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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
Demeclocycline hydrochloride, like other tetracyclines, is concentrated in the liver, where it is metabolised and excreted into the bile. It is found in much higher concentrations in the bile compared with the blood. Following a single 150 mg dose of demeclocycline hydrochloride in normal volunteers, 44% (n = 8) was excreted in urine and 13% and 46%, respectively, were excreted in faeces in two patients within 96 hours as active drug.
Fluid and electrolyte disorders
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Ploutarchos Tzoulis, Pierre-Marc G. Bouloux
An alternative treatment option is demeclocycline. Demeclocycline inhibits the action of vasopressin on the distal collecting tubule of the kidney and causes nephrogenic diabetes insipidus in most patients. The disadvantages of demeclocycline are (1) it is not effective in some patients and the response of each individual is unpredictable, (2) the onset of action is variable and usually longer than 3 days, and (3) it can cause profound polyuria and associated kidney injury.86
Water and sodium
Published in Martin Andrew Crook, Clinical Biochemistry & Metabolic Medicine, 2013
If the patient is not dehydrated and SIADH has been diagnosed, fluid intake restriction to 800–1000 mL/day may be indicated. Administration of demeclocycline, by antagonizing the action of ADH on renal tubules, may also help but may have side effects such as photosensitivity. Recently vasopressin 2 receptor antagonists such as tolvaptan have been used to treat SIADH and hyponatraemia of cardiac failure and cirrhosis.
The safety of antimicrobials for the treatment of community-acquired pneumonia
Published in Expert Opinion on Drug Safety, 2020
Carla Bastida, Dolors Soy, Antoni Torres
The routes of elimination also differ among the tetracyclines. The primary route is the kidney, via glomerular filtration. Doxycycline is partially inactivated by chelate formation in the gastrointestinal tract and is mostly excreted in feces. Minocycline and eravacycline undergo hepatic metabolism before being excreted in urine and feces. Demeclocycline, tigecycline, and omadacycline are also excreted in urine and feces as unchanged drugs, albeit in different proportions. Tetracyclines can be grouped according to their elimination half-lives into three groups: short half-life, from 5 to 9 hours (i.e. chlortetracycline, oxytetracycline, and tetracycline); intermediate half-life, from 10 to 14 hours (i.e. demeclocycline and lymecycline); and long half-life, over 16 hours (i.e. minocycline, doxycycline, tigecycline, eravacycline, and omadacycline).
HIV/AIDS-related hyponatremia: an old but still serious problem
Published in Renal Failure, 2018
Zhanjun Shu, Zimeng Tian, Jinglin Chen, Jianping Ma, Aihemaiti Abudureyimu, Qianqian Qian, Li Zhuo
Aside from the treatment of the opportunistic infection, volume replacement achieved with 0.9% (or 3% sodium chloride if necessary), is the major treatment for SIADH and CSWS. The rapidity of salt replacement depends on the rate at which the hyponatremia developed. Treatment of hyponatremia developing at a rate of ≥0.5 mmol/l/h should be aggressive, as it is a life-threatening complication and may cause death from severe cerebral edema and cerebral herniation [43,44]. Readers can also refer to the Adrogue–Maddias formulae [45], which is used widely. In addition, fluid restriction is an effective treatment for SIADH because the underlying problem is inappropriate water retention. Demeclocycline, a vasopressin antagonist, is used to treat SIADH, but its effects may be unpredictable.
Pharmacological management of hyponatremia
Published in Expert Opinion on Pharmacotherapy, 2018
Theodosios Filippatos, Moses Elisaf, George Liamis
The onset of action of demeclocycline is unpredictable and observed after 2–5 days of treatment [79]. It is worth mentioning that limited experience and no high-quality clinical evidence is available regarding long-term treatment of patients with SIAD with demeclocycline [79,80]. Furthermore, a number of side effects limits its use, such as nausea, vomiting, nephrotoxicity associated with reversible renal failure, and candidiasis due to overgrowth of resistant organisms [77,79,81]. Patients with liver disease should be treated with no than more 1 g/day, while renal and hepatic function should be carefully checked during treatment [82]. Furthermore profound polyuria may be associated with hypernatremia in patients with water restriction. Thus, careful follow-up of serum sodium levels is indicated during treatment [83,84].