Question about Tetracycline

Factual Questions
1

Dear docs and others in the know,

I’m currently taking Tetracycline for acne. When I received the prescription from my dermatologist, she said that I shouldn’t take it for 2 hours after eating, 1 hour before, or with dairy products. I found this very annoying and had a hard time taking them without not eating, so my mom talked to the pharmacist at the pharmacy here, and he said that the dermatologist didn’t know what she was talking about, and that eating would not affect the Tetracycline. All I needed to do was avoid dairy products, and I’d be fine. So

  1. Who’s right?
  2. What happens if I do inadvertently eat dairy products?

SanibelMan - My Homepage
“All right. Have it your own way. Road to hell paved with unbought stuffed dogs. Not my fault.”

2

Dr. Yahoo! sez:

  1. Do not eat dairy products (such as milk, cheese, yogurt, or ice cream) within 1 to 2 hours before or after taking tetracycline.

  2. Do not take antacids, calcium or iron supplements, sodium bicarbonate (Alka-Seltzer®, baking soda), colestipol (Colestid®), or cholestyramine (Questran®) at the same time you take tetracycline.

My handy perscription drug reference book says the same thing.

What’s the trouble? Take the pill before you go to bed. That should satisfy all of those conditions.

Don Ho can sign autographs 3.4 times faster than Efrem Zimbalist Jr.

3

The problem with tetracycline and various dairy products and otc medicines is that calcium bonds with tetracycline and effectively prevents it from getting into your system and doing its job. The proscription I’d always lived with in my tetracycline days was no dairy or calcium containing consumption within two hours of taking the pill. That does not prevent you from eating, you just can’t have a cheeseburger with your pill.

If we’re lucky, Sue will show up with the real answer.

4

Sorry, I wasn’t clear above - I have to take 4 a day, 2 in the morning and 2 at night. The doc also recommended I not take it at bedtime, which is annoying. This wouldn’t be a big problem if I ate on a schedule, but I don’t, so it is.

5

  1. As implied, but perhaps not made clear, by others, there is generally no harm in taking tetracycline with dairy foods, antacids, etc. The problem is that one doesn’t get one’s money’s worth since one doesn’t absorb as much.

  2. Another antibiotic in the tetracycline class that is effective for the treatment of acne is doxycycline. It is better absorbed, effective in lower doses (i.e. 100 mg twice a day), and cheaper per dose (at wholesale–retail prices are whatever the pharmacy can get away with charging). Furthermore, doxycycline absorbtion is NOT significantly affected by dairy products, antacids, etc. One may wash it down with a milkshake.

  3. Doxycycline should generally not be taken before bed and it should generally be washed down with food or water. A doxycline tablet that hangs up in the esophagous can cause a perforation. (Rare, but no fun at all.) Concern about esophageal erosion could be why your doctor told you not to take the tetracycline immediately before bed.

6

Don’t be too sure about there being no harm caused by eating dairy with your meds. If you bind up enough of the drug, you could lower the concentration in your blood. This might place you at risk of developing resistant bugs. Or even wiping out benign ones while letting the nasties run amok.

Maybe Sue will take a break stomping from my ass over in the peanut allergy thread and clarify this for you.

7

  1. In treating acne with a tetracycline, there is no attempt to treat with such large doses as to completely wipe out any specific bacterial species.

  2. Long term therapy with a tetracycline at the doses used in the treatment of acne does in fact promote the growth of tetracycline-resistant bacteria.

  3. If you take a tetracycline (or any other antibiotic) for acne control, you are likely to develop resistant bugs but that’s usually not a reason for worry.

  4. You may also wipe out (or at at least severely discourage) some strains of benign bugs but the only nasties that are likely to run amok are Candida albicans, and they only run amok in women.

  5. Medicine is an empirical science.

8

Ignore the superstrain hype.

Try rxlist.com for some more info on any drug.

Tetracycline is used first because its pretty cheap. Read the bottle, it has instructions on it.

If you can afford more, try for E-mycin. Its much better but it costs 4 times as much.

9

Or for acne, Retin-A.

The stuff, once you get past the dryness (exfoliate and moisturize!), is a godsend. You just have to stick with it, because things get worse before they get better.

10

Ergh. I was on tetracycline once, and boy did it cause me some stomach pain if I hadn’t had something to eat. A little food to act as a buffer is okay, but dairy is a no-no.

Despite what these people have said, tetracycline actually bonds with lactose to form a highly-volatile explosive. If you accidentally eat cheese and take tetracycline, don’t push too hard next time you go to the can…

11

RetinA is extreme, has numerous side effects. It’s only used when they have tried the rest of the nuke zit formulas.

Also, eating right & keeping the skin clean is important.

12

I didn’t comment earlier, because it looked like other posters already had this pretty well covered. :slight_smile: But since other questions have come up…

A couple of good sites about acne in general with dscussions of different treatments:

American Association of Dermatologist’s http://www.aad.org/ss98/ss98acne.html

and from NIH: http://www.nih.gov/niams/healthinfo/acne/acne.htm

Tetracycline is widely used to suppress the growth of Staph, Strep, and other bacteria commonly found in pores which can contribute to acne problems.

