Capreomycin Disease Interactions

Capreomycin is potentially ototoxic, both to vestibular and to auditory functions. The risk is greatest in patients receiving large doses for prolonged periods of time. Its use in patients with preexisting auditory impairment must be undertaken with great caution, and the risk of additional cranial nerve VIII impairment should be weighed against the benefits to be derived from therapy. Audiometric measurements and assessment of vestibular function should be performed prior to initiation of therapy with 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 with the use of capreomycin. Its use in patients with renal insufficiency must be undertaken with great caution, and the risk of additional renal injury should be weighed against the benefits to be derived from therapy. Capreomycin for injection is substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Patients with reduced renal function should have dosage reduction based on creatinine clearance using the guidelines proposed by the manufacturers (see prescribing information).

The use of capreomycin has been associated with producing hypokalemia. Therapy with capreomycin should be administered cautiously to patients with hypokalemia. Frequent monitoring of serum potassium along with appropriate electrolyte replacement is recommended.

Abnormal results in liver function tests have occurred in many persons receiving capreomycin for injection in combination with other antituberculosis agents that also are known to cause changes in hepatic function. The role of capreomycin for injection in producing these abnormalities is not clear; however, periodic determinations of liver function are recommended. Caution and close monitoring is advised in patient with liver impairment.

Hypomagnesemia and hypocalcemia may occur during therapy with capreomycin. These serum electrolyte levels should be determined frequently during therapy. Caution and close monitoring is advised in patients with baseline low levels of magnesium or calcium.