Antibiotics and antimicrobials; tablets vs capsules when available and generic vs brand names

My question primarily is from a user perspective, regarding the cost/vs side effects  of purchasing brand name capsules vs tablet forms when there is a choice. 

Cost seems to often be in favor of the tablet form. 

For those with no stomach distress with the capsules, seems either might be fine. 

For those with stomach respsonse to the capsules (such as myself) I have now realized that I do have a choice of the tablet form,

as well as a higher priced choice of another brand name Doryx that is reported to have less stomach response symptoms. Reported to be newer and more costly than either the tablet generic or the capsule generic.

Early on my response  to Doxy without food and even with food if not a full protein/fat containing meal was extreme pain and nausea ( the type that you might wish to vomit but never did fortunately). Through a process of trial and error, the solution for me was the well timed ingestion of the capsule halfway into the meal.   One the meal had moved into the small intestines the symptoms very quickly faded away.

Over the course of the past 15 weeks, I have had a few slips in this approach, taking the Doxy at the beginning of the meal or forgetting and taking it at the end of the meal.  Seems that perhaps my stomach lining or muscles may be clearing some of the C.Pn. 

I have read that abdomenal pain can be one of the many subjective presentations of porphoria.  Given my high starting dose of Doxy and my High IgG (past infection) 1:512,   and IgM ( active infection) also 1:152 a high titers as well as ever increasing brain fog prior to any treatment, my supposition is that I may have been having die-off earlier than some as a result of some active infection somewhere in my system other than my lungs. Regardless of the reason it was a writhing pain and nausea. 

It amazes me that I find myself seemingly in such a minority situation amongst folks here on this site.  From what I read, most folks seem to be guzzlng down the Doxy with a big glass of water and being so OK with that at least from the immediate stomach response perspective.

Also of note is my extreme sun sensitivity to the Doxy.  I was careful, used lots of sun block the few times I went out in the sun, wide brimmed hat etc. 

However one day I took a 2 hour drive on the interstate.  Never thought that I could get a burn through the auto tined glass.  Painful to touch on my hands that were on the steering wheel the entire time. Took several weeks to heal.  Bridge of my nose was red and sore too..  The most interesting manifestation was the very bright red spots that appeared on my arm, particularly the left towards the drivers side window and the direction of the mid-afternoon sun for the entire trip. 

Two doctors and a pharmacist saw it.  Family Practitioner (GP) said it was a Doxy reaction and that no way would I be able to keep taking it.  FFC doctor said sure we could substitute and wrote an RX for Cipro.   I decided that since Cipro info had the same cautions might as well stay with the doxy.  I reported my action of staying on the doxy and doubled my efforts to shield my skin from the sun. 

After several weeks the bright red, ever so slightly palpable spots darkened and eventually flaked off. 

My hypothesis it that it was porhporia related.  I am glad for the cool autumn weather and the several wide brim hat and cotton workgloves that I wear as necessary for driving extended periods in the bright sunlight. 

So I am looking for feedback from those that can make a comparison regarding the tablet form of Doxy vs Capsule and the brand vs generic varieties from the perspective of having similar responses to it as mine and what worked for you.   As well as those who have photosensitive experiences could be helpful.


I Will be filling Rx's soon.

Will be up dating this topic thread from time to time to report my subjective observations and experiences ingesting the various forms and alternatives of the Wheldon Protocol Variation medications over time with and without the buffer of a full meal in my stomach. 

Still it would be nice if some folks that are as "High Maintenance " as myself could lend some perspective.  Louise

Louise, USA, Northern New England. CPn, Bb(Borrelia B., Lyme,) CFS.     Started CAP 6/24/07 Doxy400, NAC1200.  Currently 9/24/07, Doxy 200 mg, NAC 1800 mg. 

  • CAP(TiniOnly): 06/07-02/09 for CFS
  • MethylationProtocolSupplements: Started08/08
  • Intermtnt CAP: 02/09-02/10
  • Full MethylProtocol & LDN 02/09
  • Off CAP: 02/10, cont LDN & MethlyProtocol support

 Louise- I've never, ever been able to take doxy without a meal. Same experience you have, and it continues to this day, so it's the doxy not the Cpn. 

I noticed that I sun-burned more easily early on, now have no added sensitivity at all. My belief is that the affect is enhanced by the porphyins in the skin, which are significantly photoreactive, and not the doxy alone. My daughter who continues with untreated Cpn and massive porphyria burns even thinking about sunlight and wearing 45spf sunscreen. I need sunscreen in Mexico, but can manage with that fine.

I would get the cheapest generic doxy and take it with food always. I don't think you'll improve the gastric stuff much on name brand. 

CAP for Chlamydia pneumonia since 11/04. 25yrs CFS & FMS- Currently: 200 Doxycycline, 500mg MWF Azithromycin, Tini pulses.


CAP for Cpn 11/04. Dx: 25+yrs CFS & FMS. Currently: 250 aithromycin mwf, doxycycline 100mg BID, restarted Tini pulses; Vit D2000 units, T4 & T3, 6mg Iodoral

Jim K, I have been taking a generic capsule.  The benefit of a capsule is the fast disintergration and dilution in large volume of water ( for those who can and susequent rapid absorption may be a plus.)  Verses a tablet, that may disolves more slowly in general, which if taken 12 ounces or more of water might just swish on through an empty stomach into my uneffected small intestines.  

