Doxycycline and alcohol

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Abstract/ Summary
The serum levels of doxycycline may fall below minimal therapeutic concentrations in alcoholic patients, but tetracycline itself is not affected and it seems likely that the other tetracyclines are also not affected. There is nothing to suggest that moderate amounts of alcohol will significantly affect the serum levels of doxycycline or any other tetracycline in normal nonalcoholic subjects.

Clinical evidence
In a comparative study the half-life of doxycycline was found to be 10 5 h in six alcoholics compared with 14 7 h in six normal healthy volunteers The serum levels of two of the alcoholic patients fell well below what is generally accepted as the minimum therapeutic concentrations The half-life of tetracycline was the same in both groups All of them were given 100 mg doxycycline daily after a 200 mg loading dose, and 500 mg tetracycline twice daily after an initial 750 mg loading dose.

In another study in normal subjects it was found that cheap red wine (but not whiskey) postponed the absorption of doxycycline, probably because of the acetic acid content which slows gastric emptying, but did not affect its total absorption The authors concluded that the acute intake of alcoholic beverages generally does not interfere with the kinetics of doxycycline to an extent which would jeopardise therapeutic levels in tissues.

Heavy drinkers can metabolize some drugs much more quickly than non-drinkers due to the enzyme inducing effects of alcohol, and this interaction with doxycycline would seem to be due to this effect, possibly associated with some reduction in absorption from the gut.

Importance and management
Information is limited, but the doxycycline-alcohol interaction appears to be established It seems to be clinically significant in alcoholic subjects but not m normal individuals One suggested solution to the problem is to dose alcoholic subjects twice daily instead of only once. Alternatively tetra-cycline could be used because it appears not to be affected. There is nothing to suggest that moderate or even occasional heavy drinking affects any of the tetracylines in normal subjects.

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