demeclocycline hydrochloride: clinical use

Prescribing considerations

• Confirm a susceptible organism and follow local antimicrobial stewardship processes when treating infection.
• The licensed SIADH indication is restricted to chronic hyponatraemia associated with malignant disease when water restriction has failed and cirrhosis is absent.
• Do not withdraw treatment controlling SIADH without an alternative control strategy.
• Consider photosensitivity and nephrotoxicity risks, particularly with prolonged use.
• Use caution with hepatic dysfunction, systemic lupus erythematosus or myasthenia gravis.

Contraindications and cautions

• Hypersensitivity to demeclocycline, another tetracycline or an excipient
• Renal impairment under the selected product information
• Pregnancy or breastfeeding under the selected product information
• Children younger than 12 years
• Acute porphyria

Monitoring

• Monitor serum sodium, fluid balance and other electrolytes when used for SIADH.
• Monitor renal function, particularly during prolonged treatment or if urine output or thirst changes.
• For long-term therapy, periodically assess hepatic and haematological parameters.
• Assess for photosensitivity, superinfection, severe diarrhoea and oesophageal injury.

Clinical pharmacology

Demeclocycline inhibits bacterial protein synthesis. In SIADH, it reduces renal responsiveness to vasopressin and induces a reversible nephrogenic diabetes-insipidus-like state. Absorption is incomplete and reduced by food, dairy products and polyvalent metal ions; elimination occurs through urine and faeces.

Formulation and product differences

• The selected product is a hard gelatin capsule containing powdered cellulose, magnesium stearate, colloidal anhydrous silica and colourants including erythrosine and iron oxides.
• Capsules must be swallowed whole; no alternative formulation is represented by the selected product.

Capsule

Route: Oral

Strengths: 150 mg, 300 mg