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Indications and Dosage
Intramuscular
Tuberculosis Adult: In combination with other appropriate antituberculosis agents when 1st-line agents are ineffective or cannot be used: 1 g (Max: 20 mg/kg) daily for 2-4 months, then reduced to 1 g 2-3 times weekly for the remainder of therapy. Dosage and treatment recommendations may vary between countries and available products (refer to specific product guidelines).
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Renal Impairment
Dose reduction may be needed based on CrCl. Refer to specific product guidelines.
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Reconstitution
Reconstitute vial labelled as 1 g with 2 mL of NaCl 0.9% or sterile water for inj. Allow 2-3 minutes for the drug to completely dissolve. For doses <1 g, vial may be diluted with 2.15 mL, 2.63 mL, 3.3 mL, or 4.3 mL of the diluent to provide a final concentration of approx 370 mg/mL, 315 mg/mL, 260 mg/mL, or 210 mg/mL, respectively.
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Contraindications
Hypersensitivity to capreomycin.
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Special Precautions
Patient with pre-existing auditory impairment; history of allergy (particularly to other drugs). Renal impairment. Elderly. Pregnancy and lactation.
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Adverse Reactions
Significant: Hypokalaemia, hypocalcaemia, hypomagnesaemia, ototoxicity, nephrotoxicity (e.g. tubular necrosis, increased BUN or serum creatinine, abnormal urinary sediment); fungal or bacterial superinfection including Clostridioides difficile-associated diarrhoea and pseudomembranous colitis (prolonged use).
Blood and lymphatic system disorders: Leucocytosis, leucopenia, eosinophilia. Rarely, thrombocytopenia. Ear and labyrinth disorders: Tinnitus, vertigo. General disorders and administration site conditions: Pain, induration, excessive bleeding and sterile abscess at the inj site. Investigations: Abnormal LFT results. Immune system disorders: Hypersensitivity reactions (e.g. urticaria and maculopapular rash associated in some cases with fever). |
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IM/IV/Parenteral: C
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Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor auditory, vestibular and renal function at baseline and regularly during therapy. Assess serum electrolytes (e.g. Ca, Mg, K) at baseline and frequently during treatment, and LFTs periodically.
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Overdosage
Symptoms: Hypokalaemia, hypomagnesaemia, hypocalcaemia, electrolyte disturbance resembling Bartter's syndrome; nephrotoxicity (e.g. acute tubular necrosis), ototoxicity (e.g. dizziness, tinnitus, vertigo, loss of high-tone acuity). Management: Symptomatic and supportive treatment. May administer activated charcoal to reduce absorption. Ensure hydration in patients with normal renal function to maintain adequate urine output. Monitor fluid balance, electrolytes, and CrCl. Haemodialysis may be considered in patients with significant renal disease.
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Drug Interactions
Increased risk of nephrotoxicity and ototoxicity with other parenteral antituberculosis drugs (e.g. streptomycin, viomycin) or other drugs with ototoxic or nephrotoxic potential (e.g. colistin, polymyxin B, amikacin, gentamicin, tobramycin, kanamycin, neomycin, vancomycin).
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Action
Description:
Mechanism of Action: Capreomycin is a cyclic polypeptide antibiotic. Its mechanism of action is not fully understood; however, it demonstrates activity against strains of Mycobacterium tuberculosis and is reserved as a 2nd-line antimycobacterial agent. Pharmacokinetics: Absorption: Time to peak plasma concentration: 1-2 hours. Excretion: Via urine (approx 50% as unchanged drug). Elimination half-life: Approx 5.2-6.8 hours. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 3000502, Capreomycin. https://pubchem.ncbi.nlm.nih.gov/compound/Capreomycin. Accessed May 30, 2023. |
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Storage
Store intact vials between 20-25°C. Reconstituted solution: Store below 25°C for up to 24 hours.
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MIMS Class
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ATC Classification
J04AB30 - capreomycin ; Belongs to the class of antibiotics. Used in the systemic treatment of tuberculosis.
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References
Anon. Capreomycin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/05/2023. Buckingham R (ed). Capreomycin Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/05/2023. Capreomycin Injection (Neon Healthcare Limited). MHRA. https://products.mhra.gov.uk. Accessed 02/05/2023. Capreomycin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 24/05/2023. Joint Formulary Committee. Capreomycin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/05/2023.
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