The Tetracycline Puzzle

There are at least 35 options to decide from once a provider decides Tetracycline is the best treatment at that time for the patient. 35! What happened to the days when there were only 1 or 2 drug choices in a class? And 1 or 2 different strengths or release mechanisms? Well, those days are long gone.

Tetracyclines are a class of antibiotics in dermatology that are mainly used to treat acne. Patients have different needs for their acne medication and some tetracyclines might work better for them than others. Some may cost more or less for any given patient depending on many factors. Fortunately, at Big Country Dermatology Pharmacy, we are always making sure the patient receives the best acne medication for them at the best cost. 


Patients without insurance have more straightforward and consistent options than patients who are insured. These patients will typically pay between $15 and $65 for a monthly prescription, if they have a pharmacy team that knows their way around the Tetracycline puzzle. On the other hand, costs of $200 – $300 for a one-month prescription are not uncommon in traditional pharmacies. Our insured patients will usually pay between $0 and $65 for a one month prescription, whereas if they went to a traditional pharmacy, they would pay much more.

Medication options


Doxycycline is known to have less photo-sensitivity than other tetracyclines. This may make it a more desirable option for patients on acne medication that spend lots of their time outside as they will have a lower risk of getting easily sunburned. On the other hand, Doxycycline has been known to cause an upset stomach in some patients. Therefore, patients who are already experiencing GI issues may want to look at other options.

Doxycycline comes in two salt forms, hyclate and monohydrate. Each salt form also comes in both tablets and capsules in a variety of different strengths. There are both brand and generic options within these different forms and strengths of Doxycycline. The hyclate form has more dosing options allowing for delayed release, extended release, and the traditional immediate release. Forms that are designed to release at a later stage in the intestinal tract can often help lower the chance of a patient experiencing an upset stomach caused by the medication.


Minocycline is another Tetracycline antibiotic that, in contrast to Doxycycline, is known to have a higher risk for photo-sensitivity and a lower risk for an upset stomach.

Minocycline comes in both immediate release forms as well as extended release forms. They are available by multiple manufacturers in different strengths and in capsule and tablet options.


Sarecycline is a relatively new Tetracycline antibiotic that is designed with weight-based dosing. Sarecycline’s claim to fame, at least at the moment, is less photo-sensitivity and less upset GI adverse events. The main draw back here is that it is only available by the name brand Seysara. This means that it is not affordable for uninsured patients, because even after manufacturer help, it still comes in at $125.


How do we make sure the patient gets the best and most cost-effective medication for their acne? It all varies depending on the patient’s needs. That is where we can help. We work together with the provider as a team to ensure the patient gets the best acne therapy. Many of our providers have come to trust the knowledge of our pharmacists to make recommendations and substitutions based on our provider protocol and the patient’s information. With our provider protocol, you can always ensure that your patient gets the best and most cost-effective treatments for their acne.



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