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I came across the following graph in a recent presentation at the recent AAD meeting and figured it was interesting enough to highlight it here.
The following graph, sourced from Collagenex (who sell Oracea), shows the blood plasma concentration of doxycycline after taking Oracea compared to 50mg once a day of generic doxycycline. The horizontal axis stretches out to 24 hours post dosage. The vertical axis is in nano-grams per milli-litre (ng/mL).
The horizontal grey line is labelled anti-microbial threshold is listed here as a concentration of 1000 nano grams/mL (i.e. 1.0µg/mL). This value of 1 microgram per millilitre is considered to be the concentration at which doxycycline is able to affect bacteria i.e. have an anti-bacterial effect.
The two inverted curves show the amount of doxycycline that is present in the blood over a 24 hour period. The top grey curve is for 50mg of generic doxycycline and the bottom green curve is for Oracea.
I read this graph to suggest that Oracea is able to maintain a sustained release of the active ingredient doxycycline without venturing into anti-microbial territory. The advantage of a delayed release product is that Oracea can offer the `area under the concentration-by-time curve’ delivery, but at sub-antimicrobial dosage over 24 hours.
That is, Oracea can deliver a dosage of doxycycline that can give measurable results, but keep the concentration of doxycycline in your blood low enough to reduce potential problems associated with antibiotics.
(click image for larger view)
*16 healthy adult subjects, per arm; mean weight 75 kg
† Measured at 7 days
Data on file, CollaGenex Pharmaceuticals, Inc.
What is happening here ?
We do know that antibiotics have non-antibiotic properties. Recent research has found biologic actions affecting inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism. Thus a whole new range of clinical applications are being investigated. So it does appear that taking a low dose, or even a sub-antibiotic dose of antibiotics can have real clinical benefits.
A Cheaper Alternative ?
As Oracea is a new prescription product it can be quite expensive, especially if you don’t have comprehensive insurance coverage. One possible alternative you could discuss with your doctor is 50mg a day of generic doxycycline. Whilst this dosage won’t have exactly the same profile in your blood, the benefits and side effects are likely to be close. See your doctor for a better opinion.
I doubt whether we will ever see a trial to prove that the benefits and side effects of Oracea and 50mg of doxycycline are comparable. Therefore it seems unlikely that one can say either way whether the above graph shows an important distinction between the two treatments.
Does it really matter that 50mg a day of doxycycline ventures above the anti-microbial threshold for a couple of hours a day, or that the overall dosage delivered is around twice for the generic ? These are questions that can’t be answered at this stage.
As with all systemic treatments, both Oracea and a low dose of doxycycline can cause unwanted side effects so the supervision of your doctor is important.
Tried 100mg. Doxy after being on Oracea for many months, because I lost my Health Insurance and couldn’t see paying $330. a month for Oracea that I had been getting at no cost. The Oracea had worked great, but within a 2 weeks of being on the 100mg. Doxy, my rosacea was back and looking horrible. I can’t help but believe there is more in Oracea than just time released Doxy???
People try the cheaper way… 20 mg twice a day
one in the morning and one during the day…
how?
crush a normal generic tablet in water and drink it along the day… i dont think of side effects when taking very low dose during the day… ie.. 20mg in 8 sips… just 2.5 mg per sip of water.
Hope that helps… save your money from the pharm industry…
of course have 1 in the morning with a full glass of water…
I lost my dermatologist and her $20 coupons with my new insurance so I’ve been without for a few weeks. Usually my face would be breaking out already. But! I was prescribed another anti-biotic for another procedure I had just had done and when that looked like it was passed the point of infection I tried something.
I cut the pills in half (the prescription was for two tablets a day) and took half in the morning and half in the evening. Right now my skin is as clear as it’s ever been. I have about a weeks worth of this stuff left and will update with the name (forgot the bottle at home) and the results. May youtube it. Also need to see if there are any side effects to liver etc.
Oh and with Blue Cross this medicine was a buck.
Ok so as described above the medication I am on is Sulfamethoxazonle-tmpds. After researchng for all of five minutes, it’s used in the treatment of acne. So bam! I may have found an alternative. The effectiveness of which will decrease over time most likely but then I would assume I could switch back to a future cheaper oracea or something else.
Update, i hot generic doxy 40mg twice a day and now do 40mg each morning and an occasional 40mg at night may twice a week. This works better than oracea. Its $4 a month. FOUR BUCKS A MONTH.
I tried generic, and it made me feel sick to my stomach. After I stopped taking it, the upset stomach went away. Went back on oracea, and I feel fine. There’s slight nausea in the one hour window when I take the pill and before food, but it doesn’t come CLOSE to how awful I felt on the generic. I didn’t want to do anything, that’s how bad it felt. And the bloating was so bad, I couldn’t even button my jeans! I think the absence of severe gastrointestinal side effects may have something to do with the fact that oracea is a timed release.