| CAPREOMYCIN SULFATE
Classifications: antibiotic; antituberculosis agent; Therapeutic: antituberculosis
Pregnancy Category: C
1 g powder for injection
Polypeptide antibiotic. Action mechanism not clear, but it is bacteriostatic.
Bacteriostatic against human strains of Mycobacterium tuberculosis and other species of Mycobacterium. Effective second-line antimycobacterial in conjunction with other antitubercular drugs.
Only in conjunction with other appropriate antitubercular drugs in treatment of pulmonary tuberculosis when bactericidal
agents (e.g., isoniazid and rifampin) cannot be tolerated or when causative organism has become resistant.
In lactation. Safe use in infants and children <2 y is not established.
Renal insufficiency (extreme caution); acoustic nerve impairment; history of allergies (especially to drugs); preexisting
liver disease; myasthenia gravis; parkinsonism; pregnancy (category C).
Route & Dosage
Adult: IM/IV 1 g/d (not to exceed 20 mg/kg/d) for 60120 d, then 1 g 23 times/wk. See prescribing information for dose adjustments
for renal insufficiency.
Clcr 2550 mL/min: reduce dose by 50%; 1024 mL/min: reduce dose by 50% and give q48h; <10 mL/min: reduce
dose by 50% and give twice weekly
- Reconstitute by adding 2 mL of NS injection or sterile water for injection to each 1 g vial. Allow 23 min for drug
to dissolve completely.
- Make IM injections deep into large muscle mass. Superficial injections are more painful and are associated with sterile
abscess. Rotate injection sites.
- Solution may become pale straw color and darken with time, but this does not indicate loss of potency.
- After reconstitution, solution may be stored 48 h at room temperature and up to 14 d under refrigeration unless otherwise
PREPARE: IV Infusion: Reconstitute by adding 2 mL of NS or sterile water to each 1 g to yield 370 mg/mL. Allow 23 min to dissolve, then
add required dose to 100 mL of NS.
ADMINISTER: IV Infusion: Give over 60 min. Avoid rapid infusion.
Adverse Effects (≥1%)Skin:
Urticaria, maculopapular rash, photosensitivity. Hematologic:
Leukocytosis, leukopenia, eosinophilia. CNS:
Neuromuscular blockage (large doses: skeletal muscle weakness, respiratory depression
or arrest). Urogenital:
Nephrotoxicity (long-term therapy), tubular necrosis. Special Senses: Ototoxicity,
eighth nerve (auditory and vestibular) damage. Metabolic:
Hypokalemia, and other electrolyte imbalances. Other:
Impaired hepatic function (decreased BSP excretion); IM site reactions: pain, induration, excessive bleeding, sterile abscesses.
Diagnostic Test Interference
BSP and PSP excretion tests may be decreased.
Increased risk of nephrotoxicity and ototoxicity with aminoglycosides
, amphotericin B, colistin, polymyxin B, cisplatin, vancomycin.
12 h. Distribution:
Does not cross bloodbrain barrier; crosses placenta. Elimination:
52% in urine unchanged in 12 h; small amount in bile. Half-Life:
Assessment & Drug Effects
- Observe injection sites for signs of excessive bleeding and inflammation.
- Lab tests: Perform the following as guidelines for therapy before drug is started and at regular intervals during therapy:
appropriate bacterial sensitivity tests; CBC; SMA-12 screening weekly; weekly renal function studies (BUN, NPN, creatinine
clearance, sediment); liver function tests (periodically); serum potassium levels (monthly).
- Reduce dosage of capreomycin in patients with impaired renal function, as it is cumulative. Follow renal function tests
- Monitor I&O rates and pattern: Report immediately any change in output or I&O ratio, any unusual appearance of urine, or
elevation of BUN above 30 mg/dL. (Normal BUN: 1020 mg/dL.)
- Evaluate hearing and balance by audiometric measurements (twice weekly or weekly) and tests of vestibular function (periodically).
Patient & Family Education
- Report any change in hearing or disturbance of balance. These effects are sometimes reversible if drug is withdrawn promptly
when first symptoms appear.
- Ensure that you know about adverse reactions and what to do about them. Report immediately the appearance of any unusual
symptom, regardless of how vague it may seem.