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Krazati

adagrasib

Drug Monograph

Black Box Warnings
Adult Dosing
Peds Dosing
Contraindications/Cautions
Drug Interactions
Adverse Reactions
Safety/Monitoring
Pregnancy/Lactation
Pharmacology
Formulary
Manufacturer/Pricing
Patient Education
Pill Pictures
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Dosing Calculator

Adult Dosing .

Dosage forms: DR TAB: 60 mg

Special Note

[equivalency or interchangeability info]: Info: 60 mg Doryx MPC = 50 mg Doryx

infections, mild-moderate bacterial

[120 mg PO qd]: Start: 120 mg PO bid x1 day; Info: duration varies by indication; do not cut/crush/chew tab

infections, severe bacterial

[120 mg PO bid]: Info: duration varies by indication; do not cut/crush/chew tab

severe acne vulgaris, adjunct tx

[120 mg PO q12h]: Info: do not cut/crush/chew tab

pneumonia, community-acquired

[120 mg PO q12h for at least 5 days]: Info: refer to IDSA guidelines; do not cut/crush/chew tab

sinusitis, acute bacterial

[240 mg/day PO divided q12-24h x5-7 days]: Info: do not cut/crush/chew tab

infections, chlamydial

[treatment]: Dose: 120 mg PO q12h x7 days; Info: 1st-line agent; do not cut/crush/chew tab

[presumptive tx (off-label)]: Dose: 120 mg PO q12h x7 days; Info: for sexual assault victims; give w/ ceftriaxone and metronidazole in female patients; give w/ ceftriaxone in male patients; do not cut/crush/chew tab

[post-exposure prophylaxis (off-label)]: Dose: 240 mg PO x1; Start: w/in 72h of oral, vaginal, or anal sex; Max: 240 mg/24h; Info: for men and transgender women who have sex with men w/ history of at least 1 bacterial sexually transmitted infection during the past 12mo; may repeat dose; do not cut/crush/chew tab

syphilis

[primary, secondary, or latent <1y]: Dose: 120 mg PO q12h x14 days; Info: for patients w/ hypersens. to PCN; not 1st-line agent; do not cut/crush/chew tab

[latent >1y or unknown duration]: Dose: 120 mg PO q12h x28 days; Info: for patients w/ hypersens. to PCN; not 1st-line agent; do not cut/crush/chew tab

[post-exposure prophylaxis (off-label)]: Dose: 240 mg PO x1; Start: w/in 72h of oral, vaginal, or anal sex; Max: 240 mg/24h; Info: for men and transgender women who have sex with men w/ history of at least 1 bacterial sexually transmitted infection during the past 12mo; may repeat dose; do not cut/crush/chew tab

lymphogranuloma venereum

[120 mg PO q12h x21 days]: Info: may give for 7 days if asymptomatic disease; 1st-line agent; do not cut/crush/chew tab

urethritis, non-gonococcal

[120 mg PO q12h x7 days]: Info: 1st-line agent; do not cut/crush/chew tab

epididymitis

[120 mg PO q12h x10 days]: Info: give w/ ceftriaxone; do not cut/crush/chew tab

proctitis

[120 mg PO q12h x7 days]: Info: give w/ ceftriaxone; extend duration to 21 days if positive rectal chlamydia test w/ bloody discharge, perianal or mucosal ulcers, or tenesmus; do not cut/crush/chew tab

anthrax

[systemic]: Dose: 120 mg PO q12h; Start: use after IV tx; Info: not recommended for CNS anthrax; may use in pregnant patients; not 1st-line agent; part of multi-drug regimen; continue abx for post-exposure prophylaxis if inhalational exposure; do not cut/crush/chew tab

[cutaneous]: Dose: 120 mg PO q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; use extended duration for post-exposure prophylaxis if bioterrorism suspected; may use in pregnant patients; do not cut/crush/chew tab

