Dosing & Uses
Dosage Forms & Strengths
powder for injection
- 1g/vial
Tuberculosis
Indicated in pulmonary infections caused by capreomycin-susceptible strains of M. tuberculosis (TB) when primary agents (isoniazid, rifampin, ethambutol, aminosalicylic acid, and streptomycin) have been ineffective or cannot be used because of toxicity or presence of resistant tubercle bacilli
1 g IM/IV qDay (not to exceed 20 mg/kg/day) x 60-120 days
Maintenance dose: 1 g IM/IV 2-3 times/week; maintain therapy for TB for 12-24 months; not to exceed 20 mg/kg/day
Dosing Considerations
Perform susceptibility studies to determine the presence of capreomycin-susceptible strain of M. tuberculosis
Dosage Forms & Strengths
powder for injection
- 1g/vial
Tuberculosis (Off-label)
Per CTC/IDSA/ATS/AAP recommendation
<15 years old and <40 kg: 15-30 mg/kg IV/IM qDay; maximum 1 g/day for 2-4 months followed by 15-30 mg/kg given twice weekly; maximum 1 g/day
>15 years old and >40 kg: 15 mg/kg IV/IM; maximum 1 g/day for 2-4 months followed by 15 mg/kg 2-3 times/week; maximum 1 g/dose
Always used in conjunction with other antitubercular agents
Monitor: Renal function qWeek, serum potassium
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (12)
- amphotericin B deoxycholate
amphotericin B deoxycholate and capreomycin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- atracurium
capreomycin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- cidofovir
capreomycin and cidofovir both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- cisatracurium
capreomycin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- neomycin PO
capreomycin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- onabotulinumtoxinA
capreomycin increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- pancuronium
capreomycin increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- rapacuronium
capreomycin increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- rimabotulinumtoxinB
capreomycin increases effects of rimabotulinumtoxinB by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.
- rocuronium
capreomycin increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- succinylcholine
capreomycin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
- vecuronium
capreomycin increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of respiratory depression.
Monitor Closely (24)
- acyclovir
acyclovir and capreomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- adefovir
adefovir and capreomycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- amikacin
amikacin and capreomycin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- carboplatin
capreomycin and carboplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cephaloridine
capreomycin and cephaloridine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cisplatin
capreomycin and cisplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- colistin
capreomycin and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- contrast media (iodinated)
capreomycin and contrast media (iodinated) both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- cyclosporine
capreomycin and cyclosporine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- dichlorphenamide
dichlorphenamide and capreomycin both decrease serum potassium. Use Caution/Monitor.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
capreomycin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- gentamicin
capreomycin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- ifosfamide
ifosfamide, capreomycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Monitor renal function.
- incobotulinumtoxinA
capreomycin increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.
- ioversol
capreomycin and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- oxaliplatin
capreomycin and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- polymyxin B
capreomycin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
capreomycin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- streptozocin
capreomycin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tacrolimus
capreomycin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- teicoplanin
capreomycin and teicoplanin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- tenofovir DF
capreomycin and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tobramycin
capreomycin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- voclosporin
voclosporin, capreomycin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
Minor (6)
- foscarnet
capreomycin and foscarnet both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- methoxyflurane
capreomycin and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- paromomycin
capreomycin and paromomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- pentamidine
capreomycin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- streptomycin
