Demeclocycline (Declomycin) is a tetracycline antibiotic that is used to treat susceptible infections. It is also used in the treatment of SIADH (syndrome of inappropriate antidiuretic hormone secretion)

Indications of Demeclocycline (Declomycin):

Note: Alternative tetracycline agents (eg, doxycycline, minocycline, tetracycline) are generally preferred over demeclocycline as an antibiotic.

• Acne:
  • It is suggested as a supplement to therapy for severe acne.
• Actinomycosis:
  • When penicillin is not recommended, it is used to treat actinomycosis brought on by Actinomyces israelii.
• Acute intestinal amebiasis:
  • It is given as adjunct therapy to amoebicides in acute intestinal amoebiasis.
• Anthrax:
  • Penicillin is used to treat anthrax caused by Bacillus anthracis when it is contraindicated.
• Cholera:
  • It works well in the treatment of Vibrio cholerae-related cholera.
• Clostridium:
  • When penicillin is contraindicated, it is used for the management of clostridial disease caused by Clostridium spp.
• Gram-negative infections:
  • It works well in the treatment of Vibrio cholerae-related cholera.
• Listeriosis:
  • When penicillin is not advised, it is used to treat Listeria monocytogenes-caused listeriosis.
• Ophthalmic infections:
  • Demeclocycline can be used to treat Chlamydia trachomatis-related trachoma or inclusion conjunctivitis.
• Plague:
  • It is effective in the treatment of plague due to Yersinia pestis.
• Relapsing fever:
  • Demeclocycline can be used to treat relapsing fever brought on by Borrelia recurrentis.
• Respiratory tract infections:
  • Treatment of upper respiratory tract infections brought on by Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella species, or Mycoplasma pneumoniae is also successful.
• Rickettsial infections:
  • It is used to treat typhus, the typhus group, Q fever, rickettsialpox, and tick-borne Rickettsiae diseases such Rocky Mountain spotted fever.
• Sexually transmitted diseases:
  • Treatment of:
    • lymphogranuloma venereum caused by Chlamydia trachomatis;
    • granuloma inguinale caused by Klebsiella granulomatis;
    • chancroid caused by Haemophilus ducreyi;
    • nongonococcal urethritis caused by Ureaplasma urealyticum or Chlamydia trachomatis;
    • when penicillin is contraindicated, uncomplicated urethritis in men caused by Neisseria gonorrhea and other uncomplicated gonococcal infections, infections in women caused by N. gonorrhoea and
    • syphilis caused by Treponema pallidum subspecies pallidum.
  • According to the Centers for Disease Control and Prevention (CDC) recommendations for sexually transmitted illnesses, demeclocycline is not a recommended choice for treating gonorrhoea. For advice, consult the most recent regulations.
• Skin and skin structure infections:
  • Demeclocycline can be used to treat Staphylococcus aureus-related infections of the skin and skin structure.
• Urinary tract infections:
  • It works well for treating urinary tract infections brought on by Klebsiella species.
• Vincent infection:
  • Penicillin is used to treat Vincent infection brought on by Fusobacterium fusiforme when it is contraindicated.
• Yaws:
  • It is used to treat yaws brought on by Treponema pallidum subspecies pertenue when penicillin is contraindicated.
• Zoonotic infections:
  • Treatment of:
    • Psittacosis (ornithosis) caused by Chlamydophila psittaci;
    • Tularemia caused by Francisella tularensis;
    • Brucellosis caused by Brucella species (in conjunction with streptomycin);
    • Bartonellosis caused by Bartonella bacilliformis;
    • Infections caused by Campylobacter fetus.
• Off Label Use of Demeclocycline in Adults:
  • Chronic SIADH (syndrome of inappropriate antidiuretic hormone secretion)

Demeclocycline dose in Adults 

Demeclocycline dose in the treatment of Susceptible infections:

• Oral: 150 mg four times per day or 300 mg twice per day

Demeclocycline (Declomycin) dose in the treatment of SIADH (off-label):

• Oral: 600 to 1,200 mg/day.

Note:

• Limited high-quality evidence exists to define the clinical role, if any, of demeclocycline in this condition.
• European clinical practise guidelines do not advocate the use of demeclocycline to treat hyponatremia in patients with SIADH.

  Demeclocycline dose in Children

Demeclocycline dose in the treatment of Susceptible infections in children:

Note: Alternative tetracyclines are recommended (eg, doxycycline, minocycline, tetracycline) over demeclocycline as an antibacterial agent.

• Children ≥8 years and Adolescents:
  • Oral: Every 6 to 12 hours, 7 to 13 mg/kg is administered.
  • The daily dosing cap is 600 mg.

Pregnancy Risk Factor D

• Demeclocycline can cross the placenta.
• The accumulation of tetracyclines in the developing teeth and long tubular bone can be observed.
• In utero prolonged or repeated exposure can cause permanent discoloration (yellow-gray, brown).
• Tetracyclines should be avoided during pregnancy. They are second-line antibiotics.
• It is not recommended to use demeclocycline in Rocky Mountain Spotted Fever or Q fever during pregnancy.
• Alternate agents in dermatological infections are preferable to demeclocycline when there is a need for systemic antibiotics.

Demeclocycline use during breastfeeding:

• Breast milk contains tetracyclines.
• The gut flora may change for reasons unrelated to dose when breast milk is consumed.
• Tetracyclines should not be used by breastfeeding mothers as they can cause permanent tooth staining.
• Sources say that breastfeeding can be continued while receiving tetracycline therapy, but it is best to use alternative agents whenever possible.
• Breastfeeding women should avoid prolonged tetracyclines treatment (eg, to treat acne).
• It is important to monitor infants for GI disorders.
• There are potential adverse events.
• The decision to breastfeed or not during therapy is based on the risks to the infant and the benefits to the mother, as determined by the manufacturer.