Years ago I had a small bowel series during testing for Gluten Enteropathy (Intolerance).   It was a bit humerous to watch those x-ray techs scramble and race to change films because my motility well exceeded what was expected.   

Have you tried both tablet and capsule forms?   has anyone else tried both tablet and capsule and have some observations of any sort to share.

There is that sunlight caution on every bottle of Doxy, has there been much talk about over sensitivity in the past several years here? 

Today I tried NAC alone with large glass of water and waited, previously I have had some nausea.   Now 15 weeks later no nausea on an empty stomach.  That is freeing and I could add it to before meal hydration and supplements.

Thanks for sharing.

Louise, USA, Northern New England. CPn, Bb(Borrelia B., Lyme,) CFS.     Started CAP 6/24/07 Doxy400, NAC1200.  Currently 9/24/07, Doxy 200 mg, NAC 1800 mg. 

  • CAP(TiniOnly): 06/07-02/09 for CFS
  • MethylationProtocolSupplements: Started08/08
  • Intermtnt CAP: 02/09-02/10
  • Full MethylProtocol & LDN 02/09
  • Off CAP: 02/10, cont LDN & MethlyProtocol support

Louise, My reading is finally catching up to the present. I just saw this and have nothing dramatic to add. But I can say that from the beginning I have had no problems except with Rifampin early on which wouldn't stay down unless I drank lots of water, which may be true with Doxy, also. However, Richard ALWAYS gets nauseated with Doxy and flagyl. I don't think he drinks much water with Doxy but you are not alone in the nausea. A few times I have suggested he eat something but secretly I'm glad he doesn't.


Rica PPMS EDSS 6.7 at beginning - now 2. Began CAP Sept, 2004 with Rifampin 150 mg 2xd, Doxy 100 mg 2xd, added regular pulses Jan 2005. Jan 2006 switched to Doxy, Azith, cont. flagyl total 46 pulses NC USA

3/9 Symptoms returning. Began 5 abx protocol 5/9 Rifampin 600, Amox 1000, Doxy 200, MWF Azith 250, flagyl 1000 daily. Began Sept 04 PPMS EDSS 6.7 Now good days EDSS 1 Mind, like parachute, work only when open. Charlie Chan  In for the duration.&am

When I take Dox, it has to be with food or else I get a sensation like low blood sugar about 20 minutes after taking it.  If I eat something with it, that doesn't happen.


CAP for M.S. since 8/2007. Currently: 200 mg Dox. Waiting to start Zith & Flagyl.

CAP for M.S. 8/2007 - 3/2009.  Twentieth pulse metronidazole + INH completed 3/12/2009.  Intermittent treatment thereafter until 11/20/2009.  

Louise... I thought this was all in my head  Image removed.... my first doxy script was bright pink tablet form and I had no problem (stomach-wise) with it.  When I got my script filled by mail, they sent me capsules which did upset my stomach but didn't really cause stomach pain.  I called and had them send me tablets... this time they were yellow and wow... (I still have quite a few of them left), but they do cause me stomach pain and nausea  and if I don't drink enough water or have food in my stomach I become very nauseus and have to lie down.

I am guessing that (at least my intolerances) are due to whatever additives are in the different tablets (manufacturers)  I have no way of knowing if I have been given generic or not.

Curious to see what I get the next time as I've changed insurance providers and the scripts by mail will be a different company, but I will request tablets! 

Jeanne ~CPN 4/2007; also HHV6, EBV, CFIDS/FM; IBS, prior kidney infections, food allergies, hypothyroid (RAI for Graves in 1998), Adrenal issues (hypo); prior bronchitis/sinus problems. Currently 200 mg/doxy & 125 mg Azith daily, supplements

JeanneRoz ~ DX'd w/ CPN 4/2007; 6/07 -"officially" dx'd w/CFIDS/FM; also: HHV6, EBV, IBS-C, 100 Doxy:BID; 500 mg Biaxin BID; Tindamax Pulses, B12 shots, ERFA Dessicated Thyroid,Cortef, Iodoral 25 mg, Vit D-6,000 uni

I don't know if this helps but...

Generics just have to be AB rated to the original drug/product.  This means that they just have to have the same amount of active ingredients. 

 What can be decidedly different is the drug delivery system for the pill/capsule/tablet.  In the case of antibiotics it's how the drug is coated or encapsulated.  You can actually take a generic drug that is AB rated to the original and systemically get a whole lot less of the drug in your system - or get a gut bomb - from the delivery system of the generic vs the original product. 


Daisy-Caregiver- Balo's Concentric Sclerosis. Began CAP 5/10/07. Doxy 200 mg, Mino 100 BID 9/1/07, AZI 250mg QD 9/10/07, NAC 1800 mg, HD Flagyl Pulses, Novantrone, Prednisone & daily lb of supplements.

Daisy - Husband on CAP 5/07.  Husband died from Acute Myelogenous Leukemia Secondary to the Infusion of Novantrone.  Ie - the treatment with the conventional MS drugs killed him.

Daisy on her own CAP 11/2012.