[post-exposure prophylaxis]: Dose: 120 mg PO q12h x60 days; Info: 1st-line agent; give in combo w/ anthrax vaccine; may use in pregnant patients; may give x42 days, or x14 days after last vaccine dose, in immunocompetent patients 18-65 yo if anthrax vaccine regimen completed; do not cut/crush/chew tab

malaria prophylaxis

[120 mg PO qd]: Start: 1-2 days before exposure; Info: do not cut/crush/chew tab; D/C 4wk after exposure; see CDC Pre-Travel Malaria Prophylaxis recommendations in Guidelines > Specialties > Infectious Diseases

tularemia

[120 mg PO q12h x14-21 days]: Info: do not cut/crush/chew tab

Rocky Mountain spotted fever

[120 mg PO q12h x5-14 days]: Info: do not cut/crush/chew tab

cholera

[360 mg PO x1]: Info: do not cut/crush/chew tab

brucellosis

[120 mg PO q12h x6wk]: Info: part of multi-drug regimen; do not cut/crush/chew tab

granuloma inguinale

[120 mg PO q12h for at least 3wk]: Info: may extend tx if not healed after 3wk; not 1st-line agent; do not cut/crush/chew tab

gonococcal infections, post-exposure prophylaxis (off-label)

[240 mg PO x1 dose]: Start: w/in 72h of oral, vaginal, or anal sex; Max: 240 mg/24h; Info: for men and transgender women who have sex with men w/ history of at least 1 bacterial sexually transmitted infection during the past 12mo; may repeat dose; do not cut/crush/chew tab

PID (off-label)

[mild-moderate infection]: Dose: 120 mg PO q12h x14 days; Info: give w/ ceftriaxone and metronidazole, cefotaxime and metronidazole, or cefoxitin plus probenecid and metronidazole; 1st-line agent; do not cut/crush/chew tab

[severe infection]: Dose: 120 mg PO q12h x14 days; Info: give w/ ceftriaxone plus metronidazole, cefotetan, cefoxitin, ampicillin/sulbactam, or cefotaxime plus metronidazole; 1st-line agent; do not cut/crush/chew tab

Lyme disease (off-label)

[120 mg PO q12h x14-21 days]: Alt: 240 mg q24h x14-21 days; Info: may give for 10-14 days if early localized disease; extend duration to 28 days if Lyme arthritis; 1st-line agent; do not cut/crush/chew tab; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

Lyme disease prophylaxis, post-exposure (off-label)

[240 mg PO x1 dose]: Start: w/in 72h of tick removal after high-risk bite; Info: do not cut/crush/chew tab; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

cervicitis, presumptive (off-label)

[120 mg PO q12h x7 days]: Info: 1st-line agent; do not cut/crush/chew tab

Mycoplasma genitalium infection (off-label)

[macrolide-susceptible]: Dose: 120 mg PO q12h x7 days; Info: follow w/ azithromycin 1 g PO x1, then 500 mg PO qd x3 days; do not cut/crush/chew tab

[macrolide-resistant or resistance unknown]: Dose: 120 mg PO q12h x7 days; Info: follow w/ moxifloxacin 400 mg PO qd x7 days; do not cut/crush/chew tab

endocarditis prophylaxis, dental (off-label)

[120 mg PO x1]: Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Adult table

malaria tx, uncomplicated (off-label)

[120 mg PO q12h x7 days]: Info: give w/ quinine sulfate; follow up tx w/ primaquine to avoid relapse in acute P. vivax or P. ovale infection; refer to CDC guidelines; do not cut/crush/chew tab

non-cholera vibrio infection, gastroenteritis (off-label)

[120 mg PO q12h x3 days]: Info: for diarrhea persisting >5 days; do not cut/crush/chew tab

anaplasmosis (off-label)

[120 mg PO q12h x10-14 days]: Info: do not cut/crush/chew tab

ehrlichiosis (off-label)

[120 mg PO q12h x5-14 days]: Info: do not cut/crush/chew tab

onchocerciasis (off-label)

[240 mg PO qd x6wk]: Start: 1wk after ivermectin tx; Info: may decr. to 120 mg PO qd if not tolerated; not 1st-line agent; do not cut/crush/chew tab

renal dosing

[no adjustment]: renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]

Peds Dosing .

