CAPREOMYCIN SULFATE

CAPREOMYCIN SULFATE
(kap-ree-oh-mye'sin)
Capastat Sulfate
Classifications: antibiotic; antituberculosis agent;
Therapeutic: antituberculosis
Prototype: Isoniazid
Pregnancy Category: C

Availability

1 g powder for injection

Action

Polypeptide antibiotic. Action mechanism not clear, but it is bacteriostatic.

Therapeutic Effect

Bacteriostatic against human strains of Mycobacterium tuberculosis and other species of Mycobacterium. Effective second-line antimycobacterial in conjunction with other antitubercular drugs.

Uses

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.

Contraindications

In lactation. Safe use in infants and children <2 y is not established.

Cautious Use

Renal insufficiency (extreme caution); acoustic nerve impairment; history of allergies (especially to drugs); preexisting liver disease; myasthenia gravis; parkinsonism; pregnancy (category C).

Route & Dosage

Tuberculosis
Adult: IM/IV 1 g/d (not to exceed 20 mg/kg/d) for 60–120 d, then 1 g 2–3 times/wk. See prescribing information for dose adjustments for renal insufficiency.

Renal Impairment
Cl_cr 25–50 mL/min: reduce dose by 50%; 10–24 mL/min: reduce dose by 50% and give q48h; <10 mL/min: reduce dose by 50% and give twice weekly

Administration

Intramuscular

Reconstitute by adding 2 mL of NS injection or sterile water for injection to each 1 g vial. Allow 2–3 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 directed.

Intravenous

PREPARE: IV Infusion: Reconstitute by adding 2 mL of NS or sterile water to each 1 g to yield 370 mg/mL. Allow 2–3 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.

Interactions

Drug: Increased risk of nephrotoxicity and ototoxicity with aminoglycosides, amphotericin B, colistin, polymyxin B, cisplatin, vancomycin.

Pharmacokinetics

Peak: 1–2 h. Distribution: Does not cross blood–brain barrier; crosses placenta. Elimination: 52% in urine unchanged in 12 h; small amount in bile. Half-Life: 4–6 h.

Nursing Implications

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 closely.
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: 10–20 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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