Indications and Usage
Demeclocycline HCl tablets are indicated in the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions below:
Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox and tick fevers caused by rickettsiae;
Respiratory tract infections caused by Mycoplasma pneumoniae
Lymphogranuloma venereum due to Chlamydia trachomatis
Psittacosis (Ornithosis) due to Chlamydia psittaci
Trachoma due to Chlamydia trachomatis, although the infectious agent is not always eliminated as judged by immunofluorescence
Inclusion conjunctivitis caused by Chlamydia trachomatis
Nongonococcal urethritis in adults caused by Ureaplasma urealyticum or Chlamydia trachomatis
Relapsing fever due to Borrelia recurrentis
Chancroid caused by Haemophilus ducreyi
Plague due to Yersinia pestis
Tularemia due to Francisella tularensis
Cholera caused by Vibrio cholerae
Campylobacter fetus infections cause by Campylobacter fetus
Brucellosis due to Brucella species (in conjunction with streptomycin);
Bartonellosis due to Bartonella bacilliformis
Granuloma inguinale caused by Calymmatobacterium granulomatis
Demeclocycline HCl tablets are indicated for treatment of infections by the following gram-negative microorganisms, when bacteriologic testing indicates appropriate susceptibility to the drug:
Escherichia coli
Enterobacter aerogenes
Shigella species
Acinetobacter species
Respiratory tract infections caused by Haemophilus influenzae
Respiratory tract and urinary tract infections caused by Klebsiella species
Demeclocycline HCl tablets are indicated for treatment of infections caused by the following gram-positive microorganisms, when bacteriologic testing indicates appropriate susceptibility to the drug:
Upper respiratory infections caused by Streptococcus pneumoniae
Skin and skin structure infections caused by Staphylococcus aureus. (Note: Tetracyclines, including demeclocycline, are not the drugs of choice in the treatment of any type of staphylococcal infection).
When penicillin is contraindicated, tetracyclines, including demeclocycline HCl, are alternative drugs in the treatment of the following infections:
Uncomplicated urethritis in men due to Neisseria gonorrhoeae, and for the treatment of other uncomplicated gonococcal infections
Infections in women caused by Neisseria gonorrhoeae
Syphilis caused by Treponema pallidum subspecies pallidum
Yaws caused by Treponema pallidum subspecies pertenue
Listeriosis due to Listeria monocytogenes
Anthrax due to Bacillus anthracis
Vincent’s infection caused by Fusobacterium fusiforme
Actinomycosis caused by Actinomyces israelii
Clostridial diseases caused by Clostridium species
In acute intestinal amebiasis, demeclocycline HCl may be a useful adjunct to amebicides.
In severe acne, demeclocycline HCl may be a useful adjunctive therapy.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of demeclocycline HCl tablets and other antibacterial drugs, demeclocycline HCl tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Dosage and Administration
Therapy should be continued for at least 24 to 48 hours after symptoms and fever have subsided.
Concomitant therapy: Absorption of tetracyclines is impaired by antacids containing aluminum, calcium, or magnesium and by iron-containing preparations. Foods and some dairy products also interfere with absorption. Oral forms of tetracycline should be given at least 1 hour before or 2 hours after meals.
In patients with renal impairment: (see WARNINGS ). Tetracyclines should be used cautiously in patients with impaired renal function. Total dosage should be decreased by reduction of recommended individual doses and/or by extending time intervals between doses.
In patients with liver impairment: Tetracyclines should be used cautiously in patients with impaired liver function. Total dosage should be decreased by reduction of recommended individual doses and/or by extending time intervals between doses. Administration of adequate amounts of fluid with the oral formulations of tetracyclines is recommended to wash down the drugs and reduce the risk of esophageal irritation and ulceration (see ADVERSE REACTIONS ).
Adults: Usual daily dose – Four divided doses of 150 mg each or two divided doses of 300 mg each.
For pediatric patients above eight years of age: Usual daily dose, 7 to 13 mg per kg body weight per day, depending upon the severity of the disease, divided into two to four doses not to exceed adult dosage of 600 mg per day.
Gonorrhea patients sensitive to penicillin may be treated with demeclocycline administered as an initial oral dose of 600 mg followed by 300 mg every 12 hours for four days to a total of 3 grams.
Contraindications
This drug is contraindicated in persons who have shown hypersensitivity to any of the tetracyclines or any of the components of the product formulation.
Adverse Reactions
The following reactions have been reported in patients receiving tetracyclines:
Gastrointestinal: Anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, pancreatitis and inflammatory lesions (with monilial overgrowth) in the anogenital region, increases in liver enzymes, and hepatic toxicity has been reported rarely.
Rarely, hepatitis and liver failure have been reported. These reactions have been caused by both the oral and parenteral administration of tetracyclines.
Instances of esophageal ulcerations have been reported in patients receiving oral tetracyclines. Most of the patients were reported to have taken the medication immediately before lying down (see DOSAGE AND ADMINISTRATION ).
Skin: Maculopapular and erythematous rashes, erythema multiforme. Exfoliative dermatitis has been reported but is uncommon. Fixed drug eruptions and Stevens-Johnson syndrome have been reported rarely. Lesions occurring on the glans penis have caused balanitis. Pigmentation of the skin and mucous membranes has also been reported. Photosensitivity is discussed above (see WARNINGS ).
Renal toxicity: Acute renal failure, rise in BUN has been reported and is apparently dose related, nephrogenic diabetes insipidus (see WARNINGS ).
Hypersensitivity reactions: Urticaria, angioneurotic edema, polyarthralgia, anaphylaxis, anaphylactoid purpura, pericarditis exacerbation of systemic lupus erythematosus, lupus-like syndrome, pulmonary infiltrates with eosinophilia.
