Rumor vs Truth
Your trusted source for facts... where we dissect the evidence behind risky rumors and reveal clinical truths.
This new podcast series from TRC Healthcare, the team behind Pharmacist’s Letter and Prescriber Insights products, is designed to help pharmacists, pharmacy technicians, prescribers, and even patients navigate some of the claims they might see about medication therapy.
Find the video version of this show on YouTube: https://www.youtube.com/@trc.healthcare
Rumor vs Truth
Tackling Tetracyclines
In this episode, hosts Don Weinberger and Steve Small separate fact from fiction when it comes to claims about tetracyclines.
Will doxycycline stain children’s teeth?
Is expired tetracycline truly deadly?
What do cats have to do with all this?
Let’s cycle through the facts!
They’ll share research and insights into some interesting claims including:
- Doxycycline should never be used in young kids due to teeth concerns.
- Doxycycline monohydrate is better than the hyclate version.
- Minocycline can permanently pigment skin.
- Expired tetracyclines are toxic.
- Tetracyclines shouldn’t be used in pregnancy.
- Tetracyclines shouldn’t be combined with milk.
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TRC Healthcare Editor Hosts:
- Stephen Small, PharmD, BCPS, BCPPS, BCCCP, CNSC
- Don Weinberger, PharmD
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Guest:
- Michael Deaney, PharmD, AAHIVP (Clinical Pharmacist, Children’s Hospital Colorado)
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The clinical resources mentioned during the podcast are part of a subscription to Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Sort Out Tetracycline Safety in Pregnancy and Lactation
- Chart: Antibiotics in Pregnancy and Lactation
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This transcript is automatically generated.
00:00:05 Narrator
Welcome to Rumor vs Truth, your trusted source for facts… where we dissect the evidence behind risky rumors and reveal clinical truths. Today we’re putting claims about tetracyclines to the test.
00:00:22 Stephen Small
All right, Don, let's jump into this question.
00:00:24 Stephen Small
What rank do you think doxycycline a tetracycline holds in the list of most prescribed antibiotics in the United States?
00:00:32 Stephen Small
Do you?
00:00:32 Don Weinberger
Think I do see a lot so easily top ten. I would put around six or seven.
00:00:38 Stephen Small
Yeah, it's about fourth.
00:00:39 Stephen Small
It or not?
00:00:40 Stephen Small
And in this episode of Rumor Vs Truth, we're going to be looking into these claims behind Tetracyclines to see, frankly if they are based on any evidence.
00:00:47 Stephen Small
And I'm Steve, the pharmacist.
00:00:50 Don Weinberger
And I'm Don the pharmacist.
00:00:51 Stephen Small
And you know us from pharmacist letter and prescriber insights and this podcast series we've brought to be designed to help pharmacists, prescribers, patients, even technicians too to help navigate some of these claims. Because pharmacists are trained to help clear some of those N.
00:01:08 Stephen Small
And the rumors and to identify the truth.
00:01:11 Stephen Small
So maybe we should serve some.
00:01:13 Stephen Small
Don, what are some examples of tetracyclines that come off the top of your head?
00:01:18 Don Weinberger
He quizzed me as Steve.
00:01:19 Stephen Small
OK.
00:01:19 Don Weinberger
So let's see the ones I know about tetracycline.
00:01:24 Stephen Small
Classic ye.
00:01:25 Don Weinberger
Yeah. Sweet. Yep.
00:01:26 Stephen Small
And then we got some newer ones too.
00:01:28 Stephen Small
Like Ometicycene, Aravicycline and maybe some less ones use like Tyga, cycling and demico cycling.
00:01:36 Stephen Small
There's a lot of these guys out here and.
00:01:37
1st.
00:01:39 Stephen Small
What they really do is they kill bacteria by stopping their protein production, and they've been around for a long time.
00:01:46 Stephen Small
I was looking back and I found they started in the 1940s almost 100 years ago.
00:01:50
Well.
00:01:51 Stephen Small
So it's pretty impressive and what kind of things do you think about, Don?
00:01:54 Stephen Small
What we use these for now, because I feel like there's so many indications.
00:01:58 Don Weinberger
Yeah. So third question.
00:02:00 Don Weinberger
You, Steve.
