BootsnAll Travel Community

I'm posting this on behalf of my girlfriend.

We've consuled a number of sources and some say that Doxycycline reduce the effect of the pill. Others say the pill will function again fully after 3/4 weeks.

E.g.: the below article :
"Antibiotics such as amoxycillin, ampicillin, erythromycin and tetracycline affect the re-absorption of oestrogen. These antibiotics alter the gut flora and ethinyloestradiol is not conjugated. There is more ethinyloestradiol passed in the stool. Pregnancy and breakthrough bleeding can occur. If any of these antibiotics are taken then the woman should continue to use the pill but should also use a barrier method for the next 14 days.

If a patient has been taking long-term antibiotic therapy (e.g. for acne vulgaris) then additional contraception should be used for the first month after starting the oral contraceptive pill. After this period gut flora should have adjusted to the effects of antibiotic therapy and additional use of the combined oral contraceptive pill so that additional contraceptive protection should not be required. Also patients on a combined oral contraceptive pill who are prescribed Doxycycline for malaria need to take additional contraceptive measures, at least for the first month."

Does this mean that after a month the pill will be safe/ should we use additional protection for our full year away (while on Doxycycline).

Thanks,
Colm

Hi Colm,
Basically pill+antibiotic = same as no pill. So anytime you take an antibiotic, your pill is not effective. If you take antibiotics over two cycles, then both months are not 'safe'.
If you take the antibiotic for the whole year, then you should look for another form of birth control
Liz

My blog: http://datigz.blogspot.com

quote:

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Originally posted by Colm:
If a patient has been taking long-term antibiotic therapy (e.g. for acne vulgaris) then additional contraception should be used for the first month after starting the oral contraceptive pill. After this period gut flora should have adjusted to the effects of antibiotic therapy and additional use of the combined oral contraceptive pill so that additional contraceptive protection should not be required. Also patients on a combined oral contraceptive pill who are prescribed Doxycycline for malaria need to take additional contraceptive measures, at least for the first month."

Does this mean that after a month the pill will be safe/ should we use additional protection for our full year away (while on Doxycycline).

Thanks,
Colm

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Additional birth control method will be needed, as Liz said previously
antibiotics + pills = NO PILL so be careful

Ga

Note on Doxycycline: NASTY antibiotic for some people (myself included) because your skin becomes very very sensitive to sun and you can burn through sunscreen. I used to half to wear long sleeve shirts when I was outdoors, which was miserable in the summer. May not be the best thing for her to take while traveling.

And yeah, you do have to use backup. Have her look at this page for some more info.

Court

"The traveler sees what he sees. The tourist sees what he has come to see." ~G.K. Chesterton

I also got Doxycycline from the doc for my upcoming 2 month internship in Costa Rica. Im worried about the sun sensitivity also. Im naturally darker, with dark eyes and hair. So i normally never burn, just get really tan. Should I be worried?

If you get really tan, I wouldn't worry about it as much as someone with lighter/paler skin. However, watch your coloring and if you feel like you're burning, you probably are, no matter how stong your sunscreen is...

Court

"The traveler sees what he sees. The tourist sees what he has come to see." ~G.K. Chesterton

This is quite a conundrum really.
The Malaria prophylaxis options that we've been recommended (from a number of sources including MASTA) are as follows:

Doxycycline, Malarone, Mefloquine.

I feel confident that Doxycycline is the right one for me. However, it is much more difficult for my girlfriend to choose. The difficulties are as follows:

Mefloquine - Not good because of family history of depression.

Doxycycline - Not good because of it's effect on the pill + sun sensitivity (how common is this?). My girlfriend has very pale skin!

Malarone - Price is unfeasible for the time required (3 months in S. America + 3/4 months in S.E Asia/ India etc....)

Another note on Mefloquine: nightmares.

Sun sensitivity is pretty common....I don't have that pale of skin and I ended up in the ER for my severe burns!!!

As far as Malarone goes...do you have insurance? You may have to pay up front, but insurance may be willing to pay for most of it.

Court

"The traveler sees what he sees. The tourist sees what he has come to see." ~G.K. Chesterton

I just went through the decision today!

The available meds were the same: Lariam (mefloquine), doxycyclen, and malarone.

I nixed lariam because I will be travelling alone, and have read enough about it to be wary. Plus, I tend to have bad luck, so I'd probably be on some crazy hallucinogenic trip while walking around Quito at night, or something like that. Hmm..I just could get myself in very bad situations being alone.

I nixed malarone because of the cost. The clinic nurse told me that in the states, it costs $6 - $14/pill depending on the pharmacy! Plus it's a daily pill (60 days x $6!). And my insurance sucks, so it's all out of pocket.