It is not well absorbed when calcium is simultaneously present in the GI tract however. For that reason, doxycycline (Vibromycin) & minocycline(Minocin) are commonly used. Erythromycin is sometimes used as well, but causes nausea in a fair number of patients. Sulfa drugs (particularly Septra/Bactrim) are also used occasionally.

Resistance is usually not a big problem because:
None of these drugs are ever used as primary therapy for an active Staph infection, so they won’t cause you to develop infections elsewhere that won’t respond to first-line agents for more serious infections.

They are generally inactive against the mostly Gram-negative gut flora.

If oral antibiotics are being used for more than 6 months, and acne worsens, one can switch to a different antibiotic, or some other therapy (Retin A, birth control pills in women) can be substituted.

Other than loss-of-effectiveness, there are no adverse effects to taking Tetracycline with food/dairy products. If you are finding this difficult to do, I would recommend discussing this with your doc.

Warning: there are docs out there who use willingness to comply with a regimen like tetracycline as an indicator of how serious this acne problem really is to you, and base decisions about using potentially toxic drugs like Retin A on this assessment.

One other VERY important thing to know about tetracycline:
Unlike most other drugs, which simply lose potency when they go past their expiration dates, tetracycline decomposes into a compound that can cause a lot of GI side effects. Do not use tetracycline past it’s expiration date!

Sue from El Paso
Siamese Attack Puppet - Texas

Experience is what you get when you didn’t get what you wanted.

13

handy, Retin-A is not the scary one. IIRC, the FDA has approved it for over-the-counter cosmetics and facial scrubs.

Acutane is the scary one. I did take it in college, because I’d been through all the others - tetrycycline, Erythromycin, Retin-A - and still had acne. Acutane is very powerful, and also extremely dangerous to a developing fetus. I had to sign about five different forms and swear cross-eyed that I was on birth control, I would absolutely not get pregnant while taking this, and I understood the risks. When I got the pills, the box had illustrations of just what birth defects a baby exposed to Acutane would have, and each of the pill blisters had an illustration of a pregnant woman with the universal circle and bar over her. They were really careful making sure I got the point.

14

You’re right, phouka - & I got them confused, too.

They are both retinoic acid derivatives (like Vitamin A). But Retin-A is, to the best of my knowledge, only available in topical preparations. Accutane is an oral medication, and the forms & signatures, and precautions sound exactly right.

  • Sue

(sorry for the confusion)

15

-off topic-

phouka, i’m just curious as to what birth defects they’re talking about. i’m currently on accutane and have heard plenty about it as i too, had to sign papers… but what specifically are the risks to a fetus?

i’ve done plenty of searching, but have yet to find out.

“If anybody wants a sheep, that is proof that he exists.”

16

Some fine points:

  1. Current thinking is that it is Propionibacterum acnes that contributes to acne, not a Staph or Strep.

  2. It is a myth, now debunked, that diet causes or exacerbates acne.

  3. Not washing your face often enough is very unlikely to give you acne if you don’t have it and if you do have acne, washing your face a lot is not likely to clear it up.

  4. Although tetracycine is very cheap by weight, doxycycline is, I repeat, cheaper than tetracycline on a per dose basis. (A typical regimen of tetracycline HCl is 2000 mg/day whereas a typical regimen of doxycycline HCl is 200 mg/day.

17

Picture me, the scientist, very confused.

Retin-A:

RETIN-A Gel, Cream and Liquid, containing tretinoin are used for the topical treatment of acne
vulgaris.

Chemically, tretinoin is all-trans-retinoic acid, also known as (all-E) 3,7-dimethyl-9-(2,6,6-
trimethyl-1-cyclohexen-1-yl)-2,4,6,8-nonatetraenoic acid.

RETIN-A Gel contains tretinoin (retinoic acid, vitamin A acid) in either of two strengths,
0.025% or 0.01 % by weight, in a gel vehicle of butylated hydroxytoluene, hydroxypropyl
cellulose and alcohol (denatured with tert-butyl alcohol and brucine sulfate) 90% w/w.

Plus:
If you are pregnant, think you are pregnant or are nursing an infant: No studies have been
conducted in humans to establish the safety of RETIN-A in pregnant women. If you are pregnant,
think you are pregnant, or are nursing a baby, consult your physician before using this
medication.
Teratogenic [teratogenic:
Causing abnormal development of the embryo. “Taber’s
Cyclopedic Medical Dictionary,” Copyright © 1999 by
F. A. Davis Co., Phil., PA effects. Pregnancy Category C.

Oral tretinoin has been shown to be teratogenic in rats when given in doses 1000 times the
topical human dose. Oral tretinoin has been shown to be fetotoxic in rats when given in doses
500 times the topical human dose.

This from rxlist.com

18

Note, from what its made from, Retin-A is very flammable. Don’t smoke around it…