100mg a day of Doxycycline is no better than Oracea

Written by on January 18, 2008 in doxycycline, Oracea (40mg doxycycline) with 18 Comments

Collagenex is reporting today that Oracea is equally effective as 100mg of doxycycline. This latest press release is a culmination of a trial that we have reported previously – oracea plus metrogel, better than 100mg doxycycline plus metrogel ? and also a 2007 SkinMed paper; maximum effective dose of doxycycline is 40mg a day.

The main point of the trial was to show that a dosage higher than Oracea’s 40mg a day, won’t result in a better decrease in papules and pustules, but may show side effects commonly associated with higher doses of antibiotics.

If Oracea is too costly to be a part of your rosacea regime, you should consider 50mg a day of generic doxycycline. This is likely to be a much cheaper alternative but also offer the same benefits as oracea.

A paper related to this press release was titled Anti-Inflammatory Dose Doxycycline (40 mg Controlled-Release) Confers Maximum Anti-Inflammatory Efficacy in Rosacea and had the following conclusion ;

Higher mg/kg doses led to higher plasma concentrations but did not lead to increased clinical efficacy. Anti-inflammatory dose doxycycline (40-mg controlled-release formulation) conferred peak anti-inflammatory efficacy in the treatment of rosacea.

From today’s Press Release:

Oracea is a patented, delayed release formulation of doxycycline, 40 mg, that is the only FDA-approved treatment for the papules and pustules associated with rosacea. Doxycycline at much higher doses is often prescribed off-label by dermatologists for the treatment of rosacea. The study demonstrated that the higher, antimicrobial dose does not provide a greater clinical benefit than the anti-inflammatory dose of 40 mg, controlled release. However, the higher dose was associated with a significantly higher incidence of adverse events.

In contrast, a clear difference was observed between the two treatment groups (Oracea vs. 100mg doxycycline) in the incidence of adverse events, primarily gastrointestinal reactions. Gastrointestinal adverse events, including nausea, vomiting, diarrhea and stomach discomfort, were observed in 26% of patients administered 100 mg of doxycycline versus only 5% in the Oracea group.

This study has demonstrated that, in patients with rosacea, increasing the daily dose of doxycycline to 100 mg does not lead to greater efficacy than Oracea, but has a much greater incidence of gastrointestinal side effects. In addition, Oracea’s onset of action was not different from the 100 mg doxycycline dose.”

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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18 Reader Comments

  1. Ben says:

    seems like they’ve tested it just about all they can for P&Ps…. hopefully they will move on to its effectiveness in ocular rosacea.

  2. Indeed Collagenex has milked as much as they can to get Oracea as the rosacea treatment. If you consider that they once had the patent for Periostat (it expired) then you realize how much work they have done to get back to where they were before ; but this time marketed towards rosacea.

    We will no doubt see ocular rosacea press releases as soon as their trials finish.

    This is all good news for us, though – good sales means more money to be invested in R&D for products like Sansrosa.


  3. ben says:

    I hope that Restasis and low dose doxycycline some day become a much more used ocular rosacea treatment (if indeed they are effective… which is looks like they are) Both are very safe as far as side effects go.

    Then if col-118 or something similar passes, and we had a decent treatment for flushing/redness, we would have a decent way to actually treat all parts of this multi-pronged disease.

  4. Eric Steiner says:

    I just returned from the pharmacy without my prescription for Oracea because it costs way, way way too much. Apparently Oracea is simply low dose sustained release doxycline. I think I could get doxycline for far less money. I think this is a good example of a drug company trying to rip off consumers. Why did my doctor prescribe this instead of doxycline? Did he get a free vacation to the Bahamas? Did he really know how much it cost?

  5. Hi Eric,

    Collagenex hope that with insurance the co-pay will be under $25. They also have a rebate card to offer $25 towards the price. I don’t imagine that anyone without insurance would find Oracea compelling – generic doxycycline is always going to be a cheaper option.

    Oracea is marketed as a treatment for rosacea, other antibiotics haven’t been tested and approved directly for rosacea. Thus Oracea has high visibility so it is easy for doctors to prescribe it.

    Good luck !

