Doxycycline for Acne: The Essential Guide

Acne can be stubborn and frustrating to treat. If topical treatments aren’t enough, your dermatologist may recommend doxycycline, an antibiotic pill used to treat moderate to severe inflammatory acne.

Doxycycline belongs to a class of antibiotics called tetracyclines. It comes in generic forms (doxycycline hyclate and doxycycline monohydrate) and brand name versions (like Vibra-Tabs, Doryx, and Oracea). 

Here’s what you should know about taking doxycycline for acne, including how it works and what to expect during treatment.

How does doxycycline work for acne?

Acne develops when excess oil, bacteria, and dead skin cells build up inside pores. This can clog the pores and trigger inflammation, leading to pimples, cysts, and other acne lesions.

Doxycycline works by lowering the amount of acne-causing bacteria in the skin and reducing inflammation. This helps clear existing acne and prevent new breakouts.

How long do you need to take doxycycline?

Dermatologists usually prescribe doxycycline for acne for about 3 to 4 months. This helps reduce the risk of antibiotic resistance, which happens when bacteria stop responding to a medication. Some people may need longer treatment depending on how well their acne responds. 

Healthcare professionals typically prescribe doxycycline along with other acne treatments, especially topical retinoids and benzoyl peroxide. These medications help keep acne under control after you stop taking doxycycline. Benzoyl peroxide may also help lower the risk of antibiotic resistance. 

If you're using doxycycline with another acne treatment, use both medications as directed for best results.

Doxycycline dosage

Here are some typical dosages of doxycycline for acne. Your dermatologist may use one of these or a different dosage, depending on your situation:

• 20 mg twice a day

• 40 mg once a day

• 50 mg twice a day

• 100 mg once a day

• 100 mg twice a day

Who should not take doxycycline?

Doxycycline may not be the right treatment for everyone. In general, you shouldn’t take doxycycline if you:

• Are pregnant or breastfeeding

• Are younger than 8 years old

• Have an allergy to doxycycline or other tetracycline antibiotics 

• Take certain medications (like isotretinoin)

What are common side effects of doxycycline?

Most people do well on doxycycline. But like all medications, it can cause side effects. Common ones include:

• Sun sensitivity (getting burned more easily in the sun): Protect yourself from the sun by wearing sunscreen, seeking shade, and wearing protective clothing. 

• Nausea, vomiting, or diarrhea: Depending on the type of doxycycline, your prescriber may recommend that you take the medication with food or switch to a different one to avoid these side effects. 

• Esophagitis (inflammation of the esophagus): The esophagus is the tube that connects the mouth to the stomach. Esophagitis is a condition that can feel like heartburn or cause pain when you swallow. You can prevent esophagitis by not lying down for at least 30 minutes after taking doxycycline.

Rare side effects of doxycycline include:

• Permanent yellow staining of teeth: Doxycycline can permanently discolor developing teeth. Because of this risk, it’s generally not recommended during pregnancy or in children younger than 8 years old. 

• Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN): These are extremely rare but serious skin reactions that can occur with certain medications, including doxycycline. Symptoms may include a painful rash, blistering skin, fever, or flu-like symptoms. Seek emergency medical attention right away if these symptoms develop. 

How long do doxycycline side effects last?

Most common doxycycline side effects improve shortly after you stop taking the medication. Here’s what you can expect: 

• Nausea, vomiting, and diarrhea: These symptoms usually improve within a few days after stopping doxycycline.

• Sun sensitivity: Your skin may remain more sensitive to the sun for about 10 to 14 days after stopping doxycycline. 

• Esophagitis: Symptoms usually improve within 1 to 2 weeks, if not sooner. 

Can doxycycline interact with any other medications?

Yes, doxycycline can interact with other medications. That means some medications and supplements can make doxycycline less effective or increase the risk of side effects.

