capreomycin (Rx)

Brand and Other Names:Capastat
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 1g/vial

Tuberculosis

1 g qDay (not to exceed 20 mg/kg/day), given IM or by IV infusion for 60-120 days

Maintenance dose: 1 g IM or IV infusion 2 or 3 times weekly; maintain therapy for tuberculosis for 12 to 24 months; 20 mg/kg/day maximum

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 great caution in patients with renal insufficiency and pre-existing auditory impairment. Weigh the risk of additional cranial nerve VIII impairment or renal injury against the benefits of the therapy. Simulatneous administration with parenteral nonantituberculous agents with ototoxic potential (e.g., polymixin A sulfate, colisitin sulfate, amikacin, gentamicin, tobramycin, vancompycin, kanamycin, and neomycin) is not recommended.

              Coadministration with antituberculous agents like streptomycin is also not recommended since they have similar and sometimes irreversible effects in cranial nerve VIII.

              Safety in pregnancy has not been determined.

              Effectiveness in pediatric patients has not been established.

              Contraindications

              Hypersensitivity

              Pregnancy

              Cautions

              Renal impairment, auditory impairment, history of allergic rxns

              Risk of hypokalemia

              Risk of rare but potentially fatal toxic nephritis

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: excretion in milk unknown; use with caution

              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

              IV Preparation

              Dissolve 1 g powder with 2, 2.15, 2.63, 3.3, or 4.3 mL of NS or SWI

              Allow 2-3 min to dissolve

              IV/IM Administration

              IM: deep IM into large muscle mass

              IV: dilute with 100 mL NS & infuse over 1 hr

              Storage

              Reconstituted soln may be stored at 2-8°C for 24 hr

              Darkening or pale straw color development may occur over time, does NOT indicate loss of potency

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Capastat injection
              -
              1 gram vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              capreomycin injection

              CAPREOMYCIN - INJECTION

              (KAP-ree-oh-MYE-sin)

              COMMON BRAND NAME(S): Capastat

              WARNING: Use capreomycin with extreme caution in people with hearing or kidney problems and in those using other drugs that may cause hearing or kidney problems (see Drug Interactions section).Other injectable medications used to treat tuberculosis (e.g., streptomycin) should not be used with capreomycin because they will increase the risk of hearing and kidney problems.

              USES: This medication is used with other drugs to treat tuberculosis (TB) infections. Capreomycin belongs to a class of drugs known as antibiotics. It is believed to work by preventing the growth of the bacteria that causes TB.

              HOW TO USE: This medication is given by injection into a muscle or infused into a vein over 1 hour, usually by a health care professional. It is usually given once a day for 2 to 4 months then reduced to 2 or 3 times a week depending on your condition and response to treatment, or use as directed by your doctor. Dosage is based on your medical condition, kidney function, and response to treatment.If you are using this medication at home, learn all preparation and usage instructions from your health care professional. If you have any questions about using this medication properly, ask your health care professional. Before using this product, check it visually for particles. When mixed, this medication may be nearly colorless or very pale yellow. The color may darken over time, but this does not make this medication less effective. If the liquid has particles or has changed to any other color than pale or dark yellow, do not use it.If you are giving this medication by injection into a muscle, remember to change the injection site with each dose to prevent irritation. Also, inject this medication into a large muscle such as the buttock or thigh to lessen pain from the injection.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear. Stopping the medication too early may result in a return of the infection. It may be necessary to continue treatment for TB for 1 to 2 years. If needed, your doctor may switch you to a drug for this same condition that can be taken by mouth.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use it on the same day(s) of the week or at the same time each day, depending on your doctor's instructions. If you are using this medication several times a week, it may help to mark your calendar with a reminder.Do not use more or less of this drug than prescribed or stop using it (or other TB medicines) even for a short time unless directed to do so by your doctor. Skipping or changing your dose without approval from your doctor may cause the amount of TB bacteria to increase, make the infection more difficult to treat (resistant), or worsen side effects. If TB becomes resistant to this medication, it might also become resistant to other TB medications.Learn how to store and discard needles, medical supplies, and any unused medication safely. Never reuse needles or syringes.Tell your doctor if your condition persists or worsens.

              SIDE EFFECTS: Pain, irritation, or skin hardening at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: signs of kidney problems (such as change in the amount of urine), ringing in the ears, trouble hearing, dizziness.Tell your doctor right away if any of these rare but very serious side effects occur: muscle weakness/cramps, irregular heartbeat, easy bleeding/bruising.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using capreomycin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, hearing trouble, dehydration, liver disease, a certain muscle disease (myasthenia gravis), Parkinson's disease.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Capreomycin may cause live bacterial vaccines (such as typhoid vaccine) to not work as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.Kidney function declines as you grow older. This medication is removed by the kidneys. Elderly people may be at a greater risk for side effects while using this drug.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: drugs that may harm either the kidneys or hearing (including amphotericin B, colistin, cidofovir, polymyxin, aminoglycosides such as amikacin/gentamicin/kanamycin/tobramycin), certain anesthetics.This document does not contain all possible interactions. Before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, ringing in the ears, loss of ability to hear high sounds, trouble breathing, change in the amount of urine.

              NOTES: Do not share this medication with others.If your doctor tells you that you are contagious, then you must avoid contact with others to prevent the spread of your TB infection.Laboratory and/or medical tests (e.g., TB cultures, kidney function, hearing tests, liver function, chest X-rays, potassium blood levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: It is important to get each dose as scheduled. If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. If you miss more than one dose, ask your health care professional right away for a new dosing schedule. Do not double the dose to catch up.

              STORAGE: Store unopened vials at room temperature between 59-86 degrees F (15-30 degrees C) away from light and heat. Once mixed the medication is good for 24 hours if refrigerated between 36-46 degrees F (2-8 degrees C). Discard the mixed medication if it is not used within this time. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              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.
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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.