Last Updated June 10, 2016
Polypeptide antibiotic, aminoglycoside
Capreomycin sulphate 1,000,000 units/vial (equivalent to 1 g capreomycin activity), to be reconstituted for intramuscular or intravenous injection
Indication: treatment of active tuberculosis resistant to first-line agents, when administered in combination with at least 1 or 2 other drugs to which the organism is known to be susceptible.
Mechanism of action: inhibits protein synthesis, likely through interaction with ribosomal subunits.
Pharmacokinetics: not well absorbed from gastrointestinal tract; after intramuscular administration: Cmax 20-47 μg/mL, Tmax 1-2 hrs, half-life 12 hrs; Cmax 30 ± 47% higher after intravenous administration; AUC similar. Minimal metabolism.
Use in Renal or Hepatic Insufficiency:
Use in Pregnancy and Breastfeeding: Pregnancy Category C. Teratogenicity in animals has been reported. Excretion into breast milk unknown. Risk of congenital deafness if used in pregnancy.*
Use in Children: 15-20 mg/kg/day, maximum 1 g/day
Contraindicated in patients with hypersensitivity to capreomycin.
Caution should be used in those with renal insufficiency or preexisting auditory impairment; risk of cranial nerve VIII impairment or renal injury should be weighed against potential benefit of treatment.
Use limited by renal toxicity; monthly creatinine and electrolyte monitoring recommended.
Concomitant administration of other parental antituberculosis agents or non-antituberculosis drugs with potential ototoxic or nephrotoxic effects not recommended.
Perform audiometry at baseline, monthly during the injectable phase, and 3 months after cessation of the injectable.*
Use alone or failure to complete full treatment regimen may result in rapid development of resistance.
Contraindicated: other aminoglycosides (streptomycin, kanamycin, amikacin) due to cumulative toxicity; other antituberculosis agents or non-antituberculosis drugs with potential ototoxic or nephrotoxic effects.
Frequent monitoring of renal function recommended in high-risk patients such as HIV-infected patients with extremely drug-resistant tuberculosis and documented acute renal failure.
Nephrotoxicity; electrolyte disturbances including hypokalaemia, hypomagnesaemia, hypocalcaemia; ototoxicity; hypersensitivity reactions including urticaria, maculopapular rash, fever; neuromuscular blockade with high doses or rapid infusions; haematological: leucopenia, leucocytosis, eosinophilia; liver function abnormalities when used with other tuberculosis drugs; local pain when given intramuscularly.
*Information from Aurum Institute Drugs on the Go.
†Information from US Prescribing Information.