00:02:01 Don Weinberger
Let's I I.
00:02:01 Stephen Small
Keep them coming.
00:02:02 Don Weinberger
It's it's a wide variety of indications, right?
00:02:05 Don Weinberger
You've seen him from acne to pneumonia.
00:02:08 Don Weinberger
To.
00:02:09 Don Weinberger
Hopefully not anthrax, but it is used for anthrax, yeah.
00:02:10 Stephen Small
Oh, true.
00:02:11 Stephen Small
Yeah, I forgot about that one.
00:02:13 Stephen Small
A really good point.
00:02:16
OK.
00:02:17 Don Weinberger
So let's you know.
00:02:18 Don Weinberger
Let's see if these any of these claims about tetracyclines if there's any ring.
00:02:23 Don Weinberger
Of truth to them.
00:02:24 Stephen Small
That's good.
00:02:25 Don Weinberger
Don't kick us off with the first one.
00:02:27 Don Weinberger
Nice. So the claim actually is doxycycline should never be used in kids under 8 years old due to teeth staining, you know, heard about this one.
00:02:36 Don Weinberger
We've seen this historically routine use of tetracyclines may cause teeth discoloration in kids.
00:02:43 Don Weinberger
But let's kind of put that in perspective.
00:02:45 Don Weinberger
Usually the teasing that we're seeing in children with with the tetracycline drug class, it's usually superficial and reversible, you know, usually on the dental cleaning. And CDC actually came out with studies showing showing that.
00:03:01 Don Weinberger
Really dark second has no effect on teeth discoloration.
00:03:06 Don Weinberger
American Academy of Pediatrics as well showed as long as it's used short course within 21 days or so. There's actually no harm.
00:03:14 Don Weinberger
To the teeth that's been shown.
00:03:16 Stephen Small
So 21 can put.
00:03:17 Stephen Small
That that song is within that window.
00:03:18 Don Weinberger
Yeah.
00:03:20 Don Weinberger
Window. Yeah, within that.
00:03:21 Narrator
Oh.
00:03:22 Don Weinberger
And nice. There was a study about.
00:03:24 Don Weinberger
They did say with Dennis as well, so they.
00:03:26 Don Weinberger
Took.
00:03:27 Don Weinberger
Two groups, you know, one set of group were children that were taking doxycycline for Rocky Mountain, spotted fever and a group of children who weren't taking doxcycline and the dentists they were blinded.
00:03:37 Don Weinberger
They don't know what you know what category Diljit actually fell into.
00:03:41 Don Weinberger
They were cleaning their.
00:03:42 Don Weinberger
They couldn't tell difference between the student, the children who had.
00:03:48 Don Weinberger
Teeth discoloration from doxycycline versus teeth, discoloration from other places. So the dentists themselves couldn't identify doxycycline induced. You know, teeth discoloration, but actually this.
00:03:59 Stephen Small
Nice. That's pretty creative.
00:04:01 Don Weinberger
Actually, yeah, I know.
00:04:03 Don Weinberger
So let's you know straight from them.
00:04:05 Don Weinberger
But however, this is a good time to bring up, you know, regular dental cleanings for patients every six months or sooner if needed.
00:04:13 Don Weinberger
For these two non stations so and also what about the other ones like Minocycline, doxycycline, tetracycline?
00:04:18 Don Weinberger
Well, those are rarely used in kids under 8 because of the narrow indication for those use acne.
00:04:22 Narrator
True, true.
00:04:23 Don Weinberger
So we don't see.
00:04:24 Don Weinberger
In children, you know, under 8 years of age.
00:04:27 Don Weinberger
So let's go and take back at the claim and get a.
00:04:31 Don Weinberger
So the claim is doxycycline should never be used in kids under 8 years old due to teeth staining.
00:04:36 Don Weinberger
And the verdict is.
00:04:42 Don Weinberger
Rumor with conditions. So I did mention that, yeah, there's a possibility of superficial, you know, tooth discoloration. But if doxycycline is the drug of choice as short course use it.
00:04:54 Stephen Small
Yeah, that's a great claim to look at.
00:04:56 Stephen Small
I was.
00:04:57 Stephen Small
And one you could sink your teeth into.
00:04:59 Stephen Small
Thank you for that.
