Capreomycin Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Tuberculosis - Active

10 to 15 mg/kg (up to 1 g) IM or IV once every 24 hours or 5 days a week.

Usual Pediatric Dose for Tuberculosis - Active

15 to 30 mg/kg (up to 1 g) IM or IV 5 to 7 days per week, in 1 or 2 divided doses.

Renal Dose Adjustments

Manufacturer recommendation:
Maintenance of a steady-state plasma level of 10 mcg/mL is recommended.
CrCl less than or equal to 80 mL/min: 10.4 mg/kg every 24 hours
CrCl less than or equal to 60 mL/min: 8.16 mg/kg every 24 hours
CrCl less than or equal to 50 mL/min: 7.01 mg/kg every 24 hours or 14 mg/kg every 48 hours
CrCl less than or equal to 40 mL/min: 5.87 mg/kg every 24 hours or 11.7 mg/kg every 48 hours
CrCl less than or equal to 30 mL/min: 4.72 mg/kg every 24 hours or 9.45 mg/kg every 48 hours or 14.2 mg/kg every 72 hours
CrCl less than or equal to 20 mL/min: 3.58 mg/kg every 24 hours or 7.16 mg/kg every 48 hours or 10.7 mg/kg every 72 hours
CrCl less than or equal to 10 mL/min: 2.43 mg/kg every 24 hours or 4.87 mg/kg every 48 hours or 7.3 mg/kg every 72 hours
CrCl = 0: 1.29 mg/kg every 24 hours or 2.58 mg/kg every 48 hours or 3.87 mg/kg every 72 hours

CDC, Infectious Diseases Society of America, American Thoracic Society recommendation:
CrCl less than 30 mL/min: 12 to 15 mg/kg 2 to 3 times a week.

Liver Dose Adjustments

No adjustment recommended.

Dose Adjustments

Elderly patients: 10 mg/kg (up to 750 mg) IM or IV 5 to 7 days per week.

Precautions

Extreme caution is recommended in patients with auditory or renal impairment. The risk of additional eighth cranial nerve or renal toxicity should be weighed against the benefits.

Audiometric and vestibular function should be assessed before starting therapy and regularly during treatment.

Renal injury with tubular necrosis, BUN or creatinine elevations, abnormal urinary sediment, and urinary casts, red cells, and white cells has been reported. Dosage reductions or discontinuation are recommended in patients with renal dysfunction or if BUN rises above 30 mg/dL. The clinical significance of abnormal urine sediment and slight elevation in the BUN (or serum creatinine) observed during long-term therapy with capreomycin has not been established. Renal function should be monitored before starting treatment and weekly thereafter.

Large intravenous doses of capreomycin may cause partial neuromuscular blockade.
Since hypokalemia, hypomagnesemia and hypocalcemia may occur during therapy, these serum electrolyte levels should monitored frequently.
Due to rapid development of resistance, capreomycin should not be used alone for the treatment of tuberculosis. It should be given in combination with other drugs to which the organism is susceptible.

Patient compliance is essential to the success of the antituberculosis regimen and to prevent development of resistant organisms. Patients should closely adhere to the drug regimen for the full duration of treatment. Directly-observed treatment (DOT) is recommended for all antituberculosis therapy.

Cautious dosing and close monitoring of elderly patients is recommended since they are more likely to have decreased renal function, hearing impairment, and a greater risk of toxicity.

Safety and effectiveness in pediatric patients have not been determined.

Dialysis

Capreomycin is removed by hemodialysis. The dose should be administered after a dialysis session.

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