DrugindexOnline^{2nd edition}

Pronouncation: (CAP-ree-oh-MY-sin)
Class: Antituberculosis agent

Trade Names:
Capastat Sulfate
- Powder for injection 1 g (as sulfate)/vial

Mechanism of Action

Pharmacology

Interferes with protein synthesis.

Pharmacokinetics

Absorption

The T _max is 1 to 2 h following IM administration.

Elimination

Approximately 52% of capreomycin is excreted unchanged in the urine within 12 h.

Indications and Usage

Treatment of tuberculosis concomitantly with other antituberculous agents.

Contraindications

Standard considerations.

Dosage and Administration

Adults

IV/IM 1 g/day (max, 20 mg/kg/day) for 60 to 120 days, followed by 1 g IV or IM 2 or 3 times weekly.

General Advice

• Reconstitute following manufacturer's instructions.
• Inspect reconstituted solution visually before administration. Do not administer if solution is cloudy, discolored, or contains particulate matter. Reconstituted solution may acquire a pale straw color and darken with time, but this is not associated with loss of potency.
• For IM administration, give reconstituted capreomycin by deep IM injection into large muscle mass.
• For IV infusion, dilute reconstituted capreomycin in 100 mL of sodium chloride 0.9% injection and infuse prescribed dose over 60 min.
• Do not add other medications to IV container.

Storage/Stability

Store powder for injection at controlled room temperature (59° to 86°F). Reconstituted solution may be stored for up to 24 h in refrigerator (36° to 46°F).

Drug Interactions

Aminoglycosides (eg, streptomycin)

May increase the risk of respiratory paralysis and renal function impairment.

Nondepolarizing neuromuscular blocking agents (eg, tubocurarine)

Neuromuscular blockade may be enhanced.

Laboratory Test Interactions

None well documented.

Adverse Reactions

EENT

Ototoxicity; hearing loss.

Genitourinary

Nephrotoxicity.

Hematologic

Leukocytosis; leukopenia; eosinophilia; thrombocytopenia.

Hepatic

Decreased bromosulfophthalein excretion; abnormal liver function tests.

Miscellaneous

Hypersensitivity (including febrile reactions, urticaria, maculopapular rash); pain; induration and excessive bleeding at injection site; sterile abscesses.

Precautions

Monitor IM injection sites Assess IM injection sites for pain, bleeding, induration, or evidence of abscess formation. Inform health care provider if noted and significant. Mycobacterial studies/Susceptibility tests Assess mycobacterial studies and susceptibility tests before and periodically throughout therapy to detect possible resistance.

Pregnancy

Category C.

Lactation

Undetermined.

Children

Safety and efficacy not established.

Renal Function

Dosage reduction is necessary.

Special Risk Patients

Use with great caution in patients with preexisting renal insufficiency or auditory impairment.

Hypokalemia

May occur during therapy.

Nephrotoxicity

Renal injury with tubular necrosis, elevation of BUN or serum creatinine, and abnormal urinary sediment may occur.

Ototoxicity

May occur; perform audiometric measurements and assess vestibular function prior to therapy and at regular intervals during treatment.

Patient Information

• Advise patient that medication will be prepared and administered by a health care provider in a health care setting.
• Review dosing schedule and prescribed length of therapy with patient. Emphasize to patient that treatment will be lengthy.
• Instruct patient to report the following symptoms to health care provider: ringing in the ears, vertigo (feeling of whirling motion), dizziness, hearing loss, itching, rash, pain, lumps, bleeding at injection site.