Doxycycline Side Effects: What the Label Lists, Plus Serious Signs

Quick answer: The sources we checked do not rank most doxycycline side effects by how often they happen. The Doryx MPC label lists anorexia, nausea, vomiting and diarrhea, and says some people get an exaggerated sunburn reaction. The label also reports esophagitis, esophageal ulcers, intracranial hypertension, severe skin reactions and Clostridioides difficile associated diarrhea. MedlinePlus says to call your doctor immediately for headache, blurred vision, seeing double or loss of vision, or for watery or bloody stools. The Doryx MPC label says to avoid concomitant use of isotretinoin (Accutane®). Tetracycline-class drugs may cause permanent tooth discoloration in the last half of pregnancy, infancy and childhood to age 8.

This page covers what the FDA label, MedlinePlus, the AAD and published studies say about doxycycline side effects, and what is specific to taking it for acne.

Which doxycycline side effects do the label and MedlinePlus list?

The label lists gut reactions, but it doesn’t rank most of them by how common they are. It says side effects to the lower bowel, particularly diarrhea, have been infrequent. The Doryx MPC label lists anorexia, nausea, vomiting, diarrhea, glossitis and dysphagia among the reactions seen with tetracyclines. MedlinePlus lists nausea, vomiting, diarrhea and loss of appetite among the effects to tell your doctor about if they are severe or do not go away.

The same MedlinePlus list includes itching of the rectum, a swollen tongue, dry mouth, anxiety and back pain. It also names swelling, redness, burning, itching or irritation of the vagina, and it names vaginal discharge. The label says Doryx MPC may result in overgrowth of non-susceptible organisms, including fungi. If such infections occur, the label says the prescriber should discontinue use and institute appropriate therapy. MedlinePlus says to tell your doctor if any of these symptoms are severe or do not go away.

MedlinePlus also lists changes in the color of skin, scars, nails, eyes or mouth. Our doxycycline vs minocycline article compares doxycycline and minocycline.

Why does doxycycline upset your stomach?

The label doesn’t give a mechanism for nausea itself. It does say that the drug is almost completely absorbed, so lower bowel effects such as diarrhea have been infrequent. If gastric irritation occurs, the label says Doryx MPC may be given with food or milk. MedlinePlus allows food or milk if your stomach becomes upset.

A 2015 trial included 662 subjects aged 12 or older with moderate to severe acne. They received subantimicrobial MR-DC 40 mg tablets, DC 100 mg capsules or placebo once daily for 16 weeks. The incidence of drug-related adverse events with the 40 mg tablets was similar to placebo and markedly smaller than with 100 mg. Your prescriber chooses the form and dose, and a trial result isn’t a reason to switch on your own.

How do you take doxycycline to lower the risk of esophagus and stomach irritation?

Esophagus irritation is one reported effect of capsule and tablet forms of this drug class. The label warns that esophagitis and esophageal ulcerations have been reported with capsule and tablet forms of tetracycline-class drugs. It adds that most of those patients took the medicine right before going to bed. The fluid, food, tablet and antacid steps below come from the label and MedlinePlus.

Take each dose with an adequate amount of fluid. The label says this washes the drug down and lowers the risk of esophageal irritation and ulceration, and MedlinePlus says to drink a full glass of water with each dose. MedlinePlus allows food or milk if your stomach becomes upset, and the label allows it if gastric irritation occurs.

MedlinePlus says to swallow delayed-release tablets whole, without splitting, chewing or crushing them, and the label says not to chew or crush Doryx MPC tablets. The label also says antacids with aluminum, calcium or magnesium, bismuth subsalicylate and iron products impair absorption. MedlinePlus gives timing for antacids, calcium supplements and laxatives containing magnesium, and says to take iron products 3 hours before or 2 hours after doxycycline.

The label doesn’t say to stay upright after a dose, so we won’t claim it does. The label says most of these patients took medications immediately before going to bed, so ask your prescriber what time of day suits you. Tell them if swallowing hurts or feels difficult. MedlinePlus lists difficulty breathing or swallowing among the symptoms to call your doctor about immediately.

Can doxycycline cause acid reflux or heartburn?

Neither the label nor MedlinePlus lists acid reflux or heartburn by those names. The label lists esophagitis and esophageal ulcerations and mentions nausea and gastric irritation, while MedlinePlus lists nausea. Tell your prescriber if you develop any of those symptoms.

How serious is doxycycline sun sensitivity?

The label describes photosensitivity as an exaggerated sunburn reaction observed in some people taking tetracyclines, and its highlights say to limit sun exposure. It also says treatment should be discontinued at the first evidence of skin erythema, which means redness.

MedlinePlus says to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses and sunscreen. Our skincare routine on acne medication article covers which gentle products fit around it.

Which serious doxycycline side effects are reported, and when should you call a doctor?

