Doxycycline - how long does it take to start working?

[Guest]

Interesting posts! So it seems some of you are on doxy and cyclosporine at the same time.
If you didn't have to use both and could control your condition using just one, which would you choose?

I do not have a medical background but I would have thought its better to use topical eye drops (Xiidra/Restasis/Ikervis) rather than be on antibiotics long term.
That is why I am trying to find alternatives to the doxy I am taking.

Doxy is known to lower MMP9 and restasis lowers T cells. They effects different inflammatory pathways. I think, depending on your condition(s), you could/should use both. Restasis didn’t work for me and I was allergic. So I feel doxy has done more for me than almost anything. Again, it’s fightikg the inflammation and disease from the inside out. Drops can’t penetrate the same way doxy can because it’s systemic.

[deep_dry_eye]

Doxy is known to lower MMP9 and restasis lowers T cells. They effects different inflammatory pathways. I think, depending on your condition(s), you could/should use both. Restasis didn’t work for me and I was allergic. So I feel doxy has done more for me than almost anything. Again, it’s fightikg the inflammation and disease from the inside out. Drops can’t penetrate the same way doxy can because it’s systemic.

Agree that the two different treatments can (combine) to help you then standalone, as they probably work differently.

However, its unclear to me systemic vs (localized) topical, which one would be better. I haven't seen studies point one way or another. One can argue that localized treatments, has more targeted tissue absoption.

[Guest]

Agree that the two different treatments can (combine) to help you then standalone, as they probably work differently.

However, its unclear to me systemic vs (localized) topical, which one would be better. I haven't seen studies point one way or another. One can argue that localized treatments, has more targeted tissue absoption.

I agree, but if the tissue is the meibomium gland, getting deep in the gland to insert a drug isn’t possible (yet). They do it superficially with a probe now, but I’m talking the entire length of the gland. In my opinion, doxy gets there because it’s systemic. That’s my point. For ocular surface issues, I’d say you clearly want a topical application.

[deep_dry_eye]

I agree, but if the tissue is the meibomium gland, getting deep in the gland to insert a drug isn’t possible (yet). They do it superficially with a probe now, but I’m talking the entire length of the gland. In my opinion, doxy gets there because it’s systemic. That’s my point. For ocular surface issues, I’d say you clearly want a topical application.

Targeted topical drugs can be more effective than systemic oral delivery. It really depends on the drug profile and concentration. i.e., your topical drugs might have higher (localized) dosage over a systemic drug which is typically absorbed by your gut/stomach instead.

Doxy is typically a systematic drug, topical ophthalmic doxy is only via compounding pharmacy at least in Canada/USA. Azithromycin on the other hand is available in both oral and topical form, azithromycin has high tissue penetration and long half life (68 hours). Cyclosporine on the other hand, is somewhat difficult to penetrate, since it is not water soluble but rather requires an oil-based delivery vehicle. And perhaps, the (lack of efficacy) of Restasis may be attributed to the poor delivery vehicle. Some evidence of this is that some patients don't respond to BID restasis but respond to QID restasis. In fact, the whole R&D of Restasis is finding the appropriate delivery vehicle to penetrate Cyclosporine into the tissue. Xiidra also has high penetration, but very low high half life (i.e., your body clears it out very quickly).

The penetration is beyond the ocular surface. In one Xiidra study, part of the study they did was instill Xiidra into rabbit/dog eyes, then kill the rabbit at various times. Next, they would measure the Xiidra at various parts of the eye tissue. Xiidra has good penetration and very low measurable plasma concentrations. This is one of the reason why Xiidra is considered a very safe drug. Here's the study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963635/

Unfortunately, the study also estimates Xiidra's half life to be close to 2 hours. I suspect we will soon see doctors give Xiidra QID a try later on.

[Guest]

Targeted topical drugs can be more effective than systemic oral delivery. It really depends on the drug profile and concentration. i.e., your topical drugs might have higher (localized) dosage over a systemic drug which is typically absorbed by your gut/stomach instead.

Doxy is typically a systematic drug, topical ophthalmic doxy is only via compounding pharmacy at least in Canada/USA. Azithromycin on the other hand is available in both oral and topical form, azithromycin has high tissue penetration and long half life (68 hours). Cyclosporine on the other hand, is somewhat difficult to penetrate, since it is not water soluble but rather requires an oil-based delivery vehicle. And perhaps, the (lack of efficacy) of Restasis may be attributed to the poor delivery vehicle. Some evidence of this is that some patients don't respond to BID restasis but respond to QID restasis. In fact, the whole R&D of Restasis is finding the appropriate delivery vehicle to penetrate Cyclosporine into the tissue. Xiidra also has high penetration, but very low high half life (i.e., your body clears it out very quickly).

