Doxycycline Esophagitis: Causes, Risks, and How to Avoid It

When you swallow doxycycline, a broad-spectrum antibiotic used for infections like acne, Lyme disease, and respiratory illnesses. Also known as a tetracycline-class drug, it’s effective—but if taken improperly, it can cause serious damage to your esophagus. This isn’t a rare side effect. It’s a preventable injury called doxycycline esophagitis, inflammation and ulceration of the esophagus caused by the pill lingering too long in the throat. Think of it like leaving a small piece of sandpaper in your throat overnight. The pill doesn’t dissolve fast enough, and its acidity burns the lining. You don’t need to be allergic. You just need to take it wrong.

Who’s most at risk? People who take doxycycline without enough water, lie down right after swallowing it, or skip the pill with a dry mouth. Older adults, those with swallowing problems, or anyone on multiple medications are more likely to get hit. It’s not just about the drug—it’s about how you take it. The same pill that helps your acne can cause chest pain, trouble swallowing, or even vomiting blood if you don’t follow basic safety rules. Pill-induced esophagitis, a broader category that includes damage from other pills like NSAIDs or potassium chloride. Doxycycline is one of the most common culprits because it sticks to tissue and stays active for hours. This isn’t a myth. It’s documented in medical journals and ER reports. One study found over 60% of cases happened because people took the pill right before bed. That’s not a coincidence. That’s a pattern.

You don’t need to avoid doxycycline. You just need to take it right. Drink a full glass of water—no less. Stay upright for at least 30 minutes after swallowing it. Don’t take it right before lying down. Avoid taking it with dairy or antacids—they block absorption and make you more likely to swallow it dry. If you feel burning behind your breastbone, stop taking it and call your doctor. This isn’t something you should wait out. Early action stops long-term damage. Below, you’ll find real-world comparisons and safety tips from people who’ve dealt with this exact problem. Not theory. Not guesswork. Practical fixes from real cases.