The symptoms below are ones MedlinePlus says to call your doctor about immediately. Call your doctor, or 911 for an emergency, if you notice any of these:

• Call for headache, blurred vision, seeing double or loss of vision, as MedlinePlus says.
• Call for watery or bloody stools, stomach cramps, or fever during treatment or for up to two or more months after stopping, as MedlinePlus says.
• Call for a rash that may occur with fever or swollen glands, as MedlinePlus says.
• Call for skin redness or purple color, peeling, itching, burning or blistering, as MedlinePlus says.
• Call for hives, as MedlinePlus says.
• Call for difficulty breathing or swallowing, as MedlinePlus says.
• Call for swelling of the eyes, face, throat, tongue or lips, which MedlinePlus also lists.
• Call for unusual bleeding or bruising, which MedlinePlus lists too.
• Call for discoloration of permanent adult teeth, which MedlinePlus also lists.

What is intracranial hypertension and why does it matter?

The label says intracranial hypertension, also called pseudotumor cerebri, has been associated with tetracyclines including doxycycline. Its signs include headache, blurred vision, diplopia and vision loss. The label says women of childbearing age who are overweight or have a history of the condition are at greater risk. It adds that the condition typically resolves after the drug is stopped, but permanent visual loss is possible. If visual disturbance occurs during treatment, the label says prompt ophthalmologic evaluation is warranted. It adds that intracranial pressure can remain elevated for weeks after the drug is stopped.

What are the severe skin reactions?

The label says severe skin reactions have been reported in people taking doxycycline, including exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis and DRESS. It says to stop the drug immediately if a severe skin reaction occurs. It also says fixed drug eruptions have occurred with doxycycline and have been associated with worsening severity upon subsequent administrations.

Can doxycycline cause Clostridioides difficile diarrhea?

Yes, the label says Clostridioides difficile associated diarrhea has been reported with nearly all antibacterial agents, including this one. It can range from mild diarrhea to fatal colitis. It says it has been reported to occur over two months after the administration of antibacterial agents. The label says this possibility must be considered in all patients who have diarrhea after antibacterial use, so mention any diarrhea to your doctor.

Can doxycycline harm the liver in some people?

The label says hepatotoxicity has been reported with tetracyclines, and it doesn’t give a rate for it. MedlinePlus tells you to share any history of liver or kidney disease with your doctor before you start.

Can you take doxycycline with isotretinoin (Accutane)?

No, both labels say to avoid using the two together. The Doryx MPC label says to avoid concomitant use of isotretinoin and Doryx MPC because isotretinoin is also known to cause pseudotumor cerebri. The Accutane® label says Accutane use has been associated with cases of pseudotumor cerebri, some of which involved concomitant use of tetracyclines. It says concomitant treatment with tetracyclines should therefore be avoided.

Avoid concomitant use of doxycycline and isotretinoin, as the Doryx MPC label says, because isotretinoin is also known to cause pseudotumor cerebri. Our doxycycline vs Accutane® article compares the two drugs in more depth.

Is doxycycline safe in pregnancy, and does it affect birth control?

The label describes tooth development as the last half of pregnancy, infancy and childhood to the age of 8 years. It says that using tetracycline-class drugs during that time may cause permanent discoloration of the teeth. The label describes the color as yellow-gray-brown. It says this is more common with long-term use but has also been seen after repeated short courses. The label further says tetracycline-class drugs can cause fetal harm, though data for doxycycline are limited.

Tell your prescriber if you are pregnant or planning a pregnancy. MedlinePlus also says to tell your doctor if you are breastfeeding, and that your doctor may tell you not to breastfeed during treatment. MedlinePlus adds that doxycycline may decrease the effectiveness of hormonal contraceptives, including pills, patches, rings and injections. It says you need another method of contraception to prevent pregnancy while taking it.

What is different about doxycycline side effects when you take it for acne?

The AAD says dermatologists prescribe an antibiotic for the shortest time possible, which usually means three to four months, and that some people need more time. The AAD also says to keep all follow-up appointments with your dermatologist.

The AAD says that when taken alone, an antibiotic can quickly lose its ability to fight acne. It also calls antibiotic resistance a global health problem. That is why your dermatologist prescribes other acne medicine along with an antibiotic, and the AAD says you may need benzoyl peroxide or adapalene gel. The 2024 AAD guideline gives oral doxycycline a strong recommendation for acne.

Does doxycycline make acne worse or cause purging?

Neither the label nor MedlinePlus lists an acne flare among doxycycline’s side effects. We didn’t find a label, AAD page or trial abstract that describes a doxycycline purge. If your acne is getting worse, message the prescriber who wrote the prescription instead of waiting. Our doxycycline for acne article covers how long to give it before judging.

Does doxycycline dry out your skin or cause weight loss?