Dosage forms: DR TAB: 60 mg

Special Note

[equivalency or interchangeability info]: Info: 60 mg Doryx MPC = 50 mg Doryx

infections, mild-moderate bacterial

[>8 yo]: Dose: 2.6 mg/kg/dose PO qd; Start: 2.6 mg/kg/dose PO bid x1 day; Max: 120 mg/dose; Info: duration varies by indication; do not cut/crush/chew tab

infections, severe bacterial

[>8 yo]: Dose: 2.6 mg/kg/dose PO bid; Max: 120 mg/dose; Info: duration varies by indication; do not cut/crush/chew tab

severe acne vulgaris, adjunct tx

[>8 yo]: Dose: 2.6 mg/kg/dose PO qd; Start: 2.6 mg/kg/dose PO bid x1 day; Max: 120 mg/dose; Info: do not cut/crush/chew tab

community-acquired pneumonia, atypical

[>8 yo]: Dose: 2.6-5.2 mg/kg/day PO divided q12h x7-10 days; Info: do not cut/crush/chew tab

infections, chlamydial

[treatment, 8 yo and older]: Dose: 120 mg PO q12h x7 days; Info: 1st-line agent; do not cut/crush/chew tab

[presumptive tx, 8 yo and older (off-label)]: Dose: 120 mg PO q12h x7 days; Info: for sexual assault victims; give w/ ceftriaxone and metronidazole in female patients; give w/ ceftriaxone in male patients; do not cut/crush/chew tab

syphilis

[primary, secondary, or latent <1y, adolescents]: Dose: 120 mg PO q12h x14 days; Info: for patients w/ hypersens. to PCN; not 1st-line agent; do not cut/crush/chew tab

[latent >1y or unknown duration, adolescents]: Dose: 120 mg PO q12h x28 days; Info: for patients w/ hypersens. to PCN; not 1st-line agent; do not cut/crush/chew tab

lymphogranuloma venereum

[preadolescents >45 kg and adolescents]: Dose: 120 mg PO q12h x21 days; Info: may give for 7 days if asymptomatic disease; 1st-line agent; do not cut/crush/chew tab

urethritis, non-gonococcal

[preadolescents >45 kg and adolescents]: Dose: 120 mg PO q12h x7 days; Info: 1st-line agent; do not cut/crush/chew tab

epididymitis

[preadolescents >45 kg and adolescents]: Dose: 120 mg PO q12h x10 days; Info: give w/ ceftriaxone; do not cut/crush/chew tab

proctitis

[preadolescents >45 kg and adolescents]: Dose: 120 mg PO q12h x7 days; Info: give w/ ceftriaxone; extend duration to 21 days if positive rectal chlamydia test w/ bloody discharge, perianal or mucosal ulcers, or tenesmus; do not cut/crush/chew tab

anthrax

[systemic]: Dose: 2.6 mg/kg/dose PO q12h; Start: use after IV tx; Max: 120 mg/dose; Info: not recommended for CNS anthrax; not 1st-line agent; part of multi-drug regimen; give x60 days total if inhalational exposure; do not cut/crush/chew tab

[cutaneous]: Dose: 2.6 mg/kg/dose PO q12h x7-10 days; Max: 120 mg/dose; Info: for non-systemic infection; give abx x60 days total if bioterrorism suspected; do not cut/crush/chew tab

[post-exposure prophylaxis]: Dose: 2.6 mg/kg/dose PO q12h x60 days; Max: 120 mg/dose; Info: 1st-line agent; do not cut/crush/chew tab

malaria prophylaxis

[>8 yo]: Dose: 2.6 mg/kg/dose PO qd; Start: 1-2 days before exposure; Max: 120 mg/day; Info: D/C 4wk after exposure; do not cut/crush/chew tab; see CDC Pre-Travel Malaria Prophylaxis recommendations in Guidelines > Specialties > Infectious Diseases

Rocky Mountain spotted fever

[2.6 mg/kg/dose PO q12h x5-14 days]: Max: 120 mg/dose; Info: do not cut/crush/chew tab

cholera

[>8 yo]: Dose: 5.2-8 mg/kg/dose PO x1; Max: 360 mg/dose; Info: do not cut/crush/chew tab

brucellosis

[>8 yo]: Dose: 120 mg PO q12h x6wk; Info: part of multi-drug regimen; do not cut/crush/chew tab

granuloma inguinale

[adolescents]: Dose: 120 mg PO q12h for at least 3wk; Info: may extend tx if not healed after 3wk; not 1st-line agent; do not cut/crush/chew tab

