Atridox eent

Periodontitis

Used orally for treatment of adult periodontitis as an adjunct to scaling and root planing to promote attachment-level gain and reduce pocket depth.14 15 16

Used subgingivally for treatment of chronic adult periodontitis to reduce pocket depth, gain clinical attachment level, and reduce bleeding associated with probing.1 2 3 4 5 7 10 11

Administration

Oral Administration

Administered orally as 20-mg tablets for adjunctive treatment of periodontitis.14

Take twice daily at least 1 hour prior to or 2 hours after meals.14

Give with adequate amounts of fluids to reduce risk of esophageal irritation and ulceration.14

Subgingival Administration

Administered subgingivally as an extended-release preparation into periodontal pockets by a dental health-care professional.1

Commercially available as a kit containing a syringe of a liquid polymeric delivery system (syringe A), a syringe of doxycycline (syringe B), and a blunt cannula.1 Contents of the 2 syringes must be mixed together prior to administration.1 (See Reconstitution under Dosage and Administration.)

Final mixture appears as a pale yellow to yellow viscous liquid;1 after subgingival administration into periodontal pockets, the liquid solidifies to provide controlled release of doxycycline over a period of 7 days.1 8

Each pair of syringes is intended for single use only.1

Administration does not require local anesthesia.1

Extended-release preparation is bioabsorbed or expelled naturally and does not need to be manually removed.1

Mix contents of the 2 paired syringes (liquid polymeric delivery system [syringe A] and doxycycline powder [syringe B]) together prior to administration.1

Remove syringes from the refrigerator at least 15 minutes prior to mixing.1

Couple syringes together and inject contents of syringe A into syringe B and then back into syringe A to complete 1 mixing cycle.1 Perform a total of 100 mixing cycles using brisk strokes (approximately 1 mixing cycle per second).1

If not administered immediately, coupled syringes may be stored in resealable pouch (or airtight container) at room temperature for up to 3 days.1 After such storage, perform an additional 10 mixing cycles prior to administration.1

After mixing, hold coupled syringes vertically with syringe A (indicated by a red stripe) at the bottom.1 Pull down on plunger of syringe A and allow contents to flow down the barrel for several seconds into syringe A.1 Uncouple syringes and attach the blunt cannula supplied in the kit to syringe A.1 Bend cannula to resemble a periodontal probe.1

Using the syringe with bent cannula, position tip of cannula near base of the periodontal pocket and administer doxycycline polymer preparation into the pocket until mixture reaches the top of the gingival margin.1 Withdraw cannula from the pocket.1

If desired, the preparation may be packed into the periodontal pocket using an appropriate dental instrument.1 Dip edge of the dental instrument in water before packing to prevent the preparation from sticking to the instrument and to speed coagulation of the polymer.1 Once the preparation is in the periodontal pocket, drip a few drops of water onto its surface to aid in coagulation of the polymer.1 If necessary, add more doxycycline polymer and pack it into periodontal pocket until full.1

After subgingival administration is completed, cover pocket with periodontal dressing (Coe-Pak) or cyanoacrylate dental adhesive.1

Consult manufacturer’s literature for additional information on preparation and subgingival administration of doxycycline polymer.1

Dosage

Available as doxycycline hyclate; dosage expressed in terms of doxycycline.1 14

Doxycycline hyclate polymer for subgingival administration: When prepared as directed (see Reconstitution under Dosage and Administration), mixture in the syringe contains 50 mg of doxycycline hyclate (equivalent to 42.5 mg of doxycycline).1

Adults

20 mg every 12 hours (morning and evening).14

Safety of >12 months of treatment and efficacy of >9 months of treatment not established.14

Dosage varies depending on the size, shape, and number of periodontal pockets treated.1

May repeat treatment 4 months after initial treatment.1

Drug interactions reported involve oral doxycycline.14 No formal drug interaction studies performed with subgingival doxycycline.1

Specific Drugs

Storage

Oral

20–25°C in tight, light-resistant container.14

Subgingival

2–30°C.1

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

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