Sunday, May 22, 2011

It's summer, make sure to warn all of your SIADH patients about sun sensitivity

This came into my office on Friday.
Demeclocycline induced sun-sensitivity

Demeclocycline is minimally effective for SIADH and has a bad side-effect profile to boot. This patient has heart failure in addition to idiopathic SIADH. So salt tablets are poorly tolerated, and he needs chronic loop diuretics to stay out of the hospital. This makes managing his water metabolism pretty tricky. The only reason I use demeclocycline as opposed to the highly-effective and safer tolvaptan is cost. Tolvaptan is $300/day wholesale, and not one of my patients has been able to get it covered by insurance.
From the University of Utah New Drug Bulletin
Way to price that drug Otsuka, such that even well insured patients can't use it. I'll never understand drug pricing.
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