In this episode, TRC Healthcare editor, Vickie Danaher, PharmD, discusses Doxycycline Post-Exposure Prophylaxis for STIs.
This is an excerpt from our August 2024 Pharmacy Essential Updates continuing education webinar series.
The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Chart: Drugs with Different Salt Forms
- Checklist: HIV Postexposure Prophylaxis (PEP) Checklist
- Chart: Sexually Transmitted Infections
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Transcript:
This transcript is automatically generated.
0:00:03 Narrator
Welcome to Clinical Capsules, your go-to podcast and trusted source for quick, evidence-based insights from TRC Healthcare. For four decades, we’ve been keeping healthcare professionals at the forefront of drug information and medical knowledge, and now we’re bringing these vital clinical updates right to your ears with new episodes every 2nd and 4th Tuesday – delivering practical, actionable takeaways in bite-sized episodes.
0:00:29 Narrator
Today, Associate Editor and Clinical Pharmacist Vickie Danaher breaks down the latest on Doxycycline Post-Exposure Prophylaxis for sexually transmitted infections, or STIs in an excerpt from our popular Pharmacy Essential Updates webinar series.
Let’s take a closer look…
0:00:51 Vickie Danaher
Let’s talk about doxycycline post exposure prophylaxis or Doxy PEP for preventing STIs.
0:01:00 Vickie Danaher
And our article says you’ll hear buzz about Doxy PEP to prevent bacterial sexually transmitted infections.
0:01:09 Vickie Danaher
And we’re discussing this today because CDC now recommends that certain high-risk patients take doxycycline as soon as possible after sex to reduce their risk of developing an STI such as chlamydia, syphilis or gonorrhea after an exposure.
0:01:27 Vickie Danaher
And one way that some people are thinking about Doxy PEP is that it’s kind of like a morning after pill for sexually transmitted infections.
0:01:35 Vickie Danaher
So, like we have Plan B and other morning after pills to take to prevent pregnancy after unprotected sex, Doxy PEP is taken after unprotected sex to prevent STIs.
0:01:48 Vickie Danaher
Evidence suggests that Doxy PEP prevents a new bacterial STI and about one in three patients per year.
0:01:56 Vickie Danaher
And more specifically, and three large randomized controlled trials, Doxy PEP has been shown to reduce syphilis and chlamydia infections by 70%.
0:02:06 Vickie Danaher
And gonococcal infections by approximately 50%.
0:02:12 Vickie Danaher
Be aware of these data are in men who have sex with men or transgender women who have had a bacterial STI in the past year.
0:02:22 Vickie Danaher
But there’s still a lot that experts are learning about Doxy PEP.
0:02:26 Vickie Danaher
For example, it’s too soon to say if Doxy PEP is effective for other patients. , There’s no current evidence to support its use in cisgender women and heterosexual men. But some of these studies are ongoing.
0:02:40 Vickie Danaher
It’s also too soon to say if other antibiotics work as post exposure prophylaxis for STIs.
0:02:47 Vickie Danaher
And the jury is still out over whether Doxy PEP will increase antimicrobial or antibiotic resistance.
0:02:55 Vickie Danaher
But Doxy PEP should reduce overall antibiotic prescribing for STI’s treatment.
0:03:02 Vickie Danaher
So these are things that will continue to be studied and monitored as guidelines for Doxy PEP are implemented.
0:03:09 Vickie Danaher
Now let’s say a closer look at who’s eligible for Doxy PEP and how we can help identify potential candidates.
0:03:17 Vickie Danaher
And really, we should keep Doxy PEP in mind in our discussions with all sexually active patients.
0:03:23 Vickie Danaher
Similar to discussions about HIV pre-exposure prophylaxis or post exposure prophylaxis.
0:03:30 Vickie Danaher
And this will help to.
0:03:30 Vickie Danaher
Raise awareness and reduce stigma about these regimens.
0:03:35 Vickie Danaher
Some examples of how we could do this in the pharmacy are watching for patients who report risk factors or who may be getting prescriptions for sexually transmitted infections.
0:03:46 Vickie Danaher
These are patients who may benefit from Doxy PEP.
0:03:50 Vickie Danaher
So, we want to be ready to recommend Doxy PEP for men who have sex with men or transgender women who have had syphilis, chlamydia or gonorrhea in the past year.
0:04:03 Vickie Danaher
And you can also consider Doxy PEP using a shared decision making approach for other men who have sex with men or transgender women, patients who have not had a bacterial STI in the last 12 months but do have risk factors for STI exposure.
0:04:20 Vickie Danaher
To patients who report on protected sex, multiple partners, sex work or participating in other high-risk behaviors that are known to increase the likelihood of exposure to STI’s.
0:04:33 Vickie Danaher
So now let’s talk about the doxycycline products that can be used as Doxy PEP to prevent STIs in these patients. And some of the things that we need to consider when dispensing these medications.
0:04:45 Vickie Danaher
And we know that we have different salt forms and different dosage forms of doxycycline which can.
0:04:51 Vickie Danaher
Sometimes get confusing.
0:04:53 Vickie Danaher
But the good news is that we can suggest any oral formulation of doxycycline for a single 200 milligram dose.
0:05:02 Vickie Danaher
So we can suggest either doxycycline monohydrate or doxycycline hyclate, keeping in mind that the monohydrate form might cause.
