Doxycycline × Isotretinoin

Both drugs can cause benign intracranial hypertension (pseudotumor cerebri). Some cases on isotretinoin occurred with concomitant tetracyclines (isotretinoin SmPC), and permanent vision loss has been reported with tetracyclines, including doxycycline (doxycycline SmPC). The risks add up when the drugs are combined.

Headache, nausea, vomiting, visual disturbances; papilloedema on fundoscopy (isotretinoin SmPC). Intracranial pressure can stay raised for weeks after the drug is stopped (doxycycline SmPC).

The combination is contraindicated: the Spanish isotretinoin SmPC contraindicates isotretinoin with tetracyclines, which include doxycycline (isotretinoin SmPC). The doxycycline SmPC and the US isotretinoin label both say the combination must be avoided (doxycycline SmPC; US isotretinoin label). If an antibiotic is needed during isotretinoin treatment, tetracyclines are not chosen. If headache, nausea, vomiting, visual disturbances or papilloedema appear, stop isotretinoin at once (isotretinoin SmPC) and refer the patient to a neurologist (US isotretinoin label); visual symptoms need an urgent eye examination (doxycycline SmPC). Intracranial pressure can stay raised for weeks after stopping, so follow the patient until it stabilises (doxycycline SmPC).