Adult: 600 mg daily in 2 or 4 divided doses. Treatment recommendations may vary among countries. Consider local treatment or detailed product guidelines. Child: >8 years 7-13 mg/kg daily in 2-4 divided doses. Max: 600 mg daily. Treatment or dosage recommendations may vary among countries. Consider local treatment or detailed product guidelines.
Oral Brucellosis
Adult: As monotherapy or in combination with streptomycin: 600 mg daily in 2 or 4 divided doses. Treatment recommendations may vary among countries. Consider local treatment or detailed product guidelines. Child: >8 years 7-13 mg/kg daily in 2-4 divided doses. Max: 600 mg daily. Treatment or dosage recommendations may vary among countries. Consider local treatment or detailed product guidelines.
Oral Acute intestinal amoebiasis, Severe acne vulgaris
Adult: As adjunctive therapy: 600 mg daily in 2 or 4 divided doses. Treatment recommendations may vary among countries. Consider local treatment or detailed product guidelines. Child: >8 years 7-13 mg/kg daily in 2-4 divided doses. Max: 600 mg daily. Treatment or dosage recommendations may vary among countries. Consider local treatment or detailed product guidelines.
Oral Chronic hyponatraemia associated with syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Adult: For cases where water restriction is ineffective and the patient does not have concomitant cirrhosis: Initially, 900-1,200 mg daily in divided doses. Maintenance: 600-900 mg daily in divided doses. Treatment should not be withdrawn without commencing other methods of therapy.
Renal Impairment
Dosage reduction may be needed.
Hepatic Impairment
Dosage reduction may be needed. Max: 1,000 mg daily.
Administration
Should be taken on an empty stomach. Take w/ a full glass of water on an empty stomach at least 1 hr before or 2 hr after meals.
Contraindications
Hypersensitivity to demeclocycline or other tetracyclines. Pregnancy and lactation.
Special Precautions
Patient with SLE, myasthenia gravis. Renal and hepatic impairment. Children and elderly.
Adverse Reactions
Significant: Photosensitivity reactions, CNS effects (e.g. dizziness, blurred vision, lightheadedness), reversible nephrogenic diabetes insipidus (prolonged use and/or high doses), increased BUN, fungal or bacterial superinfection (prolonged use), benign intracranial hypertension (pseudotumour cerebri), nephrotoxicity; exacerbation of SLE; may increase muscle weakness (in patients with myasthenia gravis); permanent yellow-grey-brown teeth discolouration, enamel hypoplasia (in children). Rarely, hepatotoxicity, hepatic failure. Blood and lymphatic system disorders: Haemolytic anaemia, aplastic anaemia, eosinophilia, neutropenia, agranulocytosis, thrombocytopenia. Cardiac disorders: Pericarditis. Ear and labyrinth disorders: Tinnitus, impaired hearing. Eye disorders: Visual disturbances. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, dysphagia, glossitis, stomatitis, oesophageal ulceration, oesophagitis, pancreatitis. Immune system disorders: Hypersensitivity reactions including anaphylaxis, anaphylactoid purpura, angioneurotic oedema. Investigations: Transient increase in LFT values; brown-black microscopic discolouration of the thyroid glands (prolonged use). Nervous system disorders: Headache; bulging fontanelles (in infants). Skin and subcutaneous tissue disorders: Urticaria, maculopapular and erythematous rashes, erythema multiforme, pruritus, bullous dermatoses, exfoliative dermatitis, skin discolouration. Potentially Fatal:Clostridium difficile-associated diarrhoea, pseudomembranous colitis. Rarely, Stevens-Johnson syndrome.
Avoid direct and prolonged exposure to sunlight and artificial UV light, if exposure cannot be avoided, use sunscreen or wear protective clothing. This drug may cause dizziness or blurred vision, if affected, do not drive or operate machinery.
Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor CBC, LFTs, and renal function. Observe for rash, anaphylactic reactions, CNS changes, and anaemia.
Drug Interactions
Increased risk of kidney failure with methoxyflurane. Impaired or reduced absorption with preparations containing Fe or Zn, antacids containing Ca, Mg, or Al; kaolin, strontium ranelate, sucralfate, tripotassium dicitratobismuthate, quinapril. May diminish the efficacy of oral contraceptives; the risk of breakthrough bleeding may also be increased when used concomitantly. May interfere with the bactericidal activity of penicillin; avoid concomitant use. Demeclocycline decreases plasma prothrombin activity; dosage adjustment of anticoagulants (e.g. coumarins, phenindione) may be needed. May increase the risk of benign intracranial hypertension with retinoids (e.g. isotretinoin, tretinoin, acitretin). Increased risk of ergotism with ergotamine and methysergide. May decrease the therapeutic effect of typhoid vaccine; avoid use 3 days before and after oral typhoid vaccine administration.
Food Interaction
Food, milk or dairy products may reduce the serum levels of demeclocycline.
Action
Description: Mechanism of Action: Demeclocycline is a tetracycline derivative that binds with the 30S and possibly the 50S ribosomal subunits of susceptible bacteria, thereby preventing protein synthesis. It possesses a wide spectrum of activity against gram-positive and gram-negative pathogenic bacteria, including some of which are unsusceptible to penicillin. The exact mechanism of action of demeclocycline for the treatment of hyponatraemia due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is unclear, but it has been associated with its ability to cause nephrogenic diabetes insipidus. Pharmacokinetics: Absorption: Irregularly and incompletely absorbed from the gastrointestinal tract. Decreased absorption with food, milk or dairy products. Time to peak plasma concentration: 3-4 hours. Distribution: Widely distributed in the body tissues and fluids; retained at sites of new bone formation and recent calcification. Crosses the placenta and enters breast milk. Volume of distribution: 1.7 L/kg. Plasma protein binding: Approx 40-90%. Excretion: Via urine (44% as demeclocycline); faeces (13-46% as demeclocycline). Elimination half-life: 10-16 hours.
Chemical Structure
Demeclocycline Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 54680690, Demeclocycline. https://pubchem.ncbi.nlm.nih.gov/compound/Demeclocycline. Accessed Apr. 26, 2022.
Storage
Store between 20-25°C. Protect from moisture and light.
J01AA01 - demeclocycline ; Belongs to the class of tetracyclines. Used in the systemic treatment of infections.
References
Gross P. Clinical Management of SIADH. Therapeutic Advances in Endocrinology and Metabolism. 2012 Apr;3(2):61-73. doi: 10.1177/2042018812437561. Accessed 01/03/2022. PMID: 23148195Miell J, Dhanjal P, Jamookeeah C. Evidence for the Use of Demeclocycline in the Treatment of Hyponatraemia Secondary to SIADH: A Systemic Review. International Journal of Clinical Practice. 2015 Dec;69(12):1396-1417. doi: 10.1111/ijcp.12713. Accessed 01/03/2022. PMID: 26289137Anon. Demeclocycline. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 18/03/2022.Anon. Demeclocycline. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 28/02/2022.Buckingham R (ed). Demeclocycline. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 28/02/2022.Demeclocycline Hydrochloride DAWA 150 mg Capsules (DAWA Limited). MHRA. https://products.mhra.gov.uk. Accessed 28/02/2022.Demeclocycline Hydrochloride DAWA 300 mg Capsules (DAWA Limited). MHRA. https://products.mhra.gov.uk. Accessed 28/02/2022.Demeclocycline Hydrochloride Tablet, Film Coated (Epic Pharma, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 28/02/2022.Joint Formulary Committee. Demeclocycline Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 28/02/2022.
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