PID (off-label)

[mild-moderate infection, preadolescents >45 kg and adolescents]: Dose: 120 mg PO q12h x14 days; Info: give w/ ceftriaxone and metronidazole, cefotaxime and metronidazole, or cefoxitin plus probenecid and metronidazole; 1st-line agent; do not cut/crush/chew tab

[severe infection, preadolescents >45 kg and adolescents]: Dose: 120 mg PO q12h x14 days; Info: give w/ ceftriaxone plus metronidazole, cefotetan, cefoxitin, ampicillin/sulbactam, or cefotaxime plus metronidazole; 1st-line agent; do not cut/crush/chew tab

Lyme disease (off-label)

[2.6 mg/kg/dose PO q12h x14-21 days]: Max: 120 mg/dose; Info: may give for 10-14 days if early localized disease; extend duration to 28 days if Lyme arthritis; 1st-line agent; do not cut/crush/chew tab; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

Lyme disease prophylaxis, post-exposure (off-label)

[5.2 mg/kg/dose PO x1 dose]: Start: w/in 72h of tick removal after high-risk bite; Max: 240 mg/dose; Info: do not cut/crush/chew tab; search 'Lyme' for epocrates Lyme Disease Dx & Tx decision tool

cervicitis, presumptive (off-label)

[preadolescents >45 kg and adolescents]: Dose: 120 mg PO q12h x7 days; Info: 1st-line agent; do not cut/crush/chew tab

Mycoplasma genitalium infection (off-label)

[macrolide-susceptible, adolescents]: Dose: 120 mg PO q12h x7 days; Info: follow w/ azithromycin 1 g PO x1, then 500 mg PO qd x3 days; do not cut/crush/chew tab

[macrolide-resistant or resistance unknown, adolescents]: Dose: 120 mg PO q12h x7 days; Info: follow w/ moxifloxacin 400 mg PO qd x7 days; do not cut/crush/chew tab

endocarditis prophylaxis, dental (off-label)

[<45 kg]: Dose: 2.6 mg/kg/dose PO x1; Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Pediatric table

[>45 kg]: Dose: 120 mg PO x1; Start: 30-60min before procedure; Info: see Infectious Disease: Endocarditis Prophylaxis, Pediatric table

malaria tx, uncomplicated (off-label)

[2.6 mg/kg/dose PO q12h x7 days]: Max: 120 mg/dose; Info: give w/ quinine sulfate; follow up tx w/ primaquine to avoid relapse in acute P. vivax or P. ovale infection; refer to CDC guidelines; do not cut/crush/chew tab

non-cholera vibrio infection, gastroenteritis (off-label)

[>8 yo, <45 kg]: Dose: 2.6 mg/kg/dose PO q12h x3 days; Max: 240 mg/day; Info: for diarrhea persisting >5 days; do not cut/crush/chew tab

[>8 yo, >45 kg]: Dose: 120 mg PO q12h x3 days; Info: for diarrhea persisting >5 days; do not cut/crush/chew tab

non-cholera vibrio infection, invasive disease (off-label)

[>8 yo, <45 kg]: Dose: 2.6 mg/kg/dose PO q12h; Max: 240 mg/day; Info: part of multi-drug regimen; do not cut/crush/chew tab

[>8 yo, >45 kg]: Dose: 120 mg PO q12h; Info: part of multi-drug regimen; do not cut/crush/chew tab

anaplasmosis (off-label)

[2.6 mg/kg/dose PO q12h x10-14 days]: Max: 120 mg/dose; Info: do not cut/crush/chew tab

ehrlichiosis (off-label)

[2.6 mg/kg/dose PO q12h x5-14 days]: Max: 120 mg/dose; Info: do not cut/crush/chew tab

onchocerciasis (off-label)

[240 mg PO qd x6wk]: Start: 1wk after ivermectin tx; Info: may decr. to 120 mg PO qd if not tolerated; not 1st-line agent; do not cut/crush/chew tab

renal dosing

[no adjustment]: renal impairment: no adjustment

HD/PD: no adjustment; no supplement

hepatic dosing

[not defined]

