebri. This is a condition where there is high pressure in the fluid around the brain. This swelling may lead to vision changes and permanent vision loss. Stop taking Doxycycline 40 mg and tell your doctor right away if you have blurred vision, vision loss, or unusual headaches.

The most common side effects of Doxycycline 40 mg include:

• soreness in the nose and throat
• sinus infection
• fungus infection
• flu-like symptoms
• diarrhea
• stomach (abdominal) bloating or pain
• high blood pressure (hypertension)
• change in certain blood tests

Tell your doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Doxycycline 40 mg. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Prasco Laboratories at 1-866-525-0688.

How should I store Doxycycline 40 mg?

• Store Doxycycline 40 mg at room temperature between 59°F to 86°F (15°C to 30°C).
• Keep Doxycycline 40 mg in a tightly closed container.
• Keep Doxycycline 40 mg inside container and out of light.

Keep Doxycycline 40 mg and all medicine out of the reach of children.

General information about Doxycycline 40 mg

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not take Doxycycline 40 mg for a condition for which it was not prescribed. Do not give Doxycycline 40 mg to other people, even if they have the same symptoms you have. It may harm them.

This Patient Information leaflet summarizes the most important information about Doxycycline 40 mg. If you would like more information, talk with your doctor. You can also ask your doctor or pharmacist for information that is written for health professionals.

What are the ingredients in Doxycycline 40 mg?

Active ingredient: doxycycline

Inactive ingredients: hypromellose, iron oxide red, iron oxide yellow, methacrylic acid copolymer, polyethylene glycol, Polysorbate 80, sugar spheres, talc, titanium dioxide, and triethyl citrate.

Marketed by:

Prasco Laboratories

Mason, OH 45040 USA

All trademarks are the property of their respective owners.

P52927-1
or
P55306-0

This Patient Information has been approved by the U.S. Food and Drug Administration.
Revised: December 2021

2 DOSAGE AND ADMINISTRATION

2.1 General Dosing Information

Take one Doxycycline 40 mg capsule once daily in the morning on an empty stomach, preferably at least one hour prior to or two hours after meals.

Administration of adequate amounts of fluid along with the capsules is recommended to wash down the capsule to reduce the risk of esophageal irritation and ulceration [see Adverse Reactions (6)].

2.2 Important Considerations for Dosing Regimen

The dosage of Doxycycline 40 mg differs from that of doxycycline used to treat infections. Exceeding the recommended dosage may result in an increased incidence of side effects including the development of resistant organisms.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Risk Summary
Doxycycline may cause reversible inhibition of bone growth and permanent discoloration of deciduous teeth when administered during the second and third trimesters of pregnancy [see Warnings and Precautions (5.1 and 5.2)]. Available data from published studies have not shown a difference in major birth defect risk with doxycycline exposure in the first trimester of pregnancy compared to unexposed pregnancies. Avoid use of Doxycycline 40 mg during the second and third trimester of pregnancy. The background risk of major birth defects and miscarriage for the indicated population is unknown. All pregnancies have a background risk of birth defect, loss, or other adverse outcomes. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2–4% and 15–20%, respectively.

Data
Human Data
Published studies, including epidemiological and observational studies, with use of doxycycline during the first trimester of pregnancy have not identified drug-related increases in major birth defects. The use of tetracycline during tooth development (second and third trimester of pregnancy) may cause permanent discoloration of deciduous teeth (yellow-gray-brown). This adverse reaction is more common during long-term use of the drug but has been observed following repeated short-term courses.

Animal Data
Results from animal studies indicate that doxycycline crosses the placenta and is found in fetal tissues.

8.2 Lactation

Risk Summary
Based on available published data, doxycycline is likely to be present in human breast milk but the specific concentration in breastmilk is not clear. There is no information on the effects of doxycycline on the breastfed infant or the effects on milk production. Because there are other antibacterial drug options available to treat rosacea in lactating women and because of the potential for serious adverse reactions, including tooth discoloration and inhibition of bone growth, advise patients that breastfeeding is not recommended during treatment with Doxycycline 40 mg and for 5 days after the last dose.

8.4 Pediatric Use

Doxycycline 40 mg should not be used in infants and children less than 8 years of age [see Warnings and Precautions (5.1)]. Doxycycline 40 mg has not been studied in children of any age with regard to safety or efficacy, therefore use in children is not recommended.

8.5 Geriatric Use

Clinical studies of Doxycycline 40 mg did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant disease or other drug therapy.