capreomycin and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- vancomycin
capreomycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
Adverse Effects
>10%
Nephrotoxicity, incr BUN (36%)
Hearing loss (11% subclinical; 3% clinical)
1-10%
Eosinophilia (dose related, >5%)
<1%
Incr LFTs
Inj site pain/induration
Leukopenia
Maculopapular rash
Urticaria
Warnings
Black Box Warnings
Use of capreomycin have been associated with worse clinical outcomes (ie, decreased effectiveness, increased mortality) compared to other parenteral therapy for pulmonary multidrug-resistant tuberculosis (MDR-TB)
Reserve capreomycin for patients with MDR-TB resistant to IV aminoglycosides and have limited treatment options
Caution in patients with renal or preexisting auditory impairment; weigh risk of additional impairment of cranial nerve VIII and/or kidneys against benefits from therapy
Concomitant use of capreomycin and other IV antituberculosis agents (streptomycin, viomycin) are not recommended
Use extreme caution if administered with other ototoxic or nephrotoxic drugs (polymyxin A sulfate, colistin sulfate, amikacin, gentamicin, tobramycin, vancomycin, kanamycin, and neomycin)
Contraindications
Hypersensitivity
Pregnancy
Cautions
Caution in renal impairment and history of allergic reactions
Risk of hypokalemia
Risk of rare but potentially fatal toxic nephritis
May be associated with worse clinical outcomes, ie, decreased effectiveness and increased mortality, compared with other parenteral therapy for pulmonary MDR-TB
Audiometric measurements and assessment of vestibular function should be performed prior to initiation of therapy and at regular intervals during treatment
Peripheral neuromuscular blocking action attributed to other polypeptide antibiotics (colistin sulfate, polymyxin A sulfate, paromomycin, and viomycin) and to aminoglycoside antibiotics (streptomycin, dihydrostreptomycin, neomycin, and kanamycin) studied; a partial neuromuscular blockade was demonstrated after large intravenous doses of this drug; action was enhanced by ether anesthesia (as has been reported for neomycin) and antagonized by neostigmine
Renal injury
- Renal injury, with tubular necrosis, elevation of blood urea nitrogen (BUN) or serum creatinine, andabnormal urinary sediment, noted; slight elevation of BUN and serum creatinine observed in a significant number of patients receiving prolonged therapy
- The appearance of casts, red cells, andwhite cells in the urine has been noted in a high percentage of cases; elevation of BUN above 30mg/100 mL or any other evidence of decreasing renal function with or without a rise in BUN levels calls forcareful evaluation of patient, and dosage should be reduced or drug completely withdrawn
- The clinical significance of abnormal urine sediment and slight elevation in the BUN (or serum creatinine) observed during long-term therapy has not been established
Pregnancy & Lactation
Pregnancy
Safety in pregnancy not determined; there are no adequate and well-controlled studies in pregnant women; therapy has been shown to be teratogenic in rats when given in doses 3 1/2 times human dose;. This drug should be used during pregnancy only if potential benefit justifies potential risk to fetus
Lactation
Not known whether this drug is excreted in human milk; because many drugs are excreted in human milk, caution should be exercised when this drug is administered to a nursing woman
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Half-life: 4-6 hr, prolonged in renal impairment
Peak Plasma Time: 1-2 hr
Excretion: urine
Mechanism of Action
Polypeptide antibiotic complex of 4 microbiologically active components, bacteriostatic
Administration
Preparation
Doses ≥1 gram: Reconstitution achieved by dissolving vial contents (1 gram) in 2 mL of 0.9% NaCl (NS) or sterile water for injection (SW)
Doses <1 gram
- Desired concentration 370 mg/mL: Dilute with 2.15 mL of NS or SW
- Desired concentration 315 mg/mL: Dilute with 2.63 mL of NS or SW
- Desired concentration 260 mg/mL: Dilute with 3.3 mL of NS or SW
- Desired concentration 210 mg/mL: Dilute with 4.3 mL of NS or SW
Allow powder to dissolve completely within 2-3 minutes
Solution may acquire a pale straw color and darken with time, but not associated with loss of potency or the development of toxicity
After reconstituting, may refrigerate for up to 24 hr
IV preparation
Dilute reconstituted solution in 100 mL 0.9% NaCl
lM Administration
Administer by deep IM injection into a large muscle mass, since superficial injection may be associated with increased pain and may develop sterile abscesses
IV Administration
Infuse IV over 60 min
Storage
Unopened vials: Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59- 86ºF)
Reconstituted solution: Refrigerate at 2-8ºC for up to 24 hr; discard unused portion
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