Doxycycline 40mg (Efracea) for Rosacea: How Low-Dose Doxycycline Works
What low-dose doxycycline is, how it treats rosacea without acting as an antibiotic, when it is used, how to take it and what to watch for.
Part of our complete guide to rosacea. Looking for treatment? See our rosacea treatments.
Key fact: Efracea is a 40mg modified-release doxycycline capsule licensed for rosacea spots. At this low dose it works as an anti-inflammatory rather than an antibiotic, and NICE recommends adding it to a cream or gel for more severe spots.
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See rosacea treatments →Most rosacea is treated with a cream or gel. When spots are more severe, or don't improve enough with a cream alone, a tablet can be added. In the UK, NICE's choice is low-dose doxycycline. This guide explains how it works. For other options, see rosacea creams and gels compared.
What is low-dose doxycycline?
Efracea is a capsule containing doxycycline 40mg, released slowly through the day. It's licensed to reduce the red bumps and pus-filled spots (papulopustular lesions) of facial rosacea in adults. Doxycycline is a tetracycline antibiotic, but at this low, slow-release dose the level in the blood stays below what is needed to kill bacteria. Instead, it blocks some of the processes that drive inflammation in rosacea, which is why it is less likely to cause antibiotic resistance than the higher doses used for infections and acne.
When is it used?
- Moderate to severe spots: NICE recommends ivermectin cream together with doxycycline 40mg.
- Mild to moderate spots that haven't improved enough with a cream or gel alone: doxycycline 40mg can be added.
- Alongside metronidazole or azelaic acid if ivermectin isn't suitable.
It doesn't treat persistent redness, flushing or thread veins, and it isn't licensed for eye rosacea; see your GP or an optician for eye symptoms.
Doxycycline 40mg vs 100mg
| Doxycycline 40mg MR (Efracea) | Doxycycline 100mg | |
|---|---|---|
| Used for | Rosacea spots | Acne and infections |
| How it works | Anti-inflammatory dose | Antibiotic dose |
| How it's taken | Once a day, on an empty stomach | Once a day, with food or water as directed |
| Interchangeable? | No: they're different doses for different purposes | |
For acne, see doxycycline for acne.
How to take it
1
One capsule each morning
Take it on an empty stomach: at least 1 hour before, or 2 hours after, food.
2
With a full glass of water, sitting or standing
Don't lie down straight afterwards: doxycycline can irritate the food pipe.
3
Keep some products apart
Antacids, iron, zinc, calcium and magnesium supplements reduce absorption. Take them at least 2 to 3 hours apart.
4
With or without a cream or gel
It can be taken on its own, but for more severe spots NICE recommends taking it alongside a cream such as ivermectin. Follow your prescriber's advice.
What to expect
Your prescriber will usually review you after about 6 weeks; if there's no effect by then, it's usually stopped. In the trials it was used for 16 weeks. Spots tend to come back within about 4 weeks of stopping, so many people carry on with a cream or gel afterwards to keep their skin clear.
Side effects and safety
Common side effects (up to 1 in 10 people) include a blocked or sore nose and sinuses, headache, anxiety, stomach pain, diarrhoea and a dry mouth.
- Sunlight: doxycycline can make your skin burn more easily. Use sunscreen, avoid sunbeds, and stop if your skin burns.
- Not with isotretinoin or other oral retinoids.
- Other medicines: tell your prescriber about warfarin, epilepsy medicines, rifampicin and diabetes medicines.
- Contraception: doxycycline doesn't reduce the effect of hormonal contraception (FSRH).
- Pregnancy and breastfeeding: doxycycline can affect a baby's developing teeth, and we don't supply it in pregnancy or while breastfeeding.
Stop and get urgent advice if you get a severe headache with blurred vision, severe or bloody diarrhoea, or a widespread rash.
Frequently asked questions
What is Efracea used for?
Efracea is a low-dose doxycycline capsule (40mg, modified-release) licensed to reduce the red bumps and pus-filled spots of rosacea on the face in adults. It can be taken on its own, or added to a cream or gel such as ivermectin when spots are moderate to severe or haven't improved enough with a cream alone.
Is low-dose doxycycline an antibiotic?
Doxycycline is an antibiotic, but at 40mg released slowly through the day the level in the blood stays below what's needed to kill bacteria. It works on rosacea by calming inflammation, so it's less likely to cause antibiotic resistance than higher doses.
How long does Efracea take to work for rosacea?
Your prescriber will usually review you after about 6 weeks, and if there's no effect it's usually stopped. In clinical trials it was taken for 16 weeks. Spots can come back within about 4 weeks of stopping, so a cream or gel is often continued.
Can I take doxycycline 100mg instead of Efracea for rosacea?
Not as a straight swap. Doxycycline 100mg is an antibiotic dose, used for acne and infections. Efracea is 40mg released slowly, licensed for rosacea and working as an anti-inflammatory. Your prescriber will decide which is appropriate.
Does doxycycline affect the contraceptive pill?
No. According to the Faculty of Sexual and Reproductive Healthcare, doxycycline doesn't reduce the effect of hormonal contraception. If you're sick or have severe diarrhoea, follow your pill's missed-pill advice.
Does Efracea help rosacea redness?
It reduces the redness around spots as inflammation settles, but it doesn't treat persistent background redness, flushing or thread veins. Brimonidine gel can be used for persistent redness, and laser or IPL for thread veins.
Ready to treat your rosacea?
Complete a short online consultation about your skin and anything you have tried. A GPhC-registered pharmacist prescriber checks your answers and, if treatment is suitable, we dispatch it from our UK pharmacy. For adults 18 and over.
Start Rosacea Consultation →References
- NICE Clinical Knowledge Summaries. Rosacea. cks.nice.org.uk/topics/rosacea
- Summaries of product characteristics (eMC): Efracea 40mg Modified Release Hard Capsules. medicines.org.uk/emc
- Faculty of Sexual and Reproductive Healthcare. Drug interactions with hormonal contraception. fsrh.org
- Schaller M et al. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 2017;176(2):465–471.
- NHS. Rosacea. nhs.uk/conditions/rosacea
Medical disclaimer: This page is for information only and isn't a substitute for medical advice. Rosacea treatments are prescription-only medicines and need a clinical consultation before they can be supplied. We don't supply rosacea treatment online in pregnancy, while breastfeeding, for eye symptoms or for flushing on its own. Always follow your prescriber's advice and the leaflet. In a medical emergency, call 999.