Capreomycin

Registered South African indications:

• Tuberculosis

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Pre-existing auditory impairment 
• Hypokalaemia 

Forms avail. in SA and covered in this monograph: inj

Tuberculosis (additional agents required)
- When primary agents are ineffective due to toxicity or resistance

• IM: Initial: 750-1000mg/day for 2-4 months; Maintenance: 1000mg, 2-3 times per week; Max: 20mg/kg/24hrs

Reconstitute with 2ml of 0.9% sodium chloride or water for injection. Allow to dissolve for 2-3ming prior to administration

Not established for use in children

Decisions related to dose adjustment/discontinuing TB regimen must be discussed in advance with Pulmonologists/Infectious Disease specialists, and cases must be dealt with individually

Pregnancy 

• Caution; not recommended
• The safety of capreomycin for use during pregnancy has not been established
• Capreomycin had been shown to be teratogenic in rats when given at 3.5 times the human dose. There are not adequate and well-controlled studies in pregnant women
• Capreomycin should be used during pregnancy only if the potential benefit justifies the potential risk to the foetus

Breastfeeding 

• Caution; not recommended
• It is not known whether capreomycin is excreted in human milk. Caution should be exercised when administering capreomycin to a nursing woman

Fertility

• Studies have not been performed to determine the potential for carcinogenicity, mutagenicity, or impairment of fertility

Renal Impairment

• Caution; dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Not yet classified (NC)

Hepatobiliary Disorders

• Abnormal hepatic function tests 

Genitourinary Disorders

• Increased serum creatinine 
• Increased blood urea 
• Abnormal urine sediment 
• Acute tubular necrosis

Endocrine and Metabolic Disorders

• Electrolyte disturbances

Skin and Subcutaneous Tissue Disorders

• Urticaria 
• Maculopapular rashes
• Sterile abscess
• Injection site reactions

Immune, Blood and Lymphatic System Disorders

• Leucocytosis 
• Leucopenia 
• Thrombocytopenia 
• Eosinophilia
• Febrile reaction

Sensory Disorders

• Tinnitus
• Vertigo
• Hearing loss

Agents with ototoxic and nephrotoxic potential

• Audiometry
• Serum electrolytes
• Renal function
• Hepatic function

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.

Injection (per vial) 1g

• Capastat (Aspen Pharmacare) originator
• Kapreon (Mylan)