Tetracycline with isotretinoin

Oil acne is treated with the usual acne vulgaris modalities, such as topical benzoyl peroxide and retinoic acid. Systemic treatment is often needed with tetracycline, erythromycin or minocycline, or with isotretinoin in severe cases. The key factor is avoiding contact with oils and grease. Work clothes should be changed daily and frequent cleansing of the skin with soap and water is advised. 

Clinically important, potentially hazardous interactions with acetaminophen, acitretin, aspirin, chloroquine, digoxin, doxepin, fat-soluble vitamins A, D, E, K, hydroxychloroquine, isotretinoin, lovastatin, mycophenolate, raloxifene, sulfasalazine, sulfonylureas, tetracycline, tricyclic antidepressants, ursodeoxycholic acid, valproic acid... 

Clinically important, potentially hazardous interactions with acitretin, bexarotene, fish oil supplements, isotretinoin, minocycline, prednisone, tetracycline, warfarin... 

Systemic side effects generally are less significant with short-term therapy. Transitory elevations in serum transaminases occur rarely. Hyperlipidemia is frequent, with 25% of patients developing increased triglyceride levels and, less frequently, increased cholesterol and low-density lipoproteins, and decreased high-density lipoproteins. Myalgias and arthralgias are common complaints. Headaches occur and rarely are a symptom of pseudotumor cerebri. Use of isotretinoin concomitantly with tetracycline antibiotics may increase the risk of pseudotumor cerebri. 

The development of pseudotumour cerebri (benign intracranial hypertension) has been associated with the concurrent use of acitretin or isotretinoin and tetracyclines. 

Oral isotretinoin can be used in patients with severe varieties of rosacea in whom only partial remissions with oral tetracyclines and metronidazole were obtained. 

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