Demeclocycline in Inappropriate A.D.H. Syndrome

Perks, W.H.; Mohr, Pavel; Liversedge, L.A.

doi:10.1016/s0140-6736(76)91958-9

Cited by 11 publications

(7 citation statements)

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“…In total, 16 non‐RCTs were considered relevant, comprising six cohort studies (four observational studies 20, 22, 26, 27, two retrospective chart analyses 21, 28, and 10 case reports 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 (Tables 2 and 3, respectively); no cost‐effectiveness or HRQoL studies were identified. Quality assessments for all studies other than case reports are presented (Appendix C).…”

Section: Resultsmentioning

confidence: 99%

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Evidence for the use of demeclocycline in the treatment of hyponatraemia secondary to SIADH : a systematic review

2015

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SummaryAimsHyponatraemia (HN) is the most common electrolyte balance disorder in clinical practice. Since the 1970s, demeclocycline has been used in some countries to treat chronic HN secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH). The precise mechanism of action of demeclocycline is unclear, but has been linked to the induction of nephrogenic diabetes insipidus. Furthermore, the safety profile of demeclocycline is variable with an inconsistent time to onset, and a potential for complications. There has been no systematic evaluation of the use of demeclocycline for the treatment of HN secondary to SIADH to date. A systematic literature review was performed to obtain an insight into the clinical safety and efficacy of demeclocycline for this condition.MethodsEmbase™, MEDLINE ®, MEDLINE ® In‐Process, and The Cochrane Library were searched on two occasions using MeSH terms combined with free‐text terms. References were screened by two independent reviewers. Relevant publications were then extracted by two independent reviewers, with a third reviewer collating and finalising extractions.ResultsThe searches returned a total of 705 hits. 632 abstracts were screened after the removal of duplicates. Following screening, 35 full‐length publications were reviewed. Of these, 17 were excluded, resulting in 18 studies deemed relevant for data extraction. Two were randomised controlled trials (RCTs), 16 were non‐RCTs, and 10 were case reports.DiscussionAlthough most reports suggest that demeclocycline can address serum sodium levels in specific patients with HN, efficacy is variable, and may depend upon the underlying aetiology. Demeclocycline dose adjustments can be complex, and as its use in clinical practice is not well defined, it can differ between healthcare professionals.ConclusionThere is a lack of clinical and economic evidence supporting the use of demeclocycline for HN secondary to SIADH. Patients receiving demeclocycline for HN secondary to SIADH must be closely monitored.

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Section: Resultsmentioning

confidence: 99%

“…Ten case reports, detailing 11 patients in total, presented safety data pertaining to demeclocycline 29, 30, 31, 32, 33, 34, 35, 36, 37, 38. Demeclocycline effectiveness and safety data reported in case studies are presented in Table 6.…”

Section: Resultsmentioning

confidence: 99%

Evidence for the use of demeclocycline in the treatment of hyponatraemia secondary to SIADH : a systematic review

2015

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“…He was main- tained at home on demeclocycline for one year until his death from bronchial carcinoma. Details have been recorded by Perks et al (1976). Renal function before and during treatment with demeclocycline is shown in table 3.…”

Section: Resultsmentioning

confidence: 99%

“…Until recently treatment has been directed at correcting the electrolyte abnormalities by fluid restriction, which may be difficult in a confused patient (Perks et al, 1976), or treatment of the primary condition. Several case reports (Cherrill et al, 1975;De Troyer and Demanet, 1975;Perks et al, 1976;Perks et al, 1978) have suggested that demeclocycline is effective in SIADH. Demeclocycline interferes with the action of antidiuretic hormone on the renal collecting ducts and thus induces nephrogenic diabetes insipidus (Singer and Rotenberg, 1973).…”

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confidence: 99%

Demeclocycline in the treatment of the syndrome of inappropriate secretion of antidiuretic hormone.

Perks¹,

Walters²,

Tams³

et al. 1979

Thorax

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Fourteen patients with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) have been treated with demethylchlortetracycline (demeclocycline) 1200 mg daily. In 12 patients the underlying lesion was malignant. The serum sodium returned to normal (> 135 mmol/l) in all patients after a mean of 8-6 days (SD+5-3 days). Blood urea rose significantly from the pretreatment level of 4-2±2-3 mmol/l to 10-1±5-1 mmol/l at ten days (p<0 001). The average maximum blood urea was 13-4-6-8 mmol/l. In four patients the urea rose above 20 mmol/l, and in two of these demecyocycline was discontinued because of this rise. The azotaemia could be attributed to a combination of increased urea production and a mild specific drug-induced nephrotoxicity. Discontinuation of demeclocycline in six patients led to a fall in serum sodium, in one case precipitously, and return of the urea towards normal levels. Demeclocycline appears therefore to be an effective maintenance treatment of SIADH, and the azotaemia that occurs is reversible and probably dose dependent.

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“…Adapted from [14,15]. The tetracycline demeclocycline has been used since the 1970 with very limited results [16][17][18] and is not readily available in most countries.1718…”

Section: Incidence and Backgroundmentioning

confidence: 99%