The penetration is beyond the ocular surface. In one Xiidra study, part of the study they did was instill Xiidra into rabbit/dog eyes, then kill the rabbit at various times. Next, they would measure the Xiidra at various parts of the eye tissue. Xiidra has good penetration and very low measurable plasma concentrations. This is one of the reason why Xiidra is considered a very safe drug. Here's the study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963635/

Unfortunately, the study also estimates Xiidra's half life to be close to 2 hours. I suspect we will soon see doctors give Xiidra QID a try later on.

Again, I agree targeted delivery can be better, but it’s bssed on the tissue. Doxy and azythromycin do not penetrate through the back of the eyelid into the gland. They treat things superficially, they do it well, but not completely. It’s also based on how the drug effects you topically vs systemic. I believe doxy and azythromycin are great orally, but topically, they fall short because of irritation. I’ve never used doxy topically so I can’ only speculate on that, but azasite I have used, and it stings just mechanically speaking. The drug and the preservative are harsh. It has its place, azasite is a great drug, but long term, most eyes couldn’t handle it imo (some can, I’ve seen people use azasite for 10 years because it’s the only thing that helps). So I think you could tailor a drug regimen that includes both topical and oral if the case requires it. You can see that if you do a search fir the drug in here. About half the people abandon it because if the sting. So there’s a lot to consider.

On paper, topical application may seem better. But if you’re causing inflammation just to get a higher percentage of drug to the tissue, you defeat the point (this is the ONLY reason I won’t try prokera, irritation). Not to mention, I have gotten better oil thinning from oral doxy than topical azasite. That’s my anecdotal experience anyway. Not to mention. I’m lowering MMPs systemically. For me, I have sleep apnea, it’s thought that holding your breath while you sleep causes a release of MMP7 and MMP9. So being able to reduce my circulating MMPs with oral medicine, is extremely valuable to me personally. Again, every application has to be considered thoroughly. Like what you saud about xiidra half life. That’s incredibly short. At the 5 hour marks it’s pretty much out of the system. So odd .

[deep_dry_eye]

Again, I agree targeted delivery can be better, but it’s bssed on the tissue. Doxy and azythromycin do not penetrate through the back of the eyelid into the gland. They treat things superficially, they do it well, but not completely. It’s also based on how the drug effects you topically vs systemic. I believe doxy and azythromycin are great orally, but topically, they fall short because of irritation.

There is no published literature I am aware of that backs this claim.

Irritation is independent of tissue penetration, I fail to see the correlation between irritation and effect of the pharmacokinetics of the drugs. One argument you could make that is you are irritated, you may tear up more and flush the drug out quickly.

I’ve never used doxy topically so I can’ only speculate on that, but azasite I have used, and it stings just mechanically speaking. The drug and the preservative are harsh. It has its place, azasite is a great drug, but long term, most eyes couldn’t handle it imo (some can, I’ve seen people use azasite for 10 years because it’s the only thing that helps). So I think you could tailor a drug regimen that includes both topical and oral if the case requires it. You can see that if you do a search fir the drug in here. About half the people abandon it because if the sting. So there’s a lot to consider.

AzaSite contains BAK yes, however there are other topical azythromycin options out there. For example, you can get it compounded preservative free for around $20 / month. For EU patients, Azyter is available, Azyter is topical azythromycin in preservative-free single dose vials.

On paper, topical application may seem better. But if you’re causing inflammation just to get a higher percentage of drug to the tissue, you defeat the point (this is the ONLY reason I won’t try prokera, irritation). Not to mention, I have gotten better oil thinning from oral doxy than topical azasite. That’s my anecdotal experience anyway. Not to mention. I’m lowering MMPs systemically. For me, I have sleep apnea, it’s thought that holding your breath while you sleep causes a release of MMP7 and MMP9. So being able to reduce my circulating MMPs with oral medicine, is extremely valuable to me personally. Again, every application has to be considered thoroughly. Like what you saud about xiidra half life. That’s incredibly short. At the 5 hour marks it’s pretty much out of the system. So odd .