Contraindications / Cautions .

hypersensitivity to drug or ingredient
hypersensitivity to tetracyclines
pregnancy (except anthrax infection or malaria tx use)
patients <8 yo
avoid: breastfeeding during tx and x5 days after D/C (Lyme disease use)
avoid: breastfeeding (>3wk tx duration except in Lyme disease use)
avoid: sun exposure
avoid: UV light exposure, artificial
caution: overweight patients of childbearing potential
caution: patients of childbearing potential w/ intracranial HTN history
caution: loiasis and onchocerciasis, concurrent
caution: abx-associated colitis history, recent
caution: botulism

Drug Interactions .

Overview

doxycycline

tetracycline

Interaction Characteristics:

affected by altered gastrointestinal motility
alters GI flora
bacteriostatic agent
binds to anion exchange resin/polymer
binds to polyvalent cations
impairs immunomodulatory bacterial infective agent
photosensitivity
potentiates neuromuscular blockade
pseudotumor cerebri

Contraindicated

acitretin

Avoid/Use Alternative

aminolevulinic acid topical

BCG live intravesical

bremelanotide

cholera vaccine, live

fecal microbiota, live

isotretinoin

methotrexate

palovarotene

porfimer

tretinoin

tretinoin topical

typhoid vaccine, live

Monitor/Modify Tx

aluminum hydroxide

ascorbic acid (vitamin C)

atracurium

bismuth subsalicylate

calcium acetate

calcium carbonate

calcium citrate

calcium gluconate

cholestyramine

chromium

ciprofloxacin

cisatracurium

colestipol

cyclosporine

cysteamine

danazol

delafloxacin

exenatide

ferric citrate

ferric maltol

ferrous fumarate

ferrous gluconate

ferrous sulfate

goserelin

histrelin

lanthanum

leuprolide

levofloxacin

lithium

lixisenatide

magnesium carbonate

magnesium citrate

magnesium hydroxide

magnesium oxide

magnesium supplement

mecasermin

molindone

moxifloxacin

nafarelin nasal

ofloxacin

pramlintide

quinapril

rocuronium

somapacitan

somatrogon

somatropin

succinylcholine

sucralfate

sucroferric oxyhydroxide

sulfate bowel prep

triptorelin

vecuronium

warfarin

zinc oral

Caution Advised

amoxicillin

ampicillin

butalbital

carbamazepine

cefaclor

cefadroxil

cefazolin

cefdinir

cefepime

cefiderocol

cefixime

cefotaxime

cefotetan

cefoxitin

cefpodoxime

cefprozil

ceftaroline

ceftazidime

ceftobiprole

ceftolozane

ceftriaxone

cefuroxime axetil

cefuroxime sodium

cephalexin

dicloxacillin

dihydroergotamine

dulaglutide

ergotamine

fosphenytoin

lactulose

liraglutide

methoxsalen

methylergonovine

nafcillin

oxacillin

penicillin G

penicillin V

pentobarbital

phenobarbital

phenytoin

piperacillin

pivmecillinam

primidone

quinine

rifampin

rifapentine

sodium picosulfate

tirzepatide

verteporfin

Adverse Reactions .

Serious Reactions

hypersensitivity reaction
skin reaction, severe
pericarditis
autoimmune disorder
hemolytic anemia
thrombocytopenia
neutropenia
hepatotoxicity
pancreatitis
esophagitis (cap or tab form)
esophageal ulcer (cap or tab form)
pseudotumor cerebri
C. difficile-associated diarrhea
photosensitivity

Common Reactions

nausea
vomiting
diarrhea
vaginitis
headache
abdominal pain
candidiasis, vulvovaginal
photosensitivity
skin hyperpigmentation
tissue hyperpigmentation
BUN elevated
tooth discoloration, permanent (patients <8 yo)
tooth discoloration, reversible (adult patients)

Safety/Monitoring .

Monitoring Parameters
BUN/Cr, CBC, LFTs if prolonged tx

Look/Sound-Alike Drug Names
doxycycline confused with: Declomycin; dicloxacillin; dicyclomine; doxazosin; doxepin; minocycline; tetracycline

Pregnancy/Lactation .