00:05:01 Stephen Small
And this one always gives me heartburn. This claim that doxycycline monohydrate is better than doxycycline hyclate 2 sulf forms of the same drug. You know, this has so much history and complexity to it. I actually reached out to an infectious disease. Pharmacist colleague of mine, Doctor Michael Deaney.
00:05:18 Stephen Small
Children's Hospital of Colorado.
00:05:20 Stephen Small
Awesome guy.
00:05:21 Stephen Small
Knowledgeable.
00:05:22 Stephen Small
So let's see what he has to say about this.
00:05:29 Stephen Small
Thank you for joining us today, Doctor Deaney.
00:05:30 Michael Deaney
Hey Steve, thanks for having me.
00:05:33 Stephen Small
Good to see you again, and let's just jump into this question here.
00:05:36 Stephen Small
What is this claim behind Monohydrate versus being better than doxycycline high clay?
00:05:42 Stephen Small
The what's the claim there?
00:05:44 Michael Deaney
Yeah, the claim is mostly based on tolerability standpoint. So not so much efficacy it has to do with GI side effects related to the high clade formulation.
00:05:55 Michael Deaney
Basically, it's a hydrochloride salt and is potentially more irritating both to the stomach.
00:05:59 Michael Deaney
As well as to the throne which caused esophagitis.
00:06:03 Stephen Small
OK. And is there any evidence to back this up?
00:06:05 Stephen Small
Do we have out there that supports?
00:06:06 Stephen Small
That.
00:06:07 Michael Deaney
There is evidence about it, and I did some digging and a lot of it, surprisingly, is in cats of all things.
00:06:13 Michael Deaney
Like specifically like Journal of Feline Medicine is where I was finding a lot of the information.
00:06:18 Michael Deaney
Essentially like they were finding based on like anecdotal case reports that there was like esophageal ulcers in people and they tested that in cats and found that the hydrochloride salt formulation did have a propensity to do that.
00:06:30 Michael Deaney
Was just more corrosive to the.
00:06:32 Michael Deaney
So when they did develop the monohydrate, they did comparisons again in cats and monohydrate had a far.
00:06:37 Michael Deaney
Lower propensity for for causing that.
00:06:40 Stephen Small
What about in humans though?
00:06:41 Stephen Small
Or.
00:06:42 Stephen Small
Do they have?
00:06:43 Michael Deaney
For them, unfortunately.
00:06:44 Michael Deaney
And when I tell you, I scoured the Internet, I scoured the Internet. I could not find any data that compared the stuff directly in human tissue.
00:06:53 Michael Deaney
Unless cat tissue.
00:06:54 Michael Deaney
Not that I'm a cat expert or anything.
00:06:57 Michael Deaney
Has a higher propensity for ulcerations than humans, though it definitely raises concern.
00:07:03 Michael Deaney
That it could potentially be Inhumans as well. And when I looked at an adverse event reporting database in Australia, it was definitely a lot higher for hydrochloride than monohydrate.
00:07:12 Stephen Small
Interesting. And how would these two salts compare with things like absorption?
00:07:16 Stephen Small
There any benefits there?
00:07:18 Michael Deaney
They've been compared in studies in the 80s when Monohydrate was first coming onto the market in humans, and there's no differences in terms of absorption, half life, really any of it's like pkpd properties, which is good.
00:07:30
Excellent.
00:07:31 Michael Deaney
So from an efficacy standpoint, they should be.
00:07:33 Michael Deaney
There's not a lot of studies looking at efficacy, but they should be.
00:07:37 Stephen Small
Interesting. So just based on the how the drug moves in the body, it's likely that they treat infections exactly the same.
00:07:42 Michael Deaney
Exactly.
00:07:43 Stephen Small
Exactly.
00:07:44 Stephen Small
So the best we've got in terms of differences on cats and some observational data in humans, OK.
00:07:47 Michael Deaney
In cats.
00:07:50 Michael Deaney
Exactly it's.
00:07:51 Stephen Small
Well, that was.
00:07:51 Stephen Small
Incredibly helpful. Michael. I'm gonna bring this back to my colleague Dawn, and we'll see what the.
00:07:56 Stephen Small
Is sounds good?
00:08:02 Stephen Small
Well.
00:08:03 Stephen Small
It's it's interesting that most of the data we have is in cats and I'm glad my cat, my orange tabby, wasn't in the room.
00:08:08 Stephen Small
Hear.
00:08:08 Stephen Small
Those experiments, right?
00:08:11 Don Weinberger
I'm really glad we got to that too, because, you know, we can get a little salty.
00:08:14 Don Weinberger
That topic so.
00:08:16 Stephen Small
It's a good one, Don.
00:08:17 Stephen Small
So that said, with this claim that doxycycline monohydrate is better than doxycycline hyclate, the verdict is.
00:08:28 Stephen Small
Rumor.
00:08:29 Stephen Small
But with conditions I have to ask you this dawn.
00:08:32 Stephen Small
Before I move on, let's see a community Harmacist gets a prescription for doxycycline hyclate.
00:08:38 Stephen Small
They just change it to monohydrate.
00:08:40 Stephen Small
The story there.
00:08:41 Don Weinberger
Yeah, we get that question a.
00:08:43 Don Weinberger
And I'm glad you actually we got to this question because we hear this a lot during our live CE webinars to answer it.
00:08:48 Stephen Small
Yeah.
00:08:49 Don Weinberger
So in particular one it just depends on the state.
00:08:51 Don Weinberger
If you're in Orangeburg state and.
00:08:52 Don Weinberger
Can look that up.
00:08:54 Don Weinberger
Those the change over from the salt do require.
00:08:59
A.
00:09:00 Don Weinberger
Permission from the.
00:09:00 Don Weinberger
Prescriber so kind of keep in mind.
00:09:02 Don Weinberger
Your you know, state laws also, if you're orange book state to kind of keep that in mind.
00:09:06 Stephen Small
Yeah. So don't just change it willingly, even though they pretty much are the.
00:09:10 Stephen Small
And there is one other thing to point out too, Don. Even though these are two different Sol forms, one thing you gotta do for both is these patients should definitely take each pill with a tall glass of water and sit upright for 30 minutes to prevent that P.
00:09:23 Stephen Small
Stuck in the esophagus and causing all that irritation were talking about a lot of good points there, regardless of the one you pick. OK.
00:09:31 Stephen Small
And then on a related note too to what you're talking about before about discoloration with teeth, this next claim I see is Minocycline can permanently discolor skin.
00:09:41 Stephen Small
Let's take a look at that one real quick. When I was looking into this, I found the Minocycline does have reports of causing a bluish black pigmentation of the skin.
00:09:51 Stephen Small
And even nails.
00:09:52 Stephen Small
Maybe teeth, bones. Even found one case report of a woman whose breast milk turned black from an acycloan. Yikes.
00:09:59 Stephen Small
Great. And usually when it involves a skin, it's the shins or ankles. Or maybe the arms.
00:10:05 Stephen Small
That you see this?
00:10:07 Stephen Small
It's happened enough over time that there's even, like a grading scale for this type of pigmentation. Adverse effect.
00:10:13 Stephen Small
Kind of weird, OK.
00:10:14 Don Weinberger
So in the words of my daughter.
00:10:16 Don Weinberger
Why? Why, why, why?
00:10:18 Stephen Small
Good question. Why? Why is this even happening?
00:10:19 Don Weinberger
Why does this happen?
00:10:19 Don Weinberger
Do you have an answer? Yeah.
00:10:21 Stephen Small
Well, looking at this, we're not totally sure, but there is a theory.
00:10:24 Stephen Small
It has to do with.
00:10:26 Stephen Small
Maybe binding to the Minocycline in the body and depositing in these tissues were frankly just not totally sure.
00:10:33 Stephen Small
And what we do know is that it typically occurs in places where maybe there's scarring, inflammation or even things like sun exposure or sunburn.
00:10:42 Stephen Small
And patients who reported this sometimes are taking a lot of minocycling like 70 to 100 grams total throughout their entire course.
00:10:50 Stephen Small
OK, grams.
00:10:52 Stephen Small
That's a lot of minocycene, and it can develop over months to years with continuous use, and it can take even years to go away, if at all.
00:10:59 Stephen Small
So when it comes to this claim that Minocycline can permanently discolor skin, the verdict is.
