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Pronunciation |
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(dem
e kloe SYE
kleen) |
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U.S. Brand
Names |
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Declomycin® |
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Generic
Available |
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No |
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Synonyms |
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Demeclocycline Hydrochloride; Demethylchlortetracycline |
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Pharmacological Index |
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Antibiotic, Tetracycline Derivative |
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Use |
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Treatment of susceptible bacterial infections (acne, gonorrhea, pertussis and
urinary tract infections) caused by both gram-negative and gram-positive
organisms; used when penicillin is contraindicated (other agents are preferred);
treatment of chronic syndrome of inappropriate secretion of antidiuretic hormone
(SIADH) |
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Pregnancy Risk
Factor |
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D |
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Contraindications |
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Hypersensitivity to demeclocycline, tetracyclines, or any
component |
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Warnings/Precautions |
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Do not administer to children <9 years of age; photosensitivity reactions
occur frequently with this drug, avoid prolonged exposure to sunlight, do not
use tanning equipment |
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Adverse
Reactions |
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1% to 10%:
Dermatologic: Photosensitivity
Gastrointestinal: Nausea, diarrhea
<1%: Pericarditis, increased intracranial pressure, bulging fontanels in
infants, dermatologic effects, pruritus, exfoliative dermatitis, diabetes
insipidus syndrome, vomiting, esophagitis, anorexia, abdominal cramps,
paresthesia, acute renal failure, azotemia, superinfections, anaphylaxis,
pigmentation of nails |
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Overdosage/Toxicology |
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Symptoms of overdose include diabetes insipidus, nausea, anorexia, diarrhea
Following GI decontamination, treatment is supportive |
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Drug
Interactions |
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Decreased effect with antacids (aluminum, calcium, zinc, or magnesium),
bismuth salts, sodium bicarbonate, barbiturates, carbamazepine, hydantoins
Decreased effect of oral contraceptives
Increased effect of warfarin |
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Stability |
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Tetracyclines form toxic products when outdated or when exposed to light,
heat, or humidity (Fanconi-like syndrome) |
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Mechanism of
Action |
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Inhibits protein synthesis by binding with the 30S and possibly the 50S
ribosomal subunit(s) of susceptible bacteria; may also cause alterations in the
cytoplasmic membrane; inhibits the action of ADH in patients with chronic
SIADH |
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Pharmacodynamics/Kinetics |
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Onset of action for diuresis in SIADH: Several days
Absorption: ~50% to 80% from GI tract; food and dairy products reduce
absorption
Protein binding: 41% to 50%
Metabolism: Small amounts metabolized in the liver to inactive metabolites;
enterohepatically recycled
Half-life: Reduced renal function: 10-17 hours
Time to peak serum concentration: Oral: Within 3-6 hours
Elimination: As unchanged drug (42% to 50%) in urine |
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Usual Dosage |
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Oral:
Adults: 150 mg 4 times/day or 300 mg twice daily
Uncomplicated gonorrhea (penicillin sensitive): 600 mg stat, 300 mg every 12
hours for 4 days (3 g total)
SIADH: 900-1200 mg/day or 13-15 mg/kg/day divided every 6-8 hours initially,
then decrease to 600-900 mg/day
Dosing adjustment/comments in renal/hepatic impairment: Should be
avoided in patients with renal/hepatic dysfunction |
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Dietary
Considerations |
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Should be taken 1 hour before or 2 hours after food or milk with plenty of
fluid |
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Monitoring
Parameters |
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CBC, renal and hepatic function |
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Test
Interactions |
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May interfere with tests for urinary glucose (false-negative urine glucose
using Clinistix®,
Tes-Tape®) |
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Mental Health: Effects
on Mental Status |
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Tetracyclines reported to cause memory disturbances, mood stabilizing and
antidepressant effects |
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Mental Health:
Effects on Psychiatric
Treatment |
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Barbiturates and carbamazepine may decrease the effects of
demeclocycline |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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Tetracyclines are not recommended for use during pregnancy or in children
less than or equal to 8 years of age since they have been reported to cause
enamel hypoplasia and permanent teeth discoloration. The use of tetracyclines
should only be used in these patients if other agents are contraindicated or
alternative antimicrobials will not eradicate the organism. Long-term use
associated with oral candidiasis. |
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Patient
Information |
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Preferable to take on an empty stomach (1 hour before or 2 hours after
meals). Take at regularly scheduled times around-the-clock. Avoid antacids,
iron, or dairy products within 2 hours of taking demeclocycline. You may
experience photosensitivity (use sunscreen, wear protective clothing and
eyewear, and avoid direct sunlight); dizziness or lightheadedness (use caution
when driving or engaging in tasks that require alertness until response to drug
is known); nausea/vomiting (frequent small meals, frequent mouth care, sucking
lozenges, or chewing gum may help); or diarrhea (buttermilk, yogurt, or boiled
milk may help). If diabetic, drug may cause false tests with
Clinitest® urine glucose monitoring; use of glucose
oxidase methods (Clinistix®) or serum glucose monitoring
is preferable. Report rash or intense itching; yellowing of skin or eyes; change
in color of urine or stools; fever or chills; dark urine or pale stools; vaginal
itching or discharge; foul-smelling stools; excessive thirst or urination; acute
headache; unresolved diarrhea; or difficulty breathing.
Pregnancy/breast-feeding precautions: Do not get pregnant while taking this
medication - Oral contraceptives effectiveness may be reduced; use appropriate
barrier contraceptive measures. Consult prescriber if
breast-feeding. |
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Dosage Forms |
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Capsule, as hydrochloride: 150 mg
Tablet, as hydrochloride: 150 mg, 300 mg |
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References |
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Abdi EA and Bishop S,
"The Syndrome of Inappropriate Antidiuretic Hormone Secretion With Carcinoma of the Tongue,"
Med Pediatr Oncol, 1988, 16(3):210-5.
Smilack JD, Wilson WR, and Cockerill FR 3d,
"Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole,"
Mayo Clin Proc, 1991, 66(12):1270-80.
Troyer AD,
"Demeclocycline. Treatment for Syndrome of Inappropriate Antidiuretic Hormone Secretion,"
JAMA, 1977, 237(25):2723-6. |
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