I fail to see why topical vs oral application can effect irritation or inflammation differently. Irritation and inflammation are also two different things. Unless you mean the delivery vehicle can cause the irritation, but there are options out there. I personally don't use AzaSite because of BAK, but there are options such as compounded formulations or preservative-free Azyter as mentioned above. I've personally had very very good success w/ Azyter, it flushes out my glands so quickly and removes the thick oil. When I was on Azyter, I felt normal again even in adverse wind conditions.


Yes, Xiidra half-life is estimated to be 2 hours, however it is still a very effective drug as many patients and studies attest to. However, at 5 hours, it doesn't mean its out of the system, it just means more than 3/4 of the drug is out of the system. If you start off with a high concentration, the drug can still be active. This is one of the reason why Xiidra is at 5%, they tried 10% in studies, but found no additional efficacy in the trials.

[Guest]

There is no published literature I am aware of that backs this claim.

Irritation is independent of tissue penetration, I fail to see the correlation between irritation and effect of the pharmacokinetics of the drugs. One argument you could make that is you are irritated, you may tear up more and flush the drug out quickly.



AzaSite contains BAK yes, however there are other topical azythromycin options out there. For example, you can get it compounded preservative free for around $20 / month. For EU patients, Azyter is available, Azyter is topical azythromycin in preservative-free single dose vials.



I fail to see why topical vs oral application can effect irritation or inflammation differently. Irritation and inflammation are also two different things. Unless you mean the delivery vehicle can cause the irritation, but there are options out there. I personally don't use AzaSite because of BAK, but there are options such as compounded formulations or preservative-free Azyter as mentioned above. I've personally had very very good success w/ Azyter, it flushes out my glands so quickly and removes the thick oil. When I was on Azyter, I felt normal again even in adverse wind conditions.


Yes, Xiidra half-life is estimated to be 2 hours, however it is still a very effective drug as many patients and studies attest to. However, at 5 hours, it doesn't mean its out of the system, it just means more than 3/4 of the drug is out of the system. If you start off with a high concentration, the drug can still be active. This is one of the reason why Xiidra is at 5%, they tried 10% in studies, but found no additional efficacy in the trials.

I just have to say this, I have a real hard time talking to you on here, because you constantly bring up studies. Studies are great, but common sense is much greater. You don’t need a study to understand how the medication effects the gland. The gland is surrounded by muscle and vasculature. The only way to get the medicine all the way into the gland is to 1) insert it with a device or 2) take it systemically and hope that the molecule gets carried into the gland. Doxycycline monohydrate is fat soluble. The idea is that the doxy mono will attach to your lipids and be brought directly into the gland, from the inside. Studies are one piece of the puzzle, a small piece honestly. If we can’t takk and bounce ideas off each other without you needing a study to back the claim, there’s no reason to continue talking to one another.

Azasite is used to uncap glands. It’s melts the oil at the margin. It help with inflammation at the margin. Once you stop, the disease deep in the gland will justvreinfect the opening. I do t need a study to tell me that. It’s what I read on here and hear from many doctors I speak with. I have seen studies as well. But I don’t rest my faith on a study.

To know weather a study is good, you have to et it properly. Has it been rescinded? Are there ethical issues? Was it properly administered? Was there a large enough sample size? There are so many working parts that most studies can just give you a clue to research further. We’re all still learning and trying to understand all this. But conversing in this manner won’t help us any.

I always try to offer refuting ideas. I’m not perfect, I say some stupid shit sometimes. But I try to use logic and facts to view the world. It would not help me to just say every time I didn’t understand something, well, there’s no study for that. I have a brain. I want to use it. I want to think about these ideas and how these things work to better understand my disease so I can treat it. I don’t know man.

[Alix]

Doxy at 40mg for several months is quite safe. Xiidra/Restasis/Ikervis is also quite safe long term.

The honest answer is that we don't have a standardized protocol. Each doctor will have different opinions.

My suggestion to you is, get on doxy for awhile, or Azithromycin. Concurrently, get on Xiidra/Restasis/Ikervis as well. See if you get substantial improvements after 1-3 months. After which, remove the doxy and see what happens. It's really trial and error, as each patient can be quite different.

The good news is, these medications are relatively low risk.

I am willing to go on both both concurrently, hit my eyes both topically and systematically. Anything for the non-stop burning to go away.

[MGD1701]

Buring

Hi Alix
possible causes

1) foamy (tear film) (= bacteria, mostly staph. + poor quality oil, kind of soap, acid stuff) could cause burning
but sometimes you can not see such foamy/soapy stuff with naked eyes.

for control bacterial overgrow, most dry eye experts in USA recommend pure HOCL, like avenova .
Others: Heyedrate (cheaper too, from Amazon? - pure too)
Ocusoft - but NOT pure - some doctors recommend it. Avenova has many useful video at youTube.
Most these experts prompt daily lid hygiene like cleaning teeth.

