No

Antibiotic, Tetracycline Derivative

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)

D

Hypersensitivity to demeclocycline, tetracyclines, or any component

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

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

Symptoms of overdose include diabetes insipidus, nausea, anorexia, diarrhea

Following GI decontamination, treatment is supportive

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

Tetracyclines form toxic products when outdated or when exposed to light, heat, or humidity (Fanconi-like syndrome)

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

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

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

Should be taken 1 hour before or 2 hours after food or milk with plenty of fluid

CBC, renal and hepatic function

May interfere with tests for urinary glucose (false-negative urine glucose using Clinistix®, Tes-Tape®)

Tetracyclines reported to cause memory disturbances, mood stabilizing and antidepressant effects

Barbiturates and carbamazepine may decrease the effects of demeclocycline

No information available to require special precautions

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.

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.

Capsule, as hydrochloride: 150 mg

Tablet, as hydrochloride: 150 mg, 300 mg

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.