Therefore, I went with doxycyclen - another daily pill + 1 month after, but a lot cheaper than malarone. They let me know of some of the possible side effects -- yes, sun sensativity, and um..possible yeast infections (yuck!). Any warnings about that??

I took chloroquine for Belize, and I think it's the easiest/least side effects, but a lot of areas have become chloroquine tolerant, so it's not a choice in a lot of places.

Marisa

http://www.geocities.com/mumsawas

Marisa-
Get a perscription for Diflucan before you go. Doctors will give you more than one too, if you ask, especially if you are going to be gone for awhile. All antibiotics like doxycycline, tetracycline, amoxicillin (lots of spelling errors in those ones) or anything that ends in "cline" increases your susceptibility to yeast infections, especially if you are on them for an extended period of time.

Court

"The traveler sees what he sees. The tourist sees what he has come to see." ~G.K. Chesterton

Colm-
With the doxy you are looking at the same side effects as if she were taking pennicillan (I forget how to spell that). If she is normally sun sensitive when she's on an anti-biotic, then she'll be sensitive again. Keep in mind you may be in the sun more than normal too though, so she may not have noticed that she was sun sensitive before.

If she is prone to yeast infections on pennicillan, then she should be bringing medication for that. It is hard to find good stuff abroad. I always get yeast infections when I take an anti-biotic.

From the sounds of it, I'd say doxy is the best choice. The side effects / cost issues of the others are not good. The side effects for the doxy are just a nuisance. So pack some strong sunscreen, get some Monistat (or whatever it is called now) and take a ton of condoms and spermicidal jelly. Remember that condoms elsewhere in the world are not the same quality as you get at home, so bring lots
Sure, you won't have the same sexual freedom as before. But, that's better than getting malaria.

Another option - I believe you can get malaria pills OTC pretty much everywhere in malaria zones, for a fraction of the cost in the US.

Liz

My blog: http://datigz.blogspot.com

Thanks for all your advice guys!!

Just to be sure my girlfriend has also booked in for a one-to-one consultancy with a doctor at Masta next Monday. I'll let you know what the final outcome and advice is.

Again - thanks
Colm

... Just 1 month to go from today!!!

I'm whiter than white can be, and I have had not a lick of problem with skin sensitivity on doxy. It's not so bad!!

PC

Check out my new RTW blog:
http://blogs.bootsnall.com/claudia

So finally we've both decided to go with Doxycycline!

With regard to it's effect on the pill my girlfriend has received the below communication from both her doctor, MASTA and from Schering AG the manufacturer of her pill 'Femodene':

“An interaction takes place between the oral contraceptive Femodene and the tetracycline antibiotic 'doxycycline'. Tetracycline antibiotics can disturb the gut flora potentially reducing contraceptive efficacy. You should discuss this with your GP when he is prescribing the antimalarial tablets. He/she will advise you that extra precautions will need to be taken for the first two weeks, plus the usual 7 days, with the elimination of the next pill free period if the first two weeks' antibiotic use extends into the last 7 days of a pack."

This is the advice that my girlfriend has received. However, I guess each of you should do your own research and ask Doctors etc... about the effects of the different Malaria pills can have on you. Though I hope this posts supports you in that research.

The one thing that we’ve learned is that in the end it's left up to the individual to make his/her own decision. In the case of Malaria there is no vaccine and no 'perfect' solution exists. Thanks again, all at BnAll for your support

Good luck with your research. Have patience and persist!

Colm

thanks for the helpful info and good question...this was a great thread

court

"The traveler sees what he sees. The tourist sees what he has come to see." ~G.K. Chesterton

I've been using doxycycline for a while now with now problems at all. The doc in Switzerland who I talked it over with told me to take my HRT at least two hours after the doxycycline to prevent the gut disturbance which reduces oestrogen efficacy. Seems to work OK for me...and the HRT is working ok. Also you shouldn't take vitamins, or minerals (like calcium tabs or magnesium) at same time as the doxy.

In Mali Doxycycline 100g is available really cheaply over the counter from pharmacies, much much cheaper than the UK or Switzerland. Probably the same elsewhere.

Stumbling across this thread was a life saver. I was prescribed doxy for my upcoming trip, and am currently on Trinessa for BC. Being the hasty person I am, I would've never read the side effects manual that comes with either, so reading this has been a blessing. I appreciated BnA so much before, now I do ever more so.

When I was on semester at sea we had some problems with people taking doxycyline and larium. Larium caused the nightmares and I know some people on doxy got burnt and yeast infections. Another thing that happened a few times which is a bit more serious is the doxy pill being stuck in the esophogous and kind of like burning a hole in it. So make sure when you take it to drink like a whole glass of water and not lay down or anything immediately after because I heard that this was really painful and you know just not a good situation.