Doxy – generic or brand?

[Pip]

Does anybody know if there is a difference in Doxy as there is in Mino?  How about any of the 'better' manufacturers?  Or the really bad manufacturers as I'd like to skip those especially

I'd really appreciate any help/advice.

Pip

[Maz]

[user=23]Pip[/user] wrote:

Does anybody know if there is a difference in Doxy as there is in Mino?  How about any of the 'better' manufacturers?  Or the really bad manufacturers as I'd like to skip those especially

Hi Pip,

I've been on generic and brand doxy and personally found the Doryx brand to be superior to the generic capsules. Doryx (doxycycline hyclate) are a delayed-released pill (shaped like a bullet/capsule). I preferred the time-released action of doryx, knowing it was keeping serum levels relatively even between doses – perhaps more important for Lyme. Questionable whether or not this is a good thing for mycos, as rising and falling serum levels may be less important for these slow-reproducing organisms and less is often more for myco (producing less die-off and more tolerable herxing).

As far as I know, there are two basic formulations of doxycycline – doxy hyclate and doxy monohydrate.

http://www.drugs.com/cdi/doxycycline-monohydrate.html

http://www.drugs.com/cdi/doxycycline-hyclate.html

Vibramycin is another brand of doxy (derived from oxytetracycline) and comes in hyclate and monohydrate – I'm still trying to figure out the difference in the hyclate and monohydrate actions! 😕

Sorry – more grist for the ol' research mill, eh? :doh:

Peace, Maz

[lynnie_sydney]

My doc absolutely believes in the brand/generic difference. There was one generic however that she said worked and she put me on it. Here is is called Doxylin (doxycycline hydrochloride) and it's manufactured by Alphapharm (owned by U.S. company Mylan). Not sure if this will be useful for you. Lynnie

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[nord]

Sorry if nitpicking, but it seems rather contradictory:

[user=27]Maz[/user] wrote:

I preferred the time-released action of doryx, knowing it was keeping serum levels relatively even between doses – perhaps more important for Lyme.

Burrascano MANAGING LYME DISEASE, 16h edition, October, 2008 Page 14 of 37:

Kill kinetics indicate that a large spike in blood and tissue levels is more effective than sustained levels, which is why with doxycycline, oral doses of 200 mg bid is more effective than 100 mg qid. Likewise, this is why IV doses of 400 mg once a day is more effective than any oral regimen.

I would like to see more on absolute concentrations vs optimal combinations. As an example, Chlamydophila Pneumoniae, combining a Tetracyclin and a Erythromycin increases the efficinecy fourfold, according to Dr Wheldon. The Burrascano guidelines sketches in the direction that the Cpn researchers at Vanderbilt went long ago. I have not found any firm advice that would mean a Lyme protocol is sufficient to eradictate Cpn (rather the contrary; seeing what forum members take and the Burrascano and other ILADS guidelines suggest most Lyme protocols are a chance hit if Cpn is completely wiped out, given more than a slight infection). BUt I can be mistaken, having the obvious fogged up :doh::)

Maz:

Questionable whether or not this is a good thing for mycos, as rising and falling serum levels may be less important for these slow-reproducing organisms and less is often more for myco (producing less die-off and more tolerable herxing).

Of course, a very good point. Reading stories where people get into rather hard-hitting Lyme protocols with suspected Cpn parallel infection and getting what is perhaps both die-off and herxing at once sound rather harsh.

Vibramycin is another brand of doxy (derived from oxytetracycline) and comes in hyclate and monohydrate – I'm still trying to figure out the difference in the hyclate and monohydrate actions! 😕

I've seen the monohydrate being developed to have less stomach issues, and there is the difference in water solubility, perhaps affecting penetration, or is it equalised after absorption?

There seem to be a lot of different experiences with original vs generics, so perhaps a good suggestion is to experiment a bit, being aware of the possible differences. A bit like different efficiency of different antibiotics, perhaps?

Thank you for the input.

[Maz]

[user=2031]nord[/user] wrote:

Sorry if nitpicking, but it seems rather contradictory:

[user=27]Maz[/user] wrote:

I preferred the time-released action of doryx, knowing it was keeping serum levels relatively even between doses – perhaps more important for Lyme.

Burrascano MANAGING LYME DISEASE, 16h edition, October, 2008 Page 14 of 37:

Kill kinetics indicate that a large spike in blood and tissue levels is more effective than sustained levels, which is why with doxycycline, oral doses of 200 mg bid is more effective than 100 mg qid. Likewise, this is why IV doses of 400 mg once a day is more effective than any oral regimen.

Vibramycin is another brand of doxy (derived from oxytetracycline) and comes in hyclate and monohydrate – I'm still trying to figure out the difference in the hyclate and monohydrate actions! 😕

I've seen the monohydrate being developed to have less stomach issues, and there is the difference in water solubility, perhaps affecting penetration, or is it equalised after absorption?

