Doxycycline Interactions: What to Expect & What to Avoid

    Doxycycline Interactions: What to Expect & What to Avoid
    Dr. Leah Millheiser, MD Headshot
    Medically reviewed by Leah Millheiser, MD Written by Our Editorial Team Last updated 5/17/2020

    Doxycycline is one of the most widely-used prescription antibiotics in the world, with millions of people receiving prescriptions for it every year in the U.S. alone. 

    If you have acne, an eye infection or other bacterial infection, your healthcare provider may recommend doxycycline as a treatment. Used regularly, doxycycline can get rid of harmful bacteria and help treat bacterial-based infections.

    It’s also used to treat infections spread by organisms like ticks and lice, lymphatic infections, infections caused by contaminated food/water and may be prescribed to people who are allergic to penicillin. It is even used to prevent malaria and treat people who’ve been exposed to anthrax.

    No, you didn’t read that wrong — the same antibiotic we prescribe to help treat anthrax, we also prescribe to help treat acne. 

    Similar to other antibiotics, doxycycline may interact with certain medications, supplements, herbal treatments and foods. Some of these interactions may make doxycycline less effective as an antibiotic, while others may be harmful and potentially dangerous. 

    Below, we’ve listed the potential interactions that may occur when you use doxycycline at the same time as other medications, supplements and foods interactions. We’ve also listed steps you can take to reduce your risk of experiencing interactions while using doxycycline. 

    Interactions Between Doxycycline and Other Medications

    Doxycycline can interact with a range of different medications, including prescription and over-the-counter drugs. 

    Isotretinoin (Accutane®)

    Isotretinoin, the active ingredient in the prescription acne medication Accutane, may interact with doxycycline and increase your risk of experiencing serious side effects. 

    Using doxycycline with isotretinoin can increase your risk of developing increased intracranial pressure (ICP), a dangerous condition in which the blood pressure in your brain rises rapidly, causing symptoms such as headache, nausea, vomiting and loss of consciousness. 

    In some cases, increased intracranial pressure may lead to permanent damage to your vision, including permanent blindness. Other serious complications of increased intracranial pressure include seizures, stroke, neurologic damage and death.

    Aminolevulinic Acid

    Aminolevulinic acid, which is used to treat actinic keratosis, may interact with doxycycline and cause you to become overly sensitive to the sun. Both of these medications can contribute to photosensitivity, causing you to become sunburned after even modest UV exposure. 

    Similar interactions may also occur with other antibiotics and photosensitizing medications, such as tetracyclines and retinoids. 

    Typhoid and Cholera Vaccines

    Doxycycline should not be used with certain vaccines, including the live, attenuated typhoid vaccine and the live cholera vaccine. Doxycycline and other antibiotics may make some vaccines less effective at protecting you from disease. 

    If you currently use or have recently used doxycycline or other antibiotics, make sure you wait at least three days after finishing treatment before receiving the live, attenuated typhoid vaccine, or wait three days after the vaccine to start taking Doxycycline.  You need to wait  14 days or longer before receiving the live, attenuated bacterial vaccine for cholera. 

    This will allow the doxycycline to clear your system and prevent it from making the vaccines less effective. 

    To check that you’re safe, talk to the healthcare professional administering the vaccine and make sure they’re aware of your recent usage of doxycycline. 

    Other Medications

    Doxycycline can also cause potentially dangerous interactions when used with other medications, including the following:

    • Methoxyflurane, commonly sold as Penthrox®, can interact with doxycycline and cause  damage to the kidneys.

    • Penicillin may be affected by doxycycline, causing it to become less effective at treating infections
    • Warfarin (and other anticoagulants) can interact with doxycycline, potentially making you more at risk of experiencing severe bleeding and other potentially serious side effects.

    • Antacids containing active ingredients such as aluminum, calcium, magnesium, bismuth subsalicylate (Pepto-Bismol®) and iron may make doxycycline less effective.

    • Barbiturates and certain anticonvulsant medications used to treat epilepsy, such as phenytoin and carbamazepine, may also make doxycycline less effective.
    • Lithium, methotrexate, diuretics and proton-pump inhibitors may interact with doxycycline.
    • Supplements containing calcium are unlikely to result in any dangerous interactions with doxycycline, but may make this medication less effective. 

    In addition to those mentioned above, doxycycline may also interact with other prescription and over-the-counter medications. A complete list of medications known to interact with doxycycline can be found here.

    To reduce your risk of experiencing a drug interaction, inform your healthcare provider of any prescription or over-the-counter medications you’re currently using or have used in the last few months before discussing doxycycline. 

    Interactions Between Doxycycline and Alcohol

    Studies suggest doxycycline may interact with alcohol, increasing your risk of experiencing side effects from the alcohol and from doxycycline. 

    In some people, drinking alcohol while taking doxycycline may affect the half-life of the drug which can reduce how effective it is in treating acne.

    Drinking alcohol while using doxycycline may also cause you to feel dizziness, drowsiness and nausea, even if you only drink a small to moderate amount of alcohol. 

    If you regularly drink alcohol, it’s best to talk to your healthcare provider about this before you start using any antibiotic, including doxycycline. They will be able to provide more advice and information about the safety of drinking alcohol during treatment with doxycycline. 

    Interactions Between Doxycycline and Food

    It’s okay to take doxycycline on an empty stomach or with food. However, certain types of food may affect your body’s ability to absorb doxycycline, making the medication less effective as an antibiotic.

    Doxycycline and Dairy

    Certain dairy products, such as milk, cream, cheese, yogurt and foods derived from dairy such as protein and calcium supplements, may affect your body’s ability to absorb doxycycline. This may make doxycycline less effective at treating infections, acne and other conditions. 

    If you’ve been prescribed doxycycline and frequently eat or drink dairy products, make sure that you inform your healthcare provider before using this medication. 

    To ensure doxycycline works properly, your healthcare provider may recommend temporarily avoiding these foods while you’re undergoing treatment or limiting your consumption of dairy to several hours before and after using doxycycline.  

    Other Foods to Avoid

    Research shows that ingestion of iron may reduce the bioavailability of tetracycline antibiotics, including doxycycline. 

    Iron supplements and iron-rich foods — such as liver, sardines, beef, lamb, eggs, canned salmon, legumes, tofu, wholegrain cereals, kale, broccoli, spinach and certain seeds and nuts — may also affect your body’s ability to absorb doxycycline. 

    While it’s okay to eat these foods while using doxycycline, it’s best to take doxycycline at least two hours before or four hours after any meals that contain these foods. 

    Doxycycline and Hormonal Birth Control 

    Doxycycline does not interact with any form of hormonal contraception, including the pill, patch, ring and other common birth control products. If you use the pill, it’s okay to keep using it while you’re on doxycycline. 

    Like other antibiotics, doxycycline may cause nausea and/or diarrhea. If you vomit shortly after taking your birth control pill, or have severe, persistent diarrhea from doxycycline, it may make your birth control pill less effective at preventing pregnancy.

    If this happens, follow the instructions provided with your birth control pill or contact your healthcare provider for assistance. You may need to use condoms or another secondary form of contraception for several days to keep yourself protected. 

    Learn More About Doxycycline

    Doxycycline is a widely-used antibiotic that’s prescribed for a range of conditions, from bacterial infections to acne. 

    Interested in learning more about doxycycline? Our guide to doxycycline goes into more detail about how doxycycline works, why it’s prescribed, its side effects, safety during pregnancy and much more. 

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.