The sources we checked don’t list dry skin or weight loss as doxycycline side effects. The label does list anorexia, meaning loss of appetite, and MedlinePlus lists loss of appetite and dry mouth. If nausea or appetite loss is changing how much you eat, tell your prescriber. For dry or irritated skin, the AAD warns that scrubbing can irritate your skin and worsen acne.

What about side effects after you stop?

Two items in the sources can outlast the last dose. MedlinePlus says to call your doctor about watery or bloody stools, stomach cramps, or fever for up to two or more months after stopping. The label says intracranial pressure can remain elevated for weeks after the drug is stopped, so patients should be monitored until they stabilize.

Is it safe to drink alcohol on doxycycline?

The Doryx MPC label lists no alcohol warning; the word appears only in the drug’s chemical name. Our can you drink alcohol on doxycycline article goes through what the published studies do and don’t say.

Are there other options if the side effects are a problem?

Ask your prescriber before you stop. Doxycycline is one of three antibiotics the AAD says the FDA has approved for acne, along with minocycline and sarecycline. Our doxycycline vs minocycline article compares the first two. Spironolactone is a different, off-label option that some women use for acne, and our spironolactone side effects article covers its own list of effects.

Where does The Goal Is Clear fit into your care?

At The Goal Is Clear, every case is reviewed by a U.S. board-certified dermatologist licensed in your state. The how it works page says you can message your dermatologist through the dashboard with side-effect reports, refill questions and photo updates. A real person reads every message.

The how it works page says you take a quiz of about two minutes, upload a front photo and a side photo, and check out through secure billing. A board-certified dermatologist then reviews your case within 24 hours.

Care is one flat price, and the pricing page lists the Acne Care path as topicals, antibiotics and more. Medication is billed separately by the pharmacy, as low as $0 for the prescription with insurance. The pricing page says care is not a guarantee of any prescription. BNG Health Services, LLC operates the brand and is not the prescribing physician.

Common questions about doxycycline side effects

What side effects does the doxycycline label list? The label lists anorexia, nausea, vomiting and diarrhea, and MedlinePlus adds that doxycycline may make your skin sensitive to sunlight. MedlinePlus says to drink a full glass of water with each dose, and to use food or milk if your stomach becomes upset.

How do you avoid irritating your esophagus on doxycycline? Take each dose with a full glass of water, as MedlinePlus says. The label says most patients with reported esophagitis or esophageal ulceration took medications immediately before going to bed. Ask your prescriber what time of day suits you.

When should you call a doctor about doxycycline? MedlinePlus says to call right away for headache, blurred vision, double vision or vision loss. It also says to call for watery or bloody stools, stomach cramps, or fever during treatment or for up to two or more months after stopping. It also says to call for a rash that may occur with fever or swollen glands. Call too for skin redness, peeling, itching, burning or blistering, or for trouble breathing or swallowing. Call 911 if something feels like an emergency.

Can you take doxycycline with Accutane? No, both labels say to avoid using the two together. Both the doxycycline label and the Accutane® label say to avoid using the two together because of pseudotumor cerebri, also called intracranial hypertension.

Is doxycycline safe to take during pregnancy? The label says tetracycline-class drugs used in the last half of pregnancy may cause permanent yellow-gray-brown tooth discoloration. It adds that they can cause fetal harm, though data for doxycycline are limited. Tell your prescriber if you are pregnant or planning a pregnancy. MedlinePlus says that if you become pregnant while taking doxycycline, you should call your doctor immediately.

What should you remember about doxycycline side effects?

Stomach upset and sun sensitivity are listed effects, so follow the MedlinePlus directions for taking the pill. Learn the short list of warning signs. Keep all follow-up appointments with your dermatologist, as the AAD says. Avoid concomitant use of doxycycline and isotretinoin, as the label says. If something on the serious list happens, contact a doctor instead of waiting for the next visit.

If you’d like a board-certified dermatologist to look at your case, take the quiz, which takes about two minutes. You can also read our FAQ first.

This article is general information, not medical advice. A prescription is never guaranteed, and treatment decisions stay with the board-certified dermatologist who reviews your case. Doryx® and Accutane® are registered trademarks of their respective owners, and isotretinoin is the generic name. The Goal Is Clear is operated by BNG Health Services, LLC, which is not the prescribing physician, and board-certified dermatologists prescribe.

Sources

• Doryx MPC (doxycycline hyclate) prescribing information, DailyMed
• Accutane (isotretinoin) prescribing information, DailyMed
• MedlinePlus, Doxycycline
• American Academy of Dermatology, How long can I take an antibiotic to treat my acne?
• American Academy of Dermatology, Acne: Diagnosis and treatment
• Reynolds et al., Guidelines of care for the management of acne vulgaris, J Am Acad Dermatol 2024
• Moore et al., Efficacy and Safety of Subantimicrobial Dose, Modified-Release Doxycycline 40 mg Versus Doxycycline 100 mg Versus Placebo for the treatment of Inflammatory Lesions in Moderate and Severe Acne, J Drugs Dermatol 2015