00:11:09 Stephen Small
True, but with conditions like we're talking about, it can depend on the dose and things like that. And Speaking of sunburn and sun exposure, we should really be recommending all of our tetracyclines patients to be using sunscreen because all these I believe, can cause photosensitivity.
00:11:25 Stephen Small
And it is recommended that patients taking long term monocycling get their skin checked yearly to look out for this.
00:11:31 Stephen Small
Good tidbits there.
00:11:33 Don Weinberger
Definitely.
00:11:35 Don Weinberger
Thank you for.
00:11:35 Don Weinberger
So let's move on to our next claim.
00:11:38 Don Weinberger
This claim is tetracyclines are toxic when they expire.
00:11:43 Don Weinberger
I remember hearing about this in.
00:11:44 Don Weinberger
I believe that there was back in the 60s, so quite a while ago there were people taking expired oil tetracycline and it was the byproducts of the breakdown.
00:11:45 Stephen Small
Yep.
00:11:59 Don Weinberger
Were causing kidney issues, something called Fenconi syndrome.
00:12:03 Don Weinberger
In these particular patients.
00:12:08 Don Weinberger
It was sort of tribute to the toxicity of the tetracycline, just breaking down to these. Like I said, these toxic byproducts and patients actually gotten. They were nausea and vomiting.
00:12:17 Don Weinberger
Actually had metabolic acidosis as well, so kind of serious condition.
00:12:21 Stephen Small
Yeah, it sounds pretty bad.
00:12:22 Don Weinberger
Yeah.
00:12:23 Don Weinberger
So you know that from the 60s, but I'll carry it all the way through to today.
00:12:27 Don Weinberger
Actually it's it's resonating, you know, from being taught today well.
00:12:31 Don Weinberger
You know, does that still have that same issue?
00:12:34 Don Weinberger
But you can kind of be reassured that there've been no recent cases of toxicity with expired oral tetracycline because of just the formulation changed from the 60s to today. Oh, nice.
00:12:45 Don Weinberger
And that actually kind of holds true.
00:12:48 Don Weinberger
To you know, the doxycycline and Minocycline, the other drugs in that class, there hasn't really been any recent case of toxicity from taking expired medications. And let's just go back to the claim here that tetracyclines.
00:13:01 Don Weinberger
Are toxic when they expire and the verdict is.
00:13:10 Don Weinberger
It is a rumor, but with conditions so well, the expectation aren't toxic from what we've seen, there is a danger to lack of potency when it comes to expired medications and you know to give a little hint. Everybody else that will be the topic of our next podcast.
00:13:25 Don Weinberger
We discuss expired medications.
00:13:28 Stephen Small
Yeah, excited for that one, Don. That's going to be great.
00:13:31 Stephen Small
And then the next thing we have here is tetracyclines cannot be used during pregnancy and this kind of goes back to what we were talking about earlier, dawn about teeth staining.
00:13:40 Stephen Small
This concern that maybe the fetus, their teeth will stain and even potentially some bone growth suppression as well.
00:13:46 Stephen Small
Looking back at what I could find, this is based on.
00:13:50 Stephen Small
Again, studies from the 60s, like you mentioned, with expired meds where premature infants who got tetracycline had decreased bone growth, but thankfully it was reversible.
00:14:00 Stephen Small
And there's also this thought that or data rather that there is some fetal teeth staining when it's taken during the 2nd and 3rd trimester of pregnancy.
00:14:09 Stephen Small
But what's interesting here, Don, is that's really the most experience we have with these.
00:14:13 Stephen Small
And now that's been extrapolated to all the tetracyclines in the entire class, maybe unfairly. We're not totally sure because tetracycline dose is back in the day were way higher than we use now.
00:14:25 Stephen Small
And in fact, doxycycline binds to calcium less than others.
00:14:29 Stephen Small
And maybe it has less bone and teeth issues because of that and going back to actual studies in pregnant patients.
00:14:37 Stephen Small
From the 1990s, even up until last year, showed that in the first trimester, major malformations are pretty rare, if nonexistent, with tetracycline and doxycycline.
00:14:47 Stephen Small
But we really don't have that kind of a data to look at the 2nd and 3rd trimester, so we're not sure in that phase.
