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

Abstract

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.

High-Throughput Identification of Antibacterials Against Pseudomonas aeruginosa

“…DMCT kill bacteria by binding to ribosomes inhibiting protein synthesis. It is used as a broad-spectrum antibiotic, but may be more often used to treat chronic syndrome of inappropriate secretion of antidiuretic hormone (SIADH) ( Miell et al, 2015 ). According to reports, DMCT is expected to be used as a contrast agent for intraoperative detection of brain tumors ( Sarkar et al, 2020 ).…”

Tolvaptan use during hyperhydration in paediatric intracranial lymphoma with SIADH

“…Although the mode of action is not well understood, it can induce nephrogenic diabetes insipidus, and a recent systematic review reported that demeclocycline was able to increase sodium levels in about 60% of patients with hyponatraemia secondary to SIADH (7). However, the onset of action is unpredictable and varies between 2 and 5 days (7). The effect is considered to be milder than that of the vaptans, and it is questionable whether this would have enabled us to hyperhydrate our patient.…”

Hyponatremia in the Neurologically Ill Patient: A Review

“…30 The use of oral medications such as demeclocycline and lithium, which act to decrease the responsiveness of the vasopressin receptor to ADH and thereby increasing water excretion, is limited by nephrotoxicity and delay in treatment to response by several days to 1 week. 31 In those with severe hyponatremia requiring more rapid correction, administration of IV sodium chloride may be required. It is important to understand, for sustained sodium increase, the sodium concentration of the IV fluid must exceed the concentration in the urine.…”