0:05:12 Vickie Danaher
Less stomach upset.
0:05:15 Vickie Danaher
And then in terms of dosage form, again any oral form is OK.
0:05:21 Vickie Danaher
What we want to generally advise using immediate release pills because the delayed release formulations of doxes like lean are more costly.
0:05:30 Vickie Danaher
And remember that when we’re dispensing, doxycycline does not automatically switch between dosage forms or between salt forms, depending on our practice or our state. This is something that will usually require prescriber or pharmacist approval.
0:05:46 Vickie Danaher
We also want to make sure to watch strings, quantities and dosage forms closely on prescriptions for Doxy PEP.
0:05:54 Vickie Danaher
For example, to equal a 200-milligram dose, patients may get two 100 milligram doxycycline immediate release pills.
0:06:02 Vickie Danaher
Or they may get one 200 milligram doxycycline hyclate delayed release pill. So you can see how that can be confusing.
0:06:13 Vickie Danaher
And when patients get Doxy PEP, we have pharmacists and technicians are in a prime position to help ensure they know how to take it properly.
0:06:20 Vickie Danaher
So how should patients take Doxy PEP?
0:06:25 Vickie Danaher
Patients should take a dose of doxycycline as soon as possible within 72 hours after oral, vaginal or **** ***.
0:06:34 Vickie Danaher
But ideally within the 1st 24 hours for the greatest efficacy.
0:06:40 Vickie Danaher
Again, each dose of Doxy PEP Pi S 200 milligrams of doxycycline, and patients should not take more than one 200 milligram dose per 24 hours even if sex occurs more frequently.
0:06:53 Vickie Danaher
When we get these prescriptions for Doxy PEP, we should expect that the number of prescribed doses will be based on the patients anticipated sexual activity until their next clinic visit.
0:07:04 Vickie Danaher
To patients will be able to self administer the medication on demand rather than having to visit a prescriber each time they need it, which increases the likelihood of administration.
0:07:16 Vickie Danaher
Like usual advise patients getting doxycycline to take it with a.
0:07:20 Vickie Danaher
Full glass of water.
0:07:21 Vickie Danaher
And to stay in an upright position for at least 30 minutes after a dose to avoid irritation and ulcers in the esophagus.
0:07:31 Vickie Danaher
Patients should also take doxycycline with food if stomach upset occurs and to also wear sunscreen, since X is likely and can make patients more sensitive to the sun.
0:07:43 Vickie Danaher
Counsel not to take doxycycline within two hours of antacids, dairy, or supplements that contain calcium, iron, or magnesium. Since these may decrease doxycycline absorption.
0:07:56 Vickie Danaher
On the other hand, in terms of interactions, be aware that it is OK for patients to take the Doxy PEP and meds for HIV pre-exposure prophylaxis or HIV Prep.
0:08:07 Vickie Danaher
And actually taking both is a good approach to reducing the chances that a patient will get STD’s and HIV.
0:08:16 Vickie Danaher
It’s also OK for patients receiving hormone therapies, such as gender affirming meds, to take Doxy PEP as well.
0:08:25 Vickie Danaher
In addition to counseling on Doxy PEP administration and interactions, we should remind patients to regularly follow up with their prescriber, such as about every three to six months.
0:08:36 Vickie Danaher
Follow up is important for many reasons, including testing for STI’s, assessing the ongoing need for Doxy PEP, and refilling these prescriptions.
0:08:47 Vickie Danaher
We should also take the opportunity to remind patients that Doxy PEP only protects against STI’s, and it’s not guaranteed 100% effective.
0:08:56 Vickie Danaher
To want to emphasize other safe sex practices, such as using condoms, reducing the number of partners, and also encourage immunization when appropriate.
0:09:06 Vickie Danaher
Since Doxy PEP does not protect against human papilloma virus or HPV monkeypox or other infections.
0:09:15 Vickie Danaher
So, for more help with ensuring patients get their right doxycycline products, you can see our resource drugs with different salt forms.
0:09:24 Vickie Danaher
And then we have some resources related to sexual health on our website that you can use in our practice, such as our HIV prep checklist or our HIV PEP checklist. And these can help you identify high risk patients and be familiar with possible regimens.
0:09:41 Narrator
We hope you enjoyed and gained practical insights from listening to this presentation!
0:09:46 Narrator
Be sure to follow or subscribe, rate, and review this show in your favorite podcast app. Or find the show on YouTube by searching for ‘TRC Healthcare’ or clicking the link in the show notes. While you’re there, check out our other TRC podcasts like Medication Talk and Rumor vs Truth.
0:10:03 Narrator
Also in the show notes, we’ve linked directly to a few of the excellent resources mentioned today available to subscribers of Pharmacist’s Letter, Pharmacy Technician’s Letter, or Prescriber Insights. On those websites you’ll also find a lot more evidence-based, concise, yet comprehensive resources on this and other medication therapy topics. And don’t forget to check out our full Pharmacy Essential Updates webinar series for deeper dives into topics that matter to your practice.
0:10:31 Narrator
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0:10:45 Narrator
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0:11:07 Narrator
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0:11:12 Narrator
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0:11:19 Narrator
Thanks for listening, stay sharp, stay current, and we’ll catch you next time on Clinical Capsules!
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