00:14:55 Stephen Small
Other things to know here too is that we really don't have any diseases or infections in.
00:15:00 Stephen Small
Where this class is even first line anyways. Really the only one I could find was rocking on spotted fever.
00:15:05 Stephen Small
You mentioned.
00:15:06 Stephen Small
Before and that's pretty darn.
00:15:09 Stephen Small
So when it comes to this claim that tetracyclines cannot be used during pregnancy, the verdict is.
00:15:17 Stephen Small
True, but with conditions like we said, it does depend on the trimester. With the first trimester having the most evidence for safety.
00:15:24 Stephen Small
But we have to be realistic here.
00:15:26 Stephen Small
There's a lot more antibiotic options we could use that have good track records in pregnancy.
00:15:31 Stephen Small
And should be used rather than these, so keep that in mind.
00:15:35 Don Weinberger
Great. And that will kind of take us.
00:15:38 Don Weinberger
To our final claim, Stevie did mention calcium and doxycycline, so that kind of segues nicely into the last.
00:15:42 Narrator
Yeah.
00:15:44 Don Weinberger
Claim is tetracyclines shouldn't be taken with.
00:15:47 Don Weinberger
Or milk.
00:15:48 Don Weinberger
Interesting. So you know, we've learned that tetracyclines work better in empty stomach.
00:15:52 Don Weinberger
How really true is?
00:15:54 Don Weinberger
So looking at like oral tetracycline itself and oral amatocyclin.
00:16:00 Don Weinberger
That is true.
00:16:01 Don Weinberger
I mean food and or milk can interfere with the absorption of of those particular antibiotics and basically how it works is getting nerdy for a second here.
00:16:09 Don Weinberger
Tetracycline and lomatosycin molecules. They're really hungry for, you know, certain metals. And that calcium and iron usually found in dairy products and.
00:16:19 Don Weinberger
Food.
00:16:20 Don Weinberger
Like to bind to those and when they bind to them, they make them insoluble.
00:16:23 Don Weinberger
And they're harder, absorb and there's issues with that.
00:16:25 Don Weinberger
So with particular oral tetracycline and omaticyclin. Yeah, empty stomach one hour.
00:16:31 Don Weinberger
Or.
00:16:31 Don Weinberger
Hour after meals kind of situation, right?
00:16:34 Don Weinberger
What about the?
00:16:35 Don Weinberger
4th popular one that you mentioned, Steve.
00:16:37 Don Weinberger
2002's.
00:16:38 Don Weinberger
Top 4.
00:16:40 Don Weinberger
Right.
00:16:41 Don Weinberger
What about that one?
00:16:42 Don Weinberger
Well, that one's hungry for calcium and iron, but less than the other.
00:16:46 Don Weinberger
So there is an absorption issue with you know is Kela 8 with those cations of you know iron and calcium.
00:16:55 Don Weinberger
But it seems a lot less affected by those.
00:16:58 Stephen Small
Interesting.
00:17:00 Don Weinberger
Officially.
00:17:01 Don Weinberger
Officially doxycycline, the labeling and your observables that print out with it will say hey empty stomach or void of a food.
00:17:06 Don Weinberger
Milk and that is.
00:17:08 Don Weinberger
It does like to bind to those particular metals.
00:17:10 Don Weinberger
But if the patient says I need to eat something because doxycycline is wrecking my stomach right now.
00:17:16 Don Weinberger
Then yeah, they can take with some food.
00:17:18 Stephen Small
Yeah, I would want that.
00:17:19 Don Weinberger
Into.
00:17:20 Don Weinberger
Yeah. So so usually.
00:17:23 Don Weinberger
And and usually that will help.
00:17:24 Don Weinberger
So just keep that in mind and also Minocycline.
00:17:29 Don Weinberger
Is kind of the same boat. Technically, the drug class does have issues with milk and food, but it's not really, really reported with that particular antibiotic as well.
00:17:37 Don Weinberger
So going back to the tetracycline shouldn't be taking food or milk.
00:17:38 Stephen Small
Good to know.
00:17:40
Claim.
00:17:44 Don Weinberger
True, but with conditions just depends on the antibiotic and the patient's comfort level when taking that particular antibiotic.
