capreomycin (Rx)

Brand and Other Names:Capastat

Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and capreomycin

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            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.

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              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

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              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
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              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.

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              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

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              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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              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.