Photosensitivity from tetracyclines

Due to their extremely polar character, tetracyclines bind with proteins to form conjugates that are difficult to extract from biological matrices. Use of dilute mineral acids is of great help in dissociating tetracyclines from proteins, but once in aqueous solution, their exfraction into volatile organic solvents for further concentration and cleanup is hampered by the unfavorable partition coefficients. Most of these antibiotics are photosensitive compounds, whereas all of them show poor stability under strong acidic and alkaline conditions with reversible formation of the 4-epi-tetracyclines in weakly acidic conditions (pH 3), and anhydro-tetracyclines in strong acidic conditions (below pH 2). 

Before the introduction of specific vasopressin receptor antagonists, pharmacological treatments for hyponatremia centered on the use of loop diuretics and nonspecific inhibitors of vasopressin signaling, such as lithium carbonate and demeclocycline.11 The utility of such therapies has been limited by a range of sideeffects. Loop diuretic use can result in electrolyte imbalances and suffers from poor response predictability.11 Lithium carbonate suffers from a low therapeutic index and a risk of renal damage as well as limited effectiveness in many patients. Lithium carbonate has therefore been nearly completely supplanted by demeclocycline, a tetracycline antibiotic, in the treatment of chronic hyponatremia.12 Demeclocycline use is itself limited by its nephrotoxicity (particularly in cirrhotic patients), ability to cause reversible uremia, and ability to induce photosensitivity.1,11... 

---