Hematologic: Hemolytic anemia, thrombocytopenia, neutropenia and eosinophilia have been reported.
CNS: Pseudotumor cerebri (benign intracranial hypertension) in adults and bulging fontanels in infants (see PRECAUTIONS – General). Dizziness, headache, tinnitus and visual disturbances have been reported. Myasthenic syndrome has been reported rarely.
Other: When given over prolonged periods, tetracyclines have been reported to produce brown-black microscopic discoloration of thyroid glands. No abnormalities of thyroid function studies are known to occur. Very rare cases of abnormal thyroid function have been reported.
Tooth discoloration has occurred in pediatric patients less than 8 years of age (see WARNINGS ), and has been reported rarely in adults.
To report SUSPECTED ADVERSE REACTIONS, contact Amneal Pharmaceuticals at 1-877-835-5472 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Overdosage
In case of overdosage, discontinue medication, treat symptomatically and institute supportive measures. Tetracyclines are not removed in significant quantities by hemodialysis or peritoneal dialysis.
Description
Demeclocycline HCl is an antibiotic isolated from a mutant strain of Streptomyces aureofaciens. Chemically it is 7-Chloro-4-(dimethylamino)-1,4,4a,5,5a,6,11,12a-octahydro-3,6,10,12,12a-pentahydroxy-1,11-dioxo-2-naphthacenecarboxamide monohydrochloride.
Its structural formula is:
Demeclocycline HCl tablets, USP, for oral administration, contain 150 mg or 300 mg of demeclocycline HCl, USP and the following inactive ingredients: alginic acid, corn starch, ethylcellulose, FD&C Red 40 aluminum lake, hypromellose, magnesium stearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, sodium lauryl sulfate, talc and titanium dioxide. In addition, the 150 mg tablet contains D&C Red 27 aluminum lake.
d94687e9-figure-01Clinical Pharmacology
Pharmacokinetics
The absorption of demeclocycline is slower than that of tetracycline. The time to reach the peak concentration is about 4 hours. After a 150 mg oral dose of demeclocycline tablet, the mean concentrations at 1 hour and 3 hours are 0.46 and 1.22 mcg/mL (n=6) respectively. The serum half-life ranges between 10 and 16 hours. When demeclocycline HCl is given concomitantly with some dairy products, or antacids containing aluminum, calcium, or magnesium, the extent of absorption is reduced by more than 50%. Demeclocycline HCl penetrates well into various body fluids and tissues. The percent of demeclocycline HCl bound to plasma protein is about 40% using a dialysis equilibrium method and 90% using an ultra-filtration method. Demeclocycline HCl, like other tetracyclines, is concentrated in the liver and excreted into the bile where it is found in much higher concentrations than in the blood. The rate of demeclocycline HCl renal clearance (35 mL/min/1.73 m2) is less than half that of tetracycline. Following a single 150 mg dose of demeclocycline HCl in normal volunteers, 44% (n=8) was excreted in urine and 13% and 46%, respectively, were excreted in feces in two patients within 96 hours as active drug.
Microbiology
Mechanism of Action
The tetracyclines are primarily bacteriostatic and are thought to exert their antimicrobial effect by the inhibition of protein synthesis. The tetracyclines, including demeclocycline have a similar antimicrobial spectrum of activity against a wide range of gram-negative and gram-positive organisms.
Mechanism(s) of Resistance
Resistance to tetracyclines may be mediated by efflux, alteration in the target site of tetracycline, enzymatic inactivation, and decreased bacterial permeability to the tetracycline or a combination of these mechanisms.
Cross Resistance
Cross-resistance between antibiotics of the tetracycline family occurs.
Demeclocycline has been shown to be active against most isolates of the following bacteria, in vitro and/or in clinical infections as described in the INDICATIONS AND USAGE section.
Gram-positive bacteria
Bacillus anthracis
Listeria monocytogenes
Staphylococcus aureus
Streptococcus pneumoniae
Gram-negative bacteria
Bartonella bacilliformis
Brucella species
Calymmatobacterium granulomatis
Campylobacter fetus
Francisella tularensis
Haemophilus ducreyi
Haemophilus influenzae
Neisseria gonorrhoeae
Vibrio cholerae
Yersinia pestis
Because isolates of the following groups of gram-negative bacteria have been shown to be resistant to tetracyclines, culture and susceptibility testing are especially recommended:
Acinetobacter species
Enterobacter aerogenes
Escherichia coli
Klebsiella species
Shigella species
Other microorganisms
Actinomyces israelii
Borrelia recurrentis
Chlamydia psittaci
Chlamydia trachomatis
Clostridium species
Entamoeba species
Fusobacterium fusiforme
Mycoplasma pneumoniae
Propionibacterium acnes
Rickettsiae
Treponema pallidum subspecies pallidum
Treponema pallidum subspecies pertenue
Ureaplasma urealyticum
Susceptibility Test Methods
For specific information regarding susceptibility test interpretive criteria and associated test methods and quality control standards recognized by FDA for this drug, please see: https://www.fda.gov/STIC.
How Supplied / Storage and Handling
Demeclocycline HCl tablets, USP, 150 mg, are supplied as round, convex, red, film-coated tablets, debossed with “AN” above “54” on one side and plain on the other side.
They are available as follows:
Bottles of 100: NDC 65162-554-10
Demeclocycline HCl tablets, USP, 300 mg, are supplied as round, convex, red, film-coated tablets, debossed with “AN” above “55” on one side and plain on the other side.
They are available as follows:
Bottles of 48: NDC 65162-555-48
Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature].
Dispense in a tight container as defined in the USP. Protect from light.
KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.