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Summary   Aims  Hyponatraemia ( 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.    Methods  Embase ™ ,  MEDLINE  ® ,  MEDLINE  ®  In‐Process, and The Cochrane Library were searched on two occasions using Me SH  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.    Results  The 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 ( RCT s), 16 were non‐ RCT s, and 10 were case reports.    Discussion  Although 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.    Conclusion  There 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.

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