2) eyes are too dry

what did doctor at dry eye clinic detect/recommend, especially lid hygiene? Did they detect inflammation?

[Alix]

Buring

Hi Alix
possible causes

1) soap + acid = foamy (tear fil)m (= bacteria) could cause burning - but sometimes you can not see such foamy with naked eyes.

for bacteria, most eye experts in USA recommend pure HOCL, like avenova or Heyedrate (cheaper too, from Amazon?)
both are pure. Ocusoft has one too but NOT pure - some doctors recommend it. Avenova has many useful video at youTube.

2) cornea is too dry

what did doctor at dry eye clinic detect/recommend, especially lid hygiene? Did they detect inflammation?

Hello It is definitely not soap, I use soap free micellar water to wipe my eyes. None of the doctors I have seen so far have mentioned anything about lid hygiene.

They said at the dry eye centre that there is inflammation for which they have given me steroid eye drops and doxycycline. I am to start on Ikervis soon.
The reason for the inflammation is MGD - I hardly have any meibomian glands left as a result of partial blinking. The quality and quantity of my lipids is very poor.

[MGD1701]

foamy, soapy

The soap I refer is not 'real' soap - something to do with poor quality oil + bacteria/Staph.
This famous dry eye expert, dr/professor explains this burning/foamy very well - 1:18-1:45
I think he has MGD too.
https://www.youtube.com/watch?v=mCwJE2tu4MI

effective/safe lid cleanser is very important - to control inflammation. steriod/doxy help but not for long-term.
I am pretty surprised such dry eye center did not even mention such basic but important stuff.

[ebi1368]

Hello It is definitely not soap, I use soap free micellar water to wipe my eyes. None of the doctors I have seen so far have mentioned anything about lid hygiene.

They said at the dry eye centre that there is inflammation for which they have given me steroid eye drops and doxycycline. I am to start on Ikervis soon.
The reason for the inflammation is MGD - I hardly have any meibomian glands left as a result of partial blinking. The quality and quantity of my lipids is very poor.

If you do not mind me asking, for how long you had partial blinking?

I also have partial blinking since lasik but I still have my gland. I want to see how long does it take for my gland to be atrophy.

[Alix]

foamy, soapy

The soap I refer is not 'real' soap - something to do with poor quality oil + bacteria/Staph.
This famous dry eye expert, dr/professor explains this burning/foamy very well - 1:18-1:45
I think he has MGD too.
https://www.youtube.com/watch?v=mCwJE2tu4MI

effective/safe lid cleanser is very important - to control inflammation. steriod/doxy help but not for long-term.
I am pretty surprised such dry eye center did not even mention such basic but important stuff.

more - my old post
http://forum.dryeyezone.com/forum/ar...a-tea-tree-oil

I am sorry I was not familiar with the phenomenon, I have no idea then if I have soapy tear film.
Not even any of the doctors I have seen at Moorfields (number one eye hospital in the UK) have mentioned eye hygiene.
Not sure what to make of this.

[MGD1701]

You wrote
''I hardly have any meibomian glands left as a result of partial blinking. The quality and quantity of my lipids is very poor.''

In fact, I dont believe just because of partial blinking. untreated inflammation is a big factor too -
since none of doctors told you about lid hygiene. They are related.

You are not alone - nearly 90% of my doctors did not tell me too. It is very sad.
Doctors have no knowledge or no time or both?
My big lessons? educate myself and explore/learn new things.

[Alix]

If you do not mind me asking, for how long you had partial blinking?

I also have partial blinking since lasik but I still have my gland. I want to see how long does it take for my gland to be atrophy.

Hi there, the first time I found out I had this partial blinking issue is when I had Lipiview at the Dry Eye Centre a couple of weeks ago. I was absolutely horrified.
I had seen numerous doctors at the hospital before this and not a single one noticed I had this problem because they had examined my eyes with only the usual standard equipment.

They said at the Dry Eye Centre that I could have been born like this, or it could have happened over time through contact lens use, or long periods in front of the computer, there was no way of knowing.

If I were you I would do blinking exercises which will keep the glands stimulated. Had I somehow found out earlier I had this problem I would have also done everything possible to stop my glands from atrophying, because once they atrophy, they cannot be regenerated.