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Indications and Dosage
Parenteral
Tuberculosis Adult: 1 g daily, by deep IM inj or IV infusion, for 2-4 mth, then 2-3 times wkly for the remainder of the therapy. Max: 20 mg/kg/day.
Child: 15-30 mg/kg daily. Max: 1 g/day. |
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Renal Impairment
Dose reduction needed based on CrCl.
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Reconstitution
Add 2 mL, 2.15 mL, 2.63 mL, 3.3 mL or 4.3 mL of NaCl 0.9% or sterile water for inj to the vial labelled as containing 1 g to provide soln containing approx 370 mg, 350 mg, 300 mg, 250 mg or 200 mg per mL. Allow 2-3 min for the drug to completely dissolve. For IV infusion, further dilute w/ 100 mL of NaCl 0.9% inj.
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Contraindications
Hypersensitivity to capreomycin and other aminoglycosides.
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Special Precautions
Patient w/ pre-existing auditory impairment. Renal impairment. Childn. Pregnancy and lactation.
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Adverse Reactions
Ototoxicity; hypokalaemia, hypocalcaemia, hypomagnesaemia and an electrolyte disturbance resembling Bartter's syndrome; leukocytosis, leucopenia, eosinophilia; hypersensitivity reactions (e.g. urticaria, photosensitivity, maculopapular rash) associated w/ fever; abnormal LFT results; partial neuromuscular blockade; pain, induration, excessive bleeding and sterile abscess on inj site.
Potentially Fatal: Nephrotoxicity, neuromuscular blockade or resp paralysis. |
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IM/IV/Parenteral: C
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Monitoring Parameters
Monitor auditory, vestibular and renal function at baseline and during therapy; frequent assessment of serum electrolytes (e.g. Ca, Mg, K) and liver function.
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Overdosage
Symptoms: Hypokalaemia, hypocalcaemia, hypomagnesaemia and an electrolyte disturbance resembling Bartter's syndrome; nephrotoxicity (e.g. acute tubular necrosis) and ototoxicity (e.g. dizziness, tinnitus, vertigo, loss of high-tone acuity). Management: Symptomatic and supportive treatment. May administer activated charcoal to reduce absorption.
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Drug Interactions
Additive and sometimes irreversible toxic effects w/ other parenteral anti-TB agents (e.g. streptomycin, viomycin). Increased risk of nephrotoxicity and ototoxicity w/ other non-antituberculosis drugs (e.g. polymyxin A sulfate, amikacin, gentamicin, tobramycin, vancomycin, kanamycin, neomycin).
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Action
Description: Capreomycin is a cyclic polypeptide antimicrobial. It is bacteriostatic against various Mycobacteria, particularly those that have become resistant to primary anti-TB drugs.
Pharmacokinetics: Absorption: Poorly absorbed from the GI tract. Time to peak plasma concentration: 1-2 hr (IM). Excretion: Via urine (approx 50%, as unchanged drug) by glomerular filtration w/in 12 hr. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Capreomycin, CID=135483770, https://pubchem.ncbi.nlm.nih.gov/compound/Capreomycin (accessed on Jan. 21, 2020) |
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Storage
Store between 15-30°C. Reconstituted soln: Store between 2-8°C, stable for 24 hr.
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MIMS Class
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References
Anon. Capreomycin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 16/10/2014. Buckingham R (ed). Capreomycin Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 16/10/2014. Capastat Sulfate Injection, Powder for Solution (Akorn). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 16/10/2014. McEvoy GK, Snow EK, Miller J et al (eds). Capreomycin Sulfate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 16/10/2014.
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