demeclocycline
Regulatory sources consulted
Approved indications
- Infections due to susceptible bacteria, including rickettsial, Mycoplasma, and Chlamydia infections and other label-listed indications, guided by culture and susceptibility.
Contraindications
Absolute
- Hypersensitivity to tetracyclines or components.
Clinical warnings
- Major warning · Do not use during tooth development through age 8 unless benefit is essential; it may cause permanent tooth discoloration and enamel hypoplasia. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- Major warning · It may cause nephrogenic diabetes insipidus and accumulation/toxicity in renal impairment. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- Major warning · It may cause Clostridioides difficile-associated diarrhea, including after completion; stop and treat according to severity. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- It may cause photosensitivity. Limit sun/UV exposure and stop for marked erythema. — DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
Drug interactions
- ModerateAntacids, iron, calcium, magnesium, zinc, and dairy products
Mechanism: Chelation reduces oral absorption.
Recommendation: Separate doses according to the label and administer with plenty of water.
DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
- ModerateAnticoagulants
Mechanism: It may depress prothrombin activity.
Recommendation: Monitor INR and reduce the anticoagulant if appropriate.
DailyMed, set_id 539add06-e0a0-401a-b4f6-20776084aa9c
Adverse events
Common (≥1%)
Nausea, vomiting, diarrhea, and epigastric discomfort
Rare but serious
Hepatitis, liver failure, ulcerative esophagitis, and intracranial hypertension
Pregnancy and lactation
Avoid during pregnancy, especially from the second half, because of permanent tooth effects and delayed fetal bone growth. Consider stopping breastfeeding or treatment.
Recent literature (PubMed)
Hyponatremia is the most common electrolyte disorder encountered in clinical practice. Conventional management strategies, including fluid restriction, hypertonic saline, and solute supplementation, often fail to achieve sustained correction, particularly in the syndrome of inappropriate antidiuretic hormone secretion (SIADH), resulting in refractory cases. A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eligible studies included randomized controlled trials, cohort studies, guideline syntheses, and mechanistic research, with risk of bias carefully evaluated. Seven studies met inclusion criteria. Tolvaptan consistently improved serum sodium concentrations in patients with SIADH and heart failure, though its use was limited by high cost and the potential for overly rapid correction. Oral urea emerged as a safe, inexpensive, and reliable option for gradual, sustained normalization of sodium levels. Vasopressin receptor antagonists (vaptans) demonstrated superiority over fluid restriction in oncology-associated hyponatremia, although relapse was frequently observed following discontinuation. Demeclocycline exhibited mechanistic efficacy but remains limited by nephrotoxicity risk. Guideline-based analyses emphasized improved diagnostic precision but revealed inconsistencies in correction thresholds and recommendations for second-line therapy. When standard correction measures fail, clinicians should reassess the underlying etiology and escalate treatment accordingly. Vaptans offer rapid correction, urea ensures safe long-term management, and demeclocycline serves as a last-line therapeutic option.
Effective management of drug-food interactions is crucial for enhancing antibiotics' efficacy/safety. Adhering to PRISMA guidelines, we conducted a systematic review to assess the impact of dietary interventions on the bioavailability of 15 macrolides and 10 tetracyclines. We included studies examining the influence of food, beverages, antacids, and mineral supplements on the pharmacokinetic parameters of orally administered macrolides and tetracyclines. We searched Medline (via PubMed), Embase and Cochrane Library databases up to December 2022. Risk of bias was assessed using Cochrane and NIH tools. Quantitative analyses were conducted if two or more comparable food-effect studies were available; otherwise, a qualitative summary was provided. We included 120 studies from 97 reports. Meta-analyses were conducted for 8 macrolides and 4 tetracyclines, with qualitative synthesis for 10 and 9, respectively. About 64% of the studies were open-label, crossover designs. Our assessment found that 37% of the studies had a high risk of bias, while only 6% had low risk. Food significantly affected 10 of 13 macrolides (77%) and 6 of 7 tetracyclines (86%). High positive effects on bioavailability were seen with extended-release azithromycin and clarithromycin, and erythromycin estolate. High negative impacts were observed with erythromycin propionate and stearate, azithromycin capsules, demeclocycline and omadacycline. Antacids and mineral supplements significantly decreased tetracyclines absorption. Milk and grapefruit juice showed variable impacts on absorption. Interactions depend on antibiotics' physicochemical characteristics, intervention type, drug formulation and potential patient factors. The quality of evidence was rated low due to outdated studies, methodological diversity and unequal data availability.