  6. Vicky says:

    I feel really depressed cos the mild rosacea on my nose that i’m currently taking antibiotics for it seems there is a growth on either side of my nose near the tip really worried this is the start of rhinophyma can anyone give me any infor on this would be grateful anyway going back to the doctors on Monday hope he can say something positive and i hope its not what i think it is.

  7. Vicki says:

    My derm prescribed 100 mg doxycycline one per day for my severe case of rosacea and seb/dermatitis. Is this too much? Would a smaller amount be just as effective?

  8. Hi Vicki,

    A higher dose is common especially when starting out and wanting to reduce the symptoms relatively quickly. You may want to explore a lower dose later when you have gotten relief from your rosacea.


  9. Vicki says:

    Thanks, David. I’m relieved.

  10. Toni says:

    Thanks David I had the same query as Vicki! Good luck Vicki.

  11. Fern Roy says:


    Do you know if anyone has tried doxycycline in a low dose (50mg) a day for ocular rosacea and if it works. Fern

  12. Amy says:

    From what I’ve heard that rebate card takes your prescription down to $25 for the entire time you stay on it as opposed to someone above saying that it only takes $25 off. Someone told me about it and said their daughter takes it and only pays $25 a month instead of the over $200 it cost at first. Check it out at oracea.com

    I am prescribed doxy and I don’t take it because of how sick it makes me and I also don’t like taking such high/constant doses of antibiotics as it can do things to women that aren’t good. I am definitely going to ask my dr to change my prescription since this is only once a day and seems to be as effective.

    • And this held true until 2021. Now, the manufacturer will not honor that discount and the new cost of your “deductible” is now over $600. Honestly, I can’t find any chemical composition (per the internet) between Oracea and Doxycycline.

  13. sam mcquillan says:

    I have been on 100mg of doxy a day for a substantial amount of years due to severe vascular Rosacea and spots mainly on my chin, if I don’t take doxy my spots gets really bad and I get extremely depressed. however since 2011 I have been starting to get gastro problems, gp put it down to ibs, I get bloated, pains in tummy, feels trapped wind etc etc.. but I’m not so sure I asked my derm if the doxy could be causing the tummy probs but he said no, I taker probiotics to try to help put back some of the good bacteria cause of the long term doxy. But I am feeling it could be the doxy causing it. however I cant cope with my skin without it, would I be better of on Orecea?? Would really appreciate advice, I cant go on like this. I have discomfort everyday and its so hard with a toddler to contend with, when I have all these ongoing problems. tia

    • Anne says:

      I just started day 2 with Oracea (40 mg. of doxyclycline) after doing a lot of research on the Internet. From what I’ve read, it can be taken with food or milk and that will not cause it to lose its effectiveness. I’ve also read that the lower doxy is just as effective as the 100 mg., but again that’s what I have read. I would try the Oracea and see if that doesn’t make a difference for you. This is day 2 and I haven’t had any stomach pain–and I would know since I take Celebrex and ibuprofen throughout the day.

  14. Anthony Interrante says:

    I started Oracea about 10 days ago and I am optimistic that it can work for my p and p’s. I have used Soolantra for 4 months and I was clear during that time. I guess I have had a reaction to something. I know that rosacea is serious but I thought I would share something that I found humorous looking back to when I first got rosacea bumps. Having struggled with acne for most of my life ( I am 44), I thought it was fun to get the bump because it did not have a head and it cleared on its own. Of course, it is not funny now that it is a struggle. I wish everyone on the site the best. Have a great night!

  15. Stephanie says:

    I have been taking some form of generic doxy or Oracea for around 9 years now. I don’t believe that the 40mg of Oracea is as effective for controlling P&Ps as the generic doxy, even at 50mg. While on Oracea my left cheek has a constant patch of bumpy, pustule riddled, super itchy flakey red skin that is persistent and will not clear. The addition of topical treatments like Finacea or Metrogel have not helped & just seem to further irritate it. When I take the generic at 50mg my skin is much clearer. I have unfortunately had a couple of instances where I got stuck without Oracea for a few days and every time my skin explodes into pizza face, and the Oracea does not get it back under control nearly as quickly. My derm always pushes the Oracea because he claims even at 50mg of doxy is enough to cause antibiotic resistance. Is this really true? It seems the 10mg difference shouldn’t make a huge difference, and it seems other people’s derms have no issue w prescribing it.

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