00:17:51 Stephen Small
Yeah, good point.
00:17:53 Don Weinberger
All right, so it looks like it was a mixture of truth and kind of rumor day. Steve, with Lolliplane being factual or with conditions on that one, so real 4 ring circus going on.
00:18:05 Stephen Small
Right. Yes, circus indeed.
00:18:08 Stephen Small
And you made some really good points.
00:18:10 Stephen Small
It's interesting how some of these claims do apply to certain tetracyclines, but maybe not others.
00:18:15 Stephen Small
And I think it really speaks to how with any Med, we have to think about the individual Med and not necessarily the whole class, just like we have to think about the individual patient and their needs, right.
00:18:25 Stephen Small
You were mentioning before and there are some really good counseling points in here, folks all across the board from drinking water with every dose and sitting upright for 30 minutes.
00:18:35 Stephen Small
Or and making sure you take it with water versus milk and things like that.
00:18:40 Stephen Small
And keep in mind, folks, today we only talked about oral examples.
00:18:44 Stephen Small
Some of these are available Ivy like Ivoxycycline.
00:18:47 Stephen Small
My folks in the hospital, I do remember about you.
00:18:50 Stephen Small
So that can also be irritating to the veins as.
00:18:53 Stephen Small
So it's a good reason to make those four to oral switches as soon as you can to avoid that vein irritation.
00:19:00 Stephen Small
So good thoughts all around for all sorts of practitioners.
00:19:04 Don Weinberger
And thank you.
00:19:05 Narrator
Yep.
00:19:06 Don Weinberger
With that, we took a real bite out of this episode, and that's a wrap on this episode actually, of rumor.
00:19:10 Don Weinberger
Truth, right?
00:19:12 Stephen Small
And if you like what you heard, folks, be sure to follow rate and review the show wherever you get your podcasts. And of course, please check us out at TRC Healthcare com.
00:19:21 Don Weinberger
All right. And take a look at our show notes or description. We've linked directly to some of our grit resources like the article on safety of tetracyclines in pregnancy and lactation. And on March 2025 issue of the hospital, pharmacist letter and hospital pharmacy technicians letter as.
00:19:35 Don Weinberger
As our handy dandy chart, reviewing antibiotic safety, evidence in pregnancy and breastfeeding.
00:19:40 Stephen Small
That is an awesome chart.
00:19:42 Stephen Small
And if you aren't already a subscriber, don't miss out on these resources, guys.
00:19:45 Stephen Small
Sign up today to stay ahead with trusted insights and tools.
00:19:49 Stephen Small
And we're an industry leading non biased source of information.
00:19:53 Stephen Small
And continuing education.
00:19:56 Don Weinberger
And if you're a student, great news students can access a free, free, free version of pharmacist letter. We link that directly in the show's notes as well, for free. Again, free.
00:20:07 Don Weinberger
Check it out please.
00:20:08 Stephen Small
Also, we need your help compiling more rumors and truths to analyze, so please send us your ideas.
00:20:14 Stephen Small
At TRC healthcare.
00:20:15 Stephen Small
Contact us or use the contact US link at the bottom of your TRC healthcare homepage and believe it or not, we got some new things too.
00:20:23 Stephen Small
Can also send us a message.
00:20:25 Stephen Small
Right in the podcast show notes as well. Just click that.
00:20:29 Stephen Small
Next link and let us know what you think claims you want us to demystify or even give us a compliment.
00:20:34 Stephen Small
Need them, right?
00:20:36 Don Weinberger
Or you can just say.
00:20:37 Don Weinberger
You know, we always like that as well.
00:20:38 Stephen Small
True, true.
00:20:39 Don Weinberger
And join us next time we'll dust off those clings about expired medications.
00:20:45 Stephen Small
Yep, and thanks for joining us.
00:20:46 Stephen Small
Versus.
00:20:47 Stephen Small
Your trusted source for facts where we dissect the evidence behind risky rumors and reveal clinical truths.
00:20:53 Stephen Small
See you next time.
00:21:10 Narrator
Want to put faces to these voices? Catch the video version on YouTube - just search 'TRC Healthcare' or click the link in our show notes. While you're there, check out our other TRC podcasts like Medication Talk and Clinical Capsules.
