Capreomycin (Injection)

As an antibiotic, capreomycin is administered by direct injection to a vein or muscle to combat drug-resistant strains of TB (tuberculosis).

Overview

Capreomycin is an antibiotic which is active against human strains of mycobacterium TB. It is typically used concomitantly with other anti-tuberculosis against to treat various infections caused by TB when primary agents have proved ineffective or cannot be used in the patient due to allergy or the presence of resistant tuberculosis bacilli.

This medication was initially discovered from the streptomyces capreolus actinobacteria in 1960, receiving approval in 1968. Since 1979, it has been used as an anti-tuberculosis agent. It is currently listed as an essential medicine by the World Health Organization, meaning it is regarded as one of the safest and most effective medications required by any health system. It functions by inhibiting the growth of mycobacterium tuberculosis.

Conditions treated

Type of medicine

  • ¬†Antibiotic

Side effects

Along with the desired effects, intravenously-administered Capreomycin can also cause a number of unwanted side effects. The most common side effects reported by patients undergoing treatment with this medicine include: black tarry stools, loss of balance, bloody urine, hearing loss, chest pain, vomiting, nausea, ringing or buzzing in the ears, chills, coughing, sore throat, difficulty breathing, drowsiness, dizziness, swelling of the legs or feet, swollen glands, difficulty hearing, an increase in thirst, loss of appetite, and/or a feeling of fullness within the ears.

As the patient continues to be administered with the drug as prescribed by a doctor and overseen by a team of healthcare professionals in a clinical setting, these symptoms should dissipate. If any of these side effects persist over time or get worse during the course of treatment, the patient is advised to follow this up with their healthcare provider immediately. In many instances, a doctor will be able to advise on ways to alleviate symptoms of mild discomfort such as a dry mouth/increase in thirst by suggesting the patient increases their water intake.

The majority of patients only experience minimal side effects while undergoing treatment with Capreomycin, if they experience any effects whatsoever. Most doctors agree that the benefits of this medicine in fighting drug-resistant tuberculosis outweigh the negative side effects.

Other side effects experienced rarely (albeit often enough to warrant mentioning) by patients undergoing treatment with an intravenous Capreomycin solution include: bleeding gums, pinprick spots on the skin, confusion, convulsions, a decrease in the amount of urine passed, irregular heartbeats, muscle spasms and twitching, tremors, a spinning sensation and/or a continuous ringing or tinnitus-like buzzing in the ears. These side effects should also lessen as treatment continues, although the patient may also wish to raise issues with their doctor should they experience a state of discomfort due to one or more of these rare side effects.

Because Capreomycin can potentially cause confusion or light-headedness, patients are advised against driving or operating heavy machinery until it has been observed that they are competent to do so. Usually, patients will receive intravenous Capreomycin in a clinical setting and are likely to have concluded treatment with the medicine prior to being discharged and in a position to drive, although care should be taken when driving as a general precaution post-treatment.

Dosage

As with all medicines, it is imperative that patients are administered intravenous Capreomycin only as prescribed by a physician. This means that patients should not receive any more of this medication than advised, either in terms of frequency or dosage size. In addition to this, patients should not be administered with the medication if their doctor or healthcare professional has advised that treatment should cease - even if a supply of the medication remains.

The standard adult dose for tuberculosis, as recommended by the manufacturer, is 10mg/kg (up to 1g) via intramuscular or intravenous injection, once every 24 hours. This treatment is usually continued for 5 days per week until the patient has responded positively.

Children may require a higher dose if their immune system is not adequately developed. Therefore, the recommended pediatric dose of Capreomycin in the treatment of tuberculosis is 15 to 30mg/kg (up to 1g) via intramuscular or intravenous injection in 1 or 2 divided doses over 5 to 7 days per week until the patient responds positively.

Although most patients will receive Capreomycin in a clinical setting, some may be shown how to use injections at home. Patients should only self-administer this medicine if they understand how to give the injection and properly understand how to dispose of used needles, IV tubing and other paraphernalia used to facilitate injection of the medicine.

