In an Anthrax Emergency: How to Prepare Doxycycline Hyclate for Children and Adults Who Cannot Swallow Pills

You will need these items to make doses of doxycycline for children and adults who cannot swallow pills:

• 1 doxycycline hyclate tablet (100 mg)
• 1 metal teaspoon
• 1 oral syringe or medicine spoon (if available)
• 2 small bowls
• small amount of drinking water (4 teaspoons or 20 mL)
• 1 of these foods or drinks to make the crushed doxycycline taste better*:
  • milk, including breast milk and formula for infants
  • chocolate milk
  • chocolate pudding
  • apple juice mixed with 2 to 4 teaspoons of sugar

*Doxycycline works just as well whether you take it with or without food or milk.

1. Put 1 doxycycline hyclate tablet in a small bowl.
2. Add 4 teaspoons (20 mL) of water to the same bowl.
3. Let the tablet soak in the water for at least 10 minutes to soften it.
4. Crush the tablet with the back of the metal spoon until you can’t see any pieces of the tablet in the water.
5. Stir the tablet and water to mix it well.

You have now made the doxycycline and water mixture.

1. Find your child’s weight on the chart below.
   Weight is better, but if you don’t know how much your child weighs, find your child’s age on the chart.
2. Follow the row of your child’s weight or age across to the column “Amount of Doxycycline & Water Mixture to Measure.”
3. Measure the amount of doxycycline and water mixture for your child’s weight or age from the first bowl.
   For a  one-half (½) teaspoon dose, fill the teaspoon halfway or use an oral syringe (if available). It is better to give a little more of the medicine than not enough.
4. Place this amount into the second bowl. This is one dose that should be mixed with food or drink.

For children weighing 76 pounds or more and adults who cannot swallow pills, use all of the doxycycline and water mixture in the first bowl (4 teaspoons); the entire contents of the first bowl makes one dose that should be mixed with food or drink

*Weight-range dosing based on 2.2 mg/kg derived dose calculation.

• Mix the dose (measured amount of doxycycline and water mixture) in the second bowl with 3 teaspoons of one of the following:
  • Milk, including breast milk and formula for infants
  • Chocolate milk
  • Chocolate pudding
    OR
  • Apple juice mixed with 2 to 4 teaspoons of sugar

  You now have one dose, mixed with food or drink.

• Stir well before giving it to your child

• Give your child all of the doxycycline, water and food mixture from the second bowl. Make sure your child swallows all of it. This is one dose.
• Do this once every 12 hours (once in the morning AND once at night) each day for as long as directed

Throw it away if your child weighs 51 pounds or more (or is 6 years or older). You do NOT have enough left over to make another dose.

Keep it if your child weighs 50 pounds or less (or is 5 years or younger). You will have enough left over to make another dose.

• Store the doxycycline and water mixture in a covered bowl or cup at room temperature (between 68–77˚F or 20–25˚C) for up to 24 hours.
• Write the date, time and container contents on a label.
• Keep the mixture in a safe place, out of the reach of children or pets.
• Throw away any unused mixture after 24 hours and make a new doxycycline and water mixture for the next dose.

What should you know about side effects?

• Do not take doxycycline if you are allergic to an ingredient in doxycycline hyclate or any tetracycline antibiotics.
• Get emergency help if you have any signs of an allergic reaction, including hives, difficulty breathing or swelling of your face, lips, tongue or throat.
• Doxycycline may cause diarrhea, skin reaction to the sun, loss of appetite, nausea and vomiting. Refer to “Anthrax Emergency: How to Take Doxycycline to Prevent Anthrax” instructions for more information on possible side effects.
• Report any reaction to doxycycline to MedWatch or 1-800-FDA-1088.