Pregnancy

Clinical Summary

may use during pregnancy for anthrax infection; weigh risk/benefit during pregnancy for malaria tx; otherwise, avoid use during pregnancy; inadequate human data available, though possible risk of spontaneous abortion; risk of permanent fetal teeth discoloration, abnormal bone development, and enamel hypoplasia based on human data w/ tetracycline class; possible risk of embryo-fetal toxicity based on conflicting animal data w/ tetracycline class

Lactation

Clinical Summary

Lyme Disease: avoid breastfeeding during tx and x5 days after D/C; no known risk of infant harm w/ short-term use based on limited human data and drug properties; theoretical risk of permanent infant teeth discoloration and abnormal bone development w/ prolonged use based on drug's mechanism of action; no human data available to assess effects on milk production

All Other Indications: avoid breastfeeding if >3wk tx duration, otherwise may use short-term while breastfeeding; no known risk of infant harm w/ short-term use based on limited human data and drug properties; theoretical risk of permanent infant teeth discoloration and abnormal bone development w/ prolonged use based on drug's mechanism of action; no human data available to assess effects on milk production

Pharmacology .

Metabolism: for doxycycline: liver minimally; CYP450: unknown

Excretion: for doxycycline: feces (primarily unchanged), urine 40% (primarily unchanged); Half-life: 18-22h

Subclass: Acne, Systemic Agents ; Anthrax ; Malaria ; Tetracyclines

Mechanism of Action
for doxycycline: binds to 30S and possibly 50S ribosomal subunit(s), inhibiting protein synthesis

Formulary .

No Formulary Selected

Manufacturer/Pricing .

Manufacturer: Mayne Pharma Group Limited

DEA/FDA: Rx

Retail Price

Estimated prices only. For current pricing, visit GoodRx.

oral delayed release tablet:

120 mg (30 ea): $392.00

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FDA Reporting Form

Classes

Drug Names

Select a medication above to begin.

Krazati

adagrasib

Drug Monograph

Adult Dosing .

Special Note

infections, mild-moderate bacterial

infections, severe bacterial

severe acne vulgaris, adjunct tx

pneumonia, community-acquired

sinusitis, acute bacterial

infections, chlamydial

syphilis

lymphogranuloma venereum

urethritis, non-gonococcal

epididymitis

proctitis

anthrax

malaria prophylaxis

tularemia

Rocky Mountain spotted fever

cholera

brucellosis

granuloma inguinale

gonococcal infections, post-exposure prophylaxis (off-label)

PID (off-label)

Lyme disease (off-label)

Lyme disease prophylaxis, post-exposure (off-label)

cervicitis, presumptive (off-label)

Mycoplasma genitalium infection (off-label)

endocarditis prophylaxis, dental (off-label)

malaria tx, uncomplicated (off-label)

non-cholera vibrio infection, gastroenteritis (off-label)

anaplasmosis (off-label)

ehrlichiosis (off-label)

onchocerciasis (off-label)

renal dosing

hepatic dosing

Peds Dosing .

Special Note

infections, mild-moderate bacterial

infections, severe bacterial

severe acne vulgaris, adjunct tx

community-acquired pneumonia, atypical

infections, chlamydial

syphilis

lymphogranuloma venereum

urethritis, non-gonococcal

epididymitis

proctitis

anthrax

malaria prophylaxis

Rocky Mountain spotted fever

cholera

brucellosis

granuloma inguinale

PID (off-label)

Lyme disease (off-label)

Lyme disease prophylaxis, post-exposure (off-label)

cervicitis, presumptive (off-label)

Mycoplasma genitalium infection (off-label)

endocarditis prophylaxis, dental (off-label)

malaria tx, uncomplicated (off-label)

non-cholera vibrio infection, gastroenteritis (off-label)

non-cholera vibrio infection, invasive disease (off-label)

anaplasmosis (off-label)

ehrlichiosis (off-label)

onchocerciasis (off-label)

renal dosing

hepatic dosing

Contraindications / Cautions .

Drug Interactions .

Overview

Contraindicated

Contraindicated

Avoid/Use Alternative

Avoid/Use Alternative

Avoid/Use Alternative