It's okay, Nord, I don't perceive it as nitpicking to question stuff…just an attempt to figure stuff out.

I may be mistaken, too, but the way I understand Burrascano's commentary on the use of tetracyclines for Lyme is that he's suggesting that the ideal is to give patients tetras in high doses in order to attain constant blood levels. The problem here is that most people can't tolerate the high doses needed to sustain a constant bombardment of borreliosis. For instance, I took tetracycline in doses of 750mg twice per day (equivalent of doxy or mino 300mg twice per day) for the first year of my Lyme treatment…this was pretty tough going, as you might imagine and, once we'd hit as much as we could in the way of coinfections  that first year, I reverted to low dose, pulsed mino/zith combo that brought me to remission by month 10 of this protocol. It's difficult to assess if this is what Burrascano is discussing here, but I'm presuming that if a patient is unable to tolerate sustained high doses of tetracyclines in the long term, then doing short, sharp, lower dose hits of 200mg doxy twice per day (BID) is more effective than trying to sustain lower doses of 100mg 4 times per day (or QID). That is to say, that 600mg per day of doxy is optimal, but usually intolerable…so the alternative is to go lower with dosing in a BID rather than a QID fashion. The use of IVs in Lyme remains controversial even between LLMDs…for some, it's lifesaving, but IV Rocephin is not necessarily a panacea for all and oral combinations may be just as effective, if not more so, according to my LLMD.

Burrascano writes (full quote on tetras from his treatment guidelines above):

“The TETRACYCLINES, including doxycycline and minocycline, are bacteriostatic unless given in high doses. If high blood levels are not attained, treatment failures in early and late disease are common. However, these high doses can be difficult to tolerate. For example, doxycycline can be very effective but only if adequate blood levels are achieved either by high oral doses (300 to 600 mg daily) or by parenteral administration. Kill kinetics indicate that a large spike in blood and tissue levels is more effective than sustained levels, which is why with doxycycline, oral doses of 200 mg bid is more effective than 100 mg qid. Likewise, this is why IV doses of 400 mg once a day is more effective than any oral regimen.”

I'm afraid I haven't really studied the CPn protocols in any great depth and you probably know more about them than I. Perhaps the CPn folk could help more with your questions in this context?
 
Thanks for sharing the info on doxy monohydrate being developed to relieve stomach issues….can you direct me to specific links regarding this?
 
Peace, Maz

[lynnie_sydney]

Kill kinetics indicate that a large spike in blood and tissue levels is more effective than sustained levels

jumping in here. Wouldnt this indicate that Minocin – which I gather has somewhat of a sustained release action – wouldnt be the best to use for Lyme then and that a more immediate release minocycline tablet (versus capsule) would be better? Lynnie

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[nord]

Thank you for understanding, you're so kind and write so great posts. 🙂

I understand the compromise between the microbiologically desired and the need to make it tolerable. I just thought that there were perhaps new developments that called for more even plasma concentrations. For intracellular action , plasma levels are possibly better to be more even, as the cell membrane crossing is a slower process.

[user=27]Maz[/user] wrote:

I'm afraid I haven't really studied the CPn protocols in any great depth and you probably know more about them than I. Perhaps the CPn folk could help more with your questions in this context?

I think I have it much figured out to my current need, but there seem to be some ideas in the Cpn treatment thinking that could add perspectives to Lyme protocols. My thinking is that applying the same approach to lyme may lead to a good alternative to those high monotherapy doses. Even if there is “Kill Kinetics” the Tetracylines are mainly inhibitors of the bacterial prolieration rather than killing them. Even if such drugs do kill off bacteria at high enough concentrations, there may be more efficient strategies. Also combining two bacteriostatic drugs may let them act synergetically, and reducing the options for the bacteria to develop resistance. Then yet another one is introduced for the kill.
[This thinking is used in Cpn where “Doxy” and “Roxi” (or “Zithro”/”Azi”) are used as combination 'static drugs enhancing the effect on the replicating form fourfold (equalling 800-1200 mg doxy if taken alone), and then “Metro”or “Tini” for the kill ? acting on the cryptic form that the 'statics drive them into; the infectous “first” form is taken care of with NAC (or “Amoxi”)]
 

Thanks for sharing the info on doxy monohydrate being developed to relieve stomach issues….can you direct me to specific links regarding this?

It was not an English text, but here's my translation (note that the brand names used in different markets can differ and refer to different formulations):

Doxyferm (doxycykline monohydrate) is a broad-spectrum antibiotic that has been in use for 25 years

/The/ Doxycycline is available in three froms; Hydrochloride (former Vibramycin, Doryx) where, after a number of reports of esophageal damage from the substance's low pH and capsule formulation the doxycycline was bound to monohydrate (Vibramycin Novum, Doxyferm), and carregate (current VIbramycin).

1.  Grahn

[nord]

Double, sorry :blush:

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