No

Antibiotic, Miscellaneous; Antitubercular Agent

Treatment of tuberculosis in conjunction with at least one other antituberculosis agent

C

Known hypersensitivity to capreomycin sulfate

Use in patients with renal insufficiency or pre-existing auditory impairment must be undertaken with great caution, and the risk of additional eighth nerve impairment or renal injury should be weighed against the benefits to be derived from therapy. Since other parenteral antituberculous agents (eg, streptomycin) also have similar and sometimes irreversible toxic effects, particularly on eighth cranial nerve and renal function, simultaneous administration of these agents with capreomycin is not recommended. Use with nonantituberculous drugs (ie, aminoglycoside antibiotics) having ototoxic or nephrotoxic potential should be undertaken only with great caution.

>10%:

Otic: Ototoxicity [subclinical hearing loss (11%), clinical loss (3%)], tinnitus

Renal: Nephrotoxicity (36%, increased BUN)

1% to 10%: Hematologic: Eosinophilia (dose-related, mild)

<1%: Vertigo, hypokalemia, leukocytosis, thrombocytopenia (rare); pain, induration, and bleeding at injection site; hypersensitivity (urticaria, rash, fever)

Symptoms of overdose include renal failure, ototoxicity, thrombocytopenia

Treatment is supportive

Increased effect/duration of nondepolarizing neuromuscular blocking agents

Additive toxicity (nephro- and ototoxicity, respiratory paralysis): Aminoglycosides (eg, streptomycin)

Capreomycin is a cyclic polypeptide antimicrobial. It is administered as a mixture of capreomycin IA and capreomycin IB. The mechanism of action of capreomycin is not well understood. Mycobacterial species that have become resistant to other agents are usually still sensitive to the action of capreomycin. However, significant cross-resistance with viomycin, kanamycin, and neomycin occurs.

Absorption: Oral: Poor absorption necessitates parenteral administration

Half-life: Dependent upon renal function and varies with creatinine clearance; 4-6 hours

Time to peak serum concentration: I.M.: Within 1 hour

Elimination: Essentially excreted unchanged in the urine; no significant accumulation after greater than or equal to 30 day of 1 g/day dosing in patients with normal renal function

I.M.:

Adults: 15-20 mg/kg/day up to 1 g/day for 60-120 days, followed by 1 g 2-3 times/week

Dosing interval in renal impairment: Adults:

Cl_cr >100 mL/minute: Administer 13-15 mg/kg every 24 hours

Cl_cr 80-100 mL/minute: Administer 10-13 mg/kg every 24 hours

Cl_cr 60-80 mL/minute: Administer 7-10 mg/kg every 24 hours

Cl_cr 40-60 mL/minute: Administer 11-14 mg/kg every 48 hours

Cl_cr 20-40 mL/minute: Administer 10-14 mg/kg every 72 hours

Cl_cr <20 mL/minute: Administer 4-7 mg/kg every 72 hours

10 mg/mL

May cause dizziness

None reported

No information available to require special precautions

No effects or complications reported

Take as prescribed; do not discontinue without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake) to reduce incidence of nephrotoxicity. While taking this medication, routine blood tests and auditory tests will be necessary. Report any hearing loss, dizziness or vertigo, persistent nausea or vomiting, loss of appetite, or increased frequency of urination. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

The solution for injection may acquire a pale straw color and darken with time; this is not associated with a loss of potency or development of toxicity

Injection, as sulfate: 100 mg/mL (10 mL)

Davidson PT and Le HQ, "Drug Treatment of Tuberculosis - 1992," Drugs, 1992, 43(5):651-73.

"Drugs for Tuberculosis," Med Lett Drugs Ther, 1993, 35(908):99-101.

Iseman MD, "Treatment of Multidrug-Resistant Tuberculosis," N Engl J Med, 1993, 329(11):784-91.