Dose adjustments are necessary for those with renal conditions. Those currently suffering from kidney problems should have doses adjusted based on creatinine clearance levels:

  • If CrCl is equal to or less than 80mL/min, patient should receive 10.4mg/kg per 24 hours
  • If CrCl is equal to or less than 60mL/min, patient should receive 8.16mg/kg per 24 hours
  • If CrCl is equal to or less than 50mL/min, patient should receive 7.01 mg/kg per 24 hours
  • If CrCl is equal to or less than 40mL/min, patient should receive 5.87mg/kg per 24 hours
  • If CrCl is equal to or less than 30mL/min, patient should receive 4.72mg/kg per 24 hours
  • If CrCl is equal to or less than 20mL/min, patient should receive 3.58mg/kg per 24 hours
  • If CrCl is equal to or less than 10mL/min, patient should receive 2.43mg/kg per 24 hours

Interactions

All drugs have the potential to interact with other chemicals or medications within the human body, and these interactions can affect the efficacy of a drug leading to it becoming ineffective in the treatment of a condition. In some instances, interactions can cause potentially serious side effects to arise. Because of this, patients are implored to keep a full and detailed list of all medications they are currently taking, including dose size and frequency of administration. This extends to complementary medicines, vitamins, herbal supplements and over the counter treatments.

Below is a partial list of medications known to majorly interact with Capreomycin. Patients who are currently undergoing treatment with any of these medicines should notify their doctor prior to receiving their first intravenous or intramuscular dose of Capreomycin:

  • Adefovir
  • Amikacin
  • Amikin
  • Arsenic trioxide
  • Amiodarone
  • Bivigam
  • BCG
  • Cidofovir
  • Live cholera vaccine
  • Cidomycin
  • Diatrizoate
  • Deferasirox
  • Dronedarone
  • Droperidol
  • Dofellitide
  • Gentamicin
  • Tacrolimus
  • Iodamide
  • Iodixanol
  • Ioxilan
  • Ioversol
  • Iopromide
  • Kanamycin
  • Metrizamide
  • Pizomide
  • Sirolimus
  • Tobramycin
  • Ziprasidone

Warnings

The administration of Capreomycin in patients with auditory impairment should be taken with extreme caution. This is because there is a risk of eighth cranial nerve impairment associated with the use of this medication.

Capreomycin should be used in conjunction with reasonable doses of other anti-TB medications. The use of this medication on its own can allow for the rapid onset of development of TB strains which are resistant to Capreomycin.

This medication is potentially ototoxic. Before treatment, the vestibular function and audiometry of the patient should be assessed. These tests should be taken again at regular intervals during treatment with Capreomycin.

Because tuberculosis is often treated over 12 to 24 months, patients should be prepared to take Capreomycin on a regular schedule for a prolonged period of time. Patients should not alter doses or administration schedules without the advice or a doctor or qualified healthcare professional.

Patients who require surgery may need to cease treatment with Capreomycin for a short period of time. This gap in treatment should be discussed with a healthcare professional to avoid a relapse of tuberculosis.

Storage

Capreomycin vials should be stored at room temperature, out of the reach of children and pets. The manufacturer recommends that it is kept away from moisture. It is therefore unsuitable for storage in the bathroom.

Self-administering patients are advised to check Capreomycin vials for particles or changes in color prior to injection. If the medicine has particles floating in it or is discolored in any way, it may no longer be effective. In this instance, the patient should contact their pharmacist to obtain new vials of the medication.

Disposable needles should be discarded via a puncture-proof bin known as a sharps container. Sharps containers can be exchanged at local pharmacies, who will dispose of the needles in a safe and hygienic manner.

Summary

When administered intramuscularly or intravenously, Capreomycin is an effective antibiotic in the treatment of tuberculosis, particularly when strains of the disease are otherwise resistant to oral antibiotics.

Patients who are self-administering intravenous Capreomycin outside of a clinical setting should take great care to ensure that they understand how to safely and effectively inject a medication. When administered incorrectly, patients leave themselves at risk of infection or damaged muscle tissue.

To get the most out of this medicine, doctor and patient should work together to ensure the potential for negative interactions to take place is eliminated. Symptoms may improve before tuberculosis infection is completely cleared, and patients are therefore advised to complete the course of treatment with Capreomycin even if they feel over the worst of the illness.

Resources
Last Reviewed:
December 22, 2017
Last Updated:
April 04, 2018
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