The following over-the-counter (OTC) medications can reduce how much doxycycline your body absorbs:

• Calcium-containing antacids, like calcium carbonate (Tums) 

• Iron supplements

• Bismuth subsalicylate (Pepto-Bismol, Kaopectate)

• Aluminum- and magnesium-containing products (milk of magnesia, Mylanta, and some multivitamins)

These prescription medications can also interact with doxycycline:

• Warfarin: Doxycycline can increase the effects of warfarin (Coumadin), raising the risk of bleeding. You’ll need to monitor your international normalized ratio (INR) while taking both medications.

• Seizure medications: Medications like phenytoin and phenobarbital may make your doxycycline less effective. 

This isn’t a complete list of all doxycycline interactions. Be sure to tell your healthcare team about all the medications you’re taking (including OTC and herbal medications) before starting doxycycline. 

What’s the best way to take doxycycline?

Doxycycline comes as a tablet or capsule that you take by mouth with a full glass of water. Below are some general tips for taking doxycycline. However, be sure to check with a healthcare professional to find out the best way to take it.

• Take doxycycline with food. Taking doxycycline with food may help reduce nausea and other stomach-related side effects. However, some forms of doxycycline, like Oracea (doxycycline 40 mg), should be taken on an empty stomach. Follow the instructions that come with your prescription. 

• Avoid dairy products and certain supplements right before and after taking doxycycline. Dairy products, calcium and iron supplements, and some antacids can reduce how much doxycycline your body absorbs. Avoid consuming these within 1 hour before or 2 hours after taking doxycycline. Talk with your prescriber about the best timing if you regularly take these products. 

What if doxycycline makes your acne worse?

Doxycycline doesn’t usually make acne worse before it gets better. If your breakouts worsen after starting doxycycline, you should ask about other acne treatment options.

Your dermatologist may adjust your treatment plan by changing your topical medication or recommending another acne treatment, like:

• A different antibiotic

• Birth control

• Spironolactone

• Isotretinoin 

Keep in mind that acne can sometimes worsen because of another treatment you’re using, rather than doxycycline itself. 

How to save on doxycycline for acne

Doxycycline hyclate and doxycycline monohydrate are similar and both prescribed for acne. Most private insurance and Medicare plans cover both. No matter which type of doxycycline you use, there are many ways to save:

• GoodRx coupons: Using GoodRx can help you save up to 90% of the average retail price of generic doxycycline. At some pharmacies, generic doxycycline hyclate and doxycycline monohydrate can be as low as $10. 

• Mail-order pharmacy: Check with your insurance plan to see if they offer discounts by using their mail-order pharmacy. 

• Copay savings card: For people with private insurance who meet certain requirements, manufacturer’s savings cards can mean big savings. For example, brand name doxycycline, like Oracea and Doryx MPC, can both be as low as $0 with the manufacturers’ savings cards. 

• Patient assistance programs: People who are uninsured or underinsured may be eligible for Oracea’s patient assistance program. This can help you get doxycycline free of cost. 

• Different forms of doxycycline: Doxycycline hyclate and doxycycline monohydrate may have different prices. Ask your pharmacist or prescriber if a lower-cost alternative is available. 

What are some alternatives to doxycycline?

Doxycycline is a popular acne medication, but it’s not for everyone. When it comes to antibiotic pills for acne, other options include:

• Minocycline

• Tetracycline

• Erythromycin

• Sulfamethoxazole / trimethoprim 

In addition to antibiotics, there are other treatments available. These include topical medications, hormonal treatments, and isotretinoin (Accutane). 

With all of the treatment recommendations out there for acne, don’t forget that healthcare professionals are there for you. Your prescriber can help with managing any side effects or figuring out your insurance coverage. 

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Written by:

Maryann Mikhail, MD

Maryann Mikhail, MD, is a board-certified dermatologist and medical writer based in South Florida. She is the founder of Waverly DermSpa in Fort Lauderdale and holds a voluntary faculty position at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami MIller School of Medicine.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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