Usage
- This drug combination is primarily prescribed for bacterial infections, particularly periodontitis (gum infection), gingivitis (inflammation of the gums), intestinal infections, urinary tract infections, gonorrhea, and respiratory tract infections. Bromelain is sometimes used as an adjunct therapy for its anti-inflammatory properties.
- Pharmacological Classification: Antibiotic (Doxycycline), Anti-inflammatory enzyme (Bromelain).
- Mechanism of Action: Doxycycline, a tetracycline antibiotic, inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. Bromelain is an enzyme complex derived from pineapple that exhibits anti-inflammatory, anti-edematous, and fibrinolytic properties.
Alternate Names
This specific combination of Bromelain and Doxycycline may be marketed under different brand names depending on the region or manufacturer (e.g., Dobact Dox). There are no widely recognized alternate names for this combination itself. Individually, Doxycycline is sometimes referred to as Vibramycin, Doryx, or Monodox. Bromelain is also known as Ananas comosus, Bromelaine or Bromelin.
How It Works
- Pharmacodynamics (Doxycycline): Doxycycline exerts its bacteriostatic effect by inhibiting bacterial protein synthesis.
- Pharmacokinetics (Doxycycline): Doxycycline is well-absorbed orally. It is metabolized in the liver, primarily by glucuronidation, and excreted via the kidneys and in feces.
- Mode of Action (Doxycycline): Binds to the 30S ribosomal subunit of bacteria, preventing the attachment of aminoacyl-tRNA to the mRNA-ribosome complex, thus inhibiting bacterial protein synthesis.
- Elimination Pathways (Doxycycline): Primarily renal and fecal excretion.
- Pharmacodynamics (Bromelain): Bromelain exerts its anti-inflammatory action through multiple mechanisms, including decreasing bradykinin levels, inhibiting prostaglandin synthesis, and modulating the immune response.
- Pharmacokinetics (Bromelain): Absorbed orally to some extent. Information about its specific metabolism and elimination is limited.
- Mode of Action (Bromelain): Acts on inflammatory mediators and the immune response
Dosage
Dosages are provided as general guidelines based on the available information and should be adjusted by the physician according to the patient’s specific needs and clinical context. Specific dosing for the Bromelain+Doxycycline combination is not explicitly available in the references. Individual dosages and combination administration should be under the guidance of a physician.
Standard Dosage
Adults:
Doxycycline: Typically 100mg twice daily or as prescribed by the physician.
Bromelain: Typically 80-400mg two to three times a day.
Children:
Doxycycline: Use in children under 8 years old should be avoided unless the benefits outweigh the risks, particularly due to the risk of tooth discoloration. Pediatric dosing is usually weight-based and must be prescribed by a doctor.
Bromelain: Not well established, use with caution under medical supervision.
Special Cases:
-
Elderly Patients: Dosage adjustments for Doxycycline may be needed in elderly patients, especially those with renal impairment. Bromelain: Dosage adjustments should be made conservatively.
-
Patients with Renal Impairment: Doxycycline dosage should be reduced in patients with renal impairment.
-
Patients with Hepatic Dysfunction: Doxycycline dosage adjustments may be required in cases of severe hepatic impairment.
-
Patients with Comorbid Conditions: Dosage should be adjusted based on the patient’s specific conditions.
Clinical Use Cases
While Doxycycline is used in various clinical settings, there are no established clinical use cases for the specific combination of Bromelain + Doxycycline in hospital settings (e.g., intubation, surgical procedures, mechanical ventilation, ICU, emergency situations).
Dosage Adjustments
Modifications are necessary based on individual patient factors like renal/hepatic dysfunction, metabolic disorders, and potential drug interactions.
Side Effects
Common Side Effects
- Gastrointestinal upset (nausea, vomiting, diarrhea)
- Photosensitivity
- Dizziness. With Bromelain, heavier menstrual bleeding can also occur.
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling)
- Severe skin reactions (Stevens-Johnson syndrome)
- Blood disorders
- Increased intracranial pressure
Long-Term Effects
Long-term Doxycycline use can lead to tooth discoloration and may affect bone growth in children.
Adverse Drug Reactions (ADR)
Severe allergic reactions, Clostridium difficile infection, drug-induced liver injury, serum sickness.
Contraindications
- Hypersensitivity to bromelain, doxycycline, or tetracycline antibiotics.
- Pregnancy (especially second and third trimesters).
- Children under 8 years of age (generally). Patients with severe hepatic impairment or colitis.
Drug Interactions
- Anticoagulants (increased bleeding risk).
- Antacids, iron, calcium, zinc supplements (decreased doxycycline absorption).
- Retinoids (increased risk of intracranial hypertension).
- Antiepileptic drugs (potential for altered drug levels).
- Other antibiotics (e.g. penicillin, amoxicillin).
- Blood thinners (Warfarin, Heparin).
- Barbiturates.
Pregnancy and Breastfeeding
Doxycycline is contraindicated during pregnancy, especially in the second and third trimesters, due to the risk of affecting fetal skeletal development and causing tooth discoloration. Its use during breastfeeding is also discouraged. Bromelain’s safety during pregnancy and breastfeeding is not well-established; therefore, it’s best to avoid use.
Drug Profile Summary
Refer to the information provided in the sections above.
Popular Combinations
No specific data available for popular combinations with Bromelain+Doxycycline. Doxycycline is sometimes combined with other antibiotics for certain infections.
Precautions
As described above in side effects, contraindications and drug interactions. General precautions like allergy checks, metabolic function tests and complete blood count should be performed. For surgical procedures, Bromelain should be stopped at least two weeks prior.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromelain + Doxycycline?
A: The recommended dosage for Bromelain + Doxycycline combination is not definitively established. Please consult the dosage section above, and a physician, for individual drug dosing, administration and contraindications.
Q2: What are the primary uses of this combination?
A: Primarily used for bacterial infections where the anti-inflammatory properties of Bromelain may be beneficial in addition to Doxycycline’s antibiotic action.
Q3: Are there any specific contraindications for this drug?
A: Yes. Contraindications include hypersensitivity to either drug, pregnancy (especially 2nd and 3rd trimesters), breastfeeding, and generally children under 8.
Q4: What are the common side effects?
A: Common side effects include gastrointestinal upset, photosensitivity, dizziness and, specifically with Bromelain, potentially heavier menstrual bleeding.
Q5: Does this combination interact with other medications?
A: Yes. Refer to drug interactions section above.
Q6: Can this combination be used during pregnancy or breastfeeding?
A: Doxycycline is contraindicated during pregnancy, particularly the second and third trimesters. Bromelain’s safety is not well-established, so it’s generally advised to avoid it. Use of either medication while breastfeeding should be avoided.
Q7: What patient education is essential for this combination?
A: Patients should be informed about potential side effects, drug interactions, and the importance of sun protection due to photosensitivity. They should also be advised to complete the full course of antibiotics even if symptoms improve. Advise about drug interactions with alcohol, blood thinners, antacids, retinoids and antiepileptic drugs. Advise caution while driving due to potential dizziness.
Q8: Are there any long-term effects of using this combination?
A: Long-term use of doxycycline can cause tooth discoloration, especially in children. Bromelain is generally not recommended for long-term continuous use without medical supervision.
Q9: Are there specific monitoring parameters for patients on this combination?
A: Monitor for signs of allergic reactions, gastrointestinal issues, photosensitivity, liver function tests (especially if abnormal prior to beginning treatment) and kidney function. Complete blood counts should be performed if clinical status suggests possibility of adverse reactions.
