Capreomycin

What is Capreomycin?

• Capreomycin (Capastat) is a polypeptide antibiotic isolated from Streptomyces capreolus.

Capreomycin

Capreomycin ball-and-stick

What are the uses of this medicine?

• Capreomycin (Capastat) is used concomitantly with other antituberculosis agents, in pulmonary infections caused by capreomycin susceptible strains of M. tuberculosis when the primary agents (isoniazid, rifampin, ethambutol, aminosalicylic acid, and streptomycin) have been ineffective.

How does this medicine work?

• Capreomycin (kap" ree oh mye' sin) is a cyclic peptide antibiotic that was initially isolated from the bacterium, Streptomyces capreolus.
• Capreomycin is believed to act by binding to bacterial ribosomes and inhibiting protein synthesis.
• Capreomycin is similar to viomycin and is considered bacterostatic rather than bacterocidal.
• While structurally different, capreomycin has similar antibacterial activity and side effects to the aminoglycosides (streptomycin, kanamycin, amikacin).
• Capreomycin is currently used only as a secondary agent in the treatment of active tuberculosis, always in combination with other antituberculosis agents such as isoniazid, ethambutol, pyrazinamide and/or rifampin (but not streptomycin or the aminoglycosides) and usually for multidrug resistant mycobacterial infections.

Who Should Not Use this medicine ?

This medicine have cannot be used in patients:

• who are hypersensitive to capreomycin.

What drug interactions can this medicine cause?

• Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

Is this medicine FDA approved?

• Capreomycin was approved for use in the United States in 1973, but is currently rarely used, streptomycin or a modern aminoglycoside being used in its place.
• Capreomycin is available in vials for intramuscular or intravenous injection under the trade name of Capastat.

How should this medicine be used?

Recommended dosage:

• Capreomycin is always administered in combination with at least 1 other antituberculosis agent to which the patient's strain of tubercle bacilli is susceptible. The usual dose is 1 g daily (not to exceed 20 mg/kg/day) given intramuscularly or intravenously for 60 to 120 days, followed by 1 g by either route 2 or 3 times weekly.
• Therapy for tuberculosis should be maintained for 12 to 24 months.

Administration:

• Capastat Sulfate may be administered intramuscularly or intravenously following reconstitution.
• Intravenously — For intravenous infusion, reconstituted Capastat Sulfate should be diluted in 100 mL of 0.9% Sodium Chloride Injection and administered over 60 minutes.
• Intramuscularly — Reconstituted Capastat Sulfate should be given by deep intramuscular injection into a large muscle mass, since superficial injection may be associated with increased pain and the development of sterile
• abscesses.
• Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As ,Capreomycin for Injection

This medicine is available in fallowing brand namesː

• Capastat

What side effects can this medication cause?

The most common side effects of this medicine include:

• tinnitus, hearing loss, proteinuria and renal dysfunction, and local injection reactions

The most serious adverse reactions may include:

• Nephrotoxicity
• Ototoxicity
• Abnormal results in liver function tests
• Leukocytosis and leukopenia
• Excessive bleeding at the injection site
• Hypersensitivity

What special precautions should I follow?

• Audiometric measurements and assessment of vestibular function should be performed prior to initiation of therapy with Capastat Sulfate and at regular intervals during treatment.
• Renal injury, with tubular necrosis, elevation of the blood urea nitrogen (BUN) or serum creatinine, and abnormal urinary sediment, has been noted.
• The peripheral neuromuscular blocking action that has been attributed to other polypeptide antibiotics (colistin sulfate, polymyxin A sulfate, paromomycin, and viomycin) and to aminoglycoside antibiotics (streptomycin, dihydrostreptomycin, neomycin, and kanamycin) has been studied with Capastat Sulfate.
• Caution should be exercised in the administration of antibiotics, including Capastat Sulfate, to any patient who has demonstrated some form of allergy, particularly to drugs.
• Regular tests of renal function should be made throughout the period of treatment, and reduced dosage should be employed in patients with known or suspected renal impairment. Renal function studies should be made both before therapy with Capastat Sulfate is started and on a weekly basis during treatment.
• Since hypokalemia, hypomagnesemia and hypocalcemia may occur during therapy, these serum electrolyte levels should be determined frequently.
• It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Capastat Sulfate is administered to a nursing woman.
• Capreomycin has not been linked to cases of clinically apparent liver disease.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• Nephrotoxicity
• dizziness
• tinnitus
• vertigo
• loss of high-tone acuity
• Neuromuscular blockage or respiratory paralysis
• Hypokalemia
• hypocalcemia
• hypomagnesemia
• electrolyte disturbance

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.
• Protect the patient's airway and support ventilation and perfusion.
• Monitor and maintain, within acceptable limits, the patient's vital signs, blood gases, serum electrolytes, etc.
• Absorption of drugs from the gastrointestinal tract may be decreased by giving activated charcoal, which, in many cases, is more effective than emesis or lavage; consider charcoal instead of or in addition to gastric emptying.
• Repeated doses of charcoal over time may hasten elimination of some drugs that have been absorbed.
• Safeguard the patient's airway when employing gastric emptying or charcoal.
• Patients who have received an overdose of capreomycin and have normal renal function should be carefully hydrated to maintain a urine output of 3 to 5 mL/kg/h.
• Fluid balance, electrolytes, and creatinine clearance should be carefully monitored.
• Hemodialysis may be effectively used to remove capreomycin in patients with significant renal disease.

Can this medicine be used in pregnancy?

• Pregnancy Category C.
• Capastat Sulfate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Can this medicine be used in children?

• Safety and effectiveness in pediatric patients have not been established.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• capreomycin

Inactive ingredients:

Who manufactures and distributes this medicine?

Manufactured by:

• Akorn, Inc.
• Lake Forest, IL

What should I know about storage and disposal of this medication?

• Store at controlled room temperature 15° to 30°C (59° to 86°F) prior to reconstitution.

The following are list of antituberculosis medications that are discussed individually:

• Bedaquiline
• Capreomycin
• Cycloserine
• Ethambutol
• Ethionamide
• Isoniazid
• Pyrazinamide
• Rifabutin
• Rifampin
• Rifapentine
• Streptomycin

• Dailymed label info on Capreomycin
• FDA Capreomycin

Capreomycin Resources
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