What is oxytetracycline?

Oxytetracycline is the oldest of the oral tetracyclines used in skin disease. This page relates specifically to its use for perioral dermatitis.

Why two tablets a dose?

There is no 500mg oxytetracycline tablet licensed in the UK, so the standard 500mg dose is taken as two 250mg tablets. At twice a day that is four tablets daily, and a four-week course is 112 tablets.

How does it treat perioral dermatitis?

Like the other tetracyclines used in skin disease, it works mainly by reducing inflammation rather than by clearing an infection.

Who this is suitable for

Adults with perioral dermatitis diagnosed by a healthcare professional who cannot take doxycycline or lymecycline. Because every dose has to be taken well away from food, most people find a once-daily option easier to keep to, so this is not usually the first choice. Our prescribers will also consider your symptoms, allergies, medical conditions, pregnancy or breastfeeding status and current medicines.

When this is not the right starting point

Oxytetracycline is not suitable if you are pregnant, might be pregnant, or are breastfeeding – erythromycin is the usual alternative. Unlike doxycycline it should also be avoided if you have any degree of kidney impairment. It is not suitable if you have lupus, porphyria, or are taking an oral retinoid.

Stopping steroid creams

Perioral dermatitis is very often caused by a steroid cream used on the face. Stopping the steroid is the single most important part of treatment, and the rash will usually flare for two to four weeks after you stop before it begins to settle. The antibiotic is used alongside that to shorten the flare.

Antibiotic stewardship

A course is usually four to six weeks. Treatment is reviewed at twelve weeks and not continued beyond that without an in-person review, to limit the risk of resistance.

How to take oxytetracycline for perioral dermatitis

If prescribed, take two 250mg tablets twice a day, morning and evening. Always follow your pharmacy label.

Empty Stomach: Take each dose an hour before food or two hours after. Food, and milk in particular, markedly reduces how much is absorbed.
Take With Water: Swallow the tablets whole with a full glass of water.
Stay Upright: Stay sitting or standing for at least 30 minutes afterwards.
Space It Out: Do not take it within two hours of milk, antacids, or iron, zinc, calcium or magnesium supplements.
Complete The Course: Keep taking it for the full course even once your skin improves.
Do Not Share: Do not share your medicine with anyone else.

If you miss a dose

Take it when you remember, unless it is nearly time for the next one. If it is nearly time, skip the missed dose and continue as normal. Do not take a double dose to make up for one you missed.

If you vomit

If you are sick soon after taking a dose, contact a pharmacist or prescriber for advice, because you may not have absorbed the medicine.

Who should not take oxytetracycline

Anyone allergic to any tetracycline antibiotic
Anyone who is pregnant, might be pregnant, or is breastfeeding
Anyone under 12 years of age
Anyone with systemic lupus erythematosus (SLE)
Anyone with kidney impairment, or with severe liver disease
Anyone with porphyria
Anyone taking an oral retinoid such as isotretinoin or acitretin, or high-dose vitamin A

Tell your prescriber if you take

Warfarin or another blood thinner, lithium, medicines for diabetes, or any oral retinoid.

Off-label use

No medicine holds a UK licence specifically for perioral dermatitis. This treatment is prescribed off-label, which means your prescriber is using it outside the terms of its licence because the evidence supports it. You will be asked to confirm you understand this during your consultation.

Active ingredient

Each tablet contains 250mg of oxytetracycline, as oxytetracycline dihydrate.

Other ingredients

Some brands contain tartrazine (E102), which can cause an allergic reaction in a small number of people, and sucrose or glucose. Inactive ingredients differ between manufacturers. Read the patient information leaflet supplied with your pack for the complete ingredient list, particularly if you have an allergy or intolerance. If you have a known allergy, tell us during your consultation so our clinicians can check the pack before we dispense.

Like all medicines, oxytetracycline can cause side effects, although not everyone gets them.

Common or recognised effects

Feeling sick or being sick
Diarrhoea or stomach discomfort
Increased sensitivity to sunlight
Thrush or another fungal overgrowth
Loss of appetite

Taking each dose with a full glass of water while sitting or standing protects your gullet. Because it has to be taken away from food, nausea is more common with this than with the once-daily options.

Stop taking oxytetracycline and call 999 or go to A&E if you develop

Swelling of the face, lips, tongue or throat, difficulty breathing, or a widespread itchy rash
A severe rash with blistering or peeling skin
A severe headache with blurred or double vision
Severe chest pain or pain on swallowing

Contact your GP or call NHS 111 promptly if you develop

Yellowing of the skin or eyes, or dark urine
Severe or bloody diarrhoea during or after the course
Thrush that does not settle with pharmacy treatment
A sunburn-like reaction after only brief sun exposure
Unusual bruising, mouth ulcers or marked tiredness