Demeclocycline (Declomycin) dose adjustment in renal disease:

• Use with caution as the manufacturer's labelling makes no specified dosage modifications.
• An increase in the time interval between doses or dose reduction is recommended.
• Tetracyclines are not removed in significant quantities by hemodialysis or peritoneal dialysis.   

Demeclocycline (Declomycin) dose adjustment in liver disease:

• Use with caution as the manufacturer's labelling makes no specified dosage modifications.
• An increase in the time interval between doses or dose reduction is recommended.   

Side effects of demeclocycline:

• Cardiovascular:
  • Pericarditis
• Central Nervous System:
  • Bulging Fontanel (Infants)
  • Dizziness
  • Headache
  • Pseudotumor Cerebri (Adults)
• Dermatologic:
  • Erythema Multiforme
  • Erythematous Rash
  • Maculopapular Rash
  • Skin Photosensitivity
  • Skin Pigmentation
  • Urticaria
• Endocrine & Metabolic:
  • Microscopic Thyroid Discoloration (Brown/Black)
  • Nephrogenic Diabetes Insipidus
• Gastrointestinal:
  • Anorexia
  • Dental Discoloration
  • Diarrhea
  • Dysphagia
  • Enterocolitis
  • Esophageal Ulcer
  • Glossitis
  • Nausea
  • Pancreatitis
  • Vomiting
• Genitourinary:
  • Balanitis
  • Inflammatory Anogenital Lesion (With Monilial Overgrowth)
• Hematologic & Oncologic:
  • Eosinophilia
  • Hemolytic Anemia
  • Iga Vasculitis
  • Neutropenia
  • Thrombocytopenia
• Hepatic:
  • Increased Liver Enzymes
• Hypersensitivity:
  • Anaphylaxis
  • Angioedema
• Infection:
  • Superinfection
• Neuromuscular & Skeletal:
  • Exacerbation Of Systemic Lupus Erythematosus
  • Lambert-Eaton Syndrome
  • Lupus-Like Syndrome
  • Polyarthralgia
• Ophthalmic:
  • Visual Disturbance
• Otic:
  • Tinnitus
• Renal:
  • Acute Renal Failure
  • Increased Blood Urea Nitrogen
• Respiratory:
  • Pulmonary Infiltrates

Contraindications to Demeclocycline (Declomycin):

Demeclocycline, Tetracyclines, or any other ingredient in this formulation-related allergic reactions.

Warnings and precautions

• CNS effects
  • Demeclocycline may cause dizziness, blurred sight, or lightheadedness. This can lead to impairment of mental or physical abilities.
  • Patients should be cautious when operating machinery or driving.
• Diabetes insipidus syndrome
  • Demeclocycline may cause dose-dependent nephrogenic diabeticus insipidus.
  • This condition is reversible upon discontinuation. However, this adverse effect of demeclocycline was used as a therapeutic advantage for hyponatremia associated to SIADH.
• BUN Increased
  • Patients with renal dysfunction should not use it. It has anti-anabolic properties that can cause increased BUN levels.
• Intracranial hypertension (eg pseudotumor cerebri).
  • Headaches, impaired vision, and intracranial pressure can all be symptoms.
  • It is treatable by withdrawing but permanent sequelae may be possible.
• Photosensitivity
  • Photosensitivity is possible.
  • Skin erythema should not be treated with drugs.
  • Avoid prolonged sun exposure and use sunscreen. Avoid using tanning agents.
• Superinfection
  • Superinfections caused by fungi or bacteria, like pseudomembranous collitis and C. difficile-associated diarrhoea, can be treated with long-term medication.
  • Several months after receiving antibiotics, CDAD was monitored.
• Hepatic impairment
  • Patients with hepatic impairment should exercise caution when adjusting their doses and/or adjusting the interval frequency.
  • It is rare for it to cause hepatotoxicity or hepatic failure.
• Renal impairment
  • It is important to adjust the dosage and/or adjust the interval frequency with caution.
  • It can cause nephrotoxicity, especially in the setting of cystic fibrosis.

Demeclocycline: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• CBC
• Liver function tests
• Renal function tests

How to administer Demeclocycline (Declomycin)?

• It needs to be taken orally either two hours before or after milk or food.
• It ought to be consumed with lots of water to reduce the danger of esophageal irritability and ulcers.

Mechanism of action of Demeclocycline (Declomycin):

• By attaching to the 30S or 50S ribosomal units of the sensitive bacterium, demeclocycline prevents protein synthesis.
• It can cause cytoplasmic membrane damage and inhibition of ADH in patients suffering from chronic SIADH.

The onset of action in the treatment of SIADH:

• 2 to 5 days.

Absorption:

• 66%.
• The extent of absorption is reduced by food and by certain antacids and dairy products containing aluminum, calcium, magnesium, or iron.

Protein binding:

• 40% to 90%.

Metabolism:

• None.

Half-life elimination:

• 10 to 16 hours.

Time to peak serum concentration:

• 4 hours.

Excretion:

• Urine (44% as unchanged drug);
• feces (13% to 46% as unchanged drug).

International Brands of Demeclocycline:

• Alkonatrem Gel
• Declomycin
• Demecline
• Ledermicina
• Ledermycin
• Ledermycine
• Perciclina
• Unicycline

Demeclocycline Brands in Pakistan: