Perio Protect Advanced

Vibramycin® - doxycycline CALCIUM SYRUP (NDC  0069-0971-93) and

dye-free doxycycline CALCIUM compound

50mg/5ml doxycycline calcium is administered via Perio Tray delivery to help suppress the inflammatory response and stabilize bone. Vibramycin® from Pfizer has been unavailable for several years. A dye-free version that is compounded has a limited shelf life.

Short-Term Use (2-3 weeks)

for antioxidant/anti-inflammatory properties

Prescribe 15-30ml for initial weeks of tray delivery

Long-Term Use

(12+ months) for bone stabilization 

Prescribe 60ml 

Doxycycline calcium helps

• decrease oxidative stress during the initial phase of treatment for acute and chronically inflamed tissues.
  
• decrease matrix metalloproteinases to reduce connective tissue breakdown.
• manage long-term osteogenic activity by decreasing osteoclastic activity and enabling osteoblasts to continue to function. Clinically, this usage has resulted in decreased bone loss and increased bone healing/repair.(1-3)
  

Do not substitute the 50mg/5ml doxycycline calcium. Doxycycline monohydrate oral suspensions, once reconstituted, are only stable for 14 days, and they may contain sugar which can cause tooth or root decay. Vibramycin® with doxycycline calcium and the dye-free compound are sweetened with sorbitol which is not absorbed within the gastrointestinal tract. Vibramycin has an extended shelf life. The dye-free doxycycline calcium has a shelf life of 120 days.

Doxycycline calcium is used in a subclinical dose with Perio Gel® via Perio Tray delivery. It is not recommended to use doxycycline calcium alone in the Perio Tray. In controlled clinical trials, doxycycline calcium in the Perio Tray with 1.7% hydrogen peroxide gel (Perio Gel®, QNT Anderson LLC, Bismarck, ND) helped reduce inflammation.(4) The antibiotic did not help reduce probing depths more than the peroxide gel alone.

Administration: Place gel in a thin line or ribbon on the occlusal surface of the tray and evenly distribute up to 3 drops of doxycycline calcium throughout the tray.[i] (30ml averages 600 drops, providing 100 daily treatments.)

Contraindications: Some patients have experienced superficial staining with long-term use of Vibramycin Syrup. This is easily removed with a coronal polish. Avoid usage for patients considering orthodontics in the future. The dye-free version reduces staining.

Three drops of doxycycline calcium in a prescription tray is a sub-therapeutic dosage. Systemic antibiotics have not been tested in combination with prescription tray usage and it is important to know that systemic doses have adverse reactions for patients who are on anticoagulant therapy and may require downward adjustments of their anticoagulant dosage.

Vibramycin® and the dye-free doxycycline calcium compound contain sodium metabisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people. Please check Periostat in your PDR for additional information.

Doxycycline should not be prescribed for pregnant or nursing patients or for patients allergic to tetracyclines. A 500mg daily oral dose of Vitamin C is an alternative antioxidant to help manage oxidative stress. Vitamin C does not effectively control matrix metalloproteinases or osteogenic activity.

1. Keller DC, Carano A. Tetracycline effect on osteoclastic and osteoblastic activity. Gen Dent. 1995 Jan-Feb;43(1):60-3. PMID: 7758924.

2. Keller DC. How to Manage Oral Biofilm a case presentation. DPR. 2010 July.

3. Harasty L. Case study report DPS May-June 2022.

4. Putt M, Mallatt M, Messmann L, and Proskin H. A 6-month clinical investigation of custom tray application of peroxide gel with or without doxycycline as adjuncts to scaling and root planning for treatment of periodontitis. American Journal of Dentistry. 2014;27:273-284.

Pharmacies and Rx Forms for Dye-Free Doxycycline Calcium Syrup (by state)