Capreomycin Dosage

Applies to the following strengths: 1 g

Usual Adult Dose for Tuberculosis - Active

Initial dose: 20 mg/kg IM or IV once a day for 60 to 120 days
Maintenance dose: 1 gram IM or IV 2 to 3 times a week
Maximum dose: 1 gram/day
Duration of therapy: 12 to 24 months

Comments:

Susceptibility studies should be performed prior to initiation to determine the presence of susceptible strains of Mycoplasma tuberculosis.
This drug should be given with at least 1 other susceptible antituberculosis drug.
Patients should be changed to appropriate oral therapy if facilities capable of administering this drug are unavailable.

Use: Concomitantly with other appropriate antituberculosis agents to treat pulmonary infections caused by susceptible strains of M tuberculosis when the primary agents (isoniazid, rifampin, ethambutol, aminosalicylic acid, streptomycin) have been ineffective or cannot be used because of toxicity or the presence of resistant tubercle bacilli

American Thoracic Society (ATS), US Centers for Disease Control and Prevention (US CDC), and Infectious Diseases Society of America (IDSA) Recommendations:
15 mg/kg IM or IV once a day OR 25 mg/kg IM or IV 3 times a week
Maximum dose: 1 gram/day

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

Usual Geriatric Dose for Tuberculosis - Active

ATS, US CDC, and IDSA Recommendations:
15 mg/kg IM or IV once a day OR 15 to 25 mg IM or IV 3 times a week

Comment: Patients with renal dysfunction and/or those who are older may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

Usual Pediatric Dose for Tuberculosis - Active

American Academy of Pediatrics (AAP) Recommendations:
Infants, Children, and Adolescents: 15 to 30 mg/kg IM once a day
Maximum dose: 1 gram/day
Duration of therapy: 2 months (with isoniazid, rifampin, and pyrazinamide)

Uses:

Adjunctive treatment of drug-resistant tuberculosis
Adjunctive treatment of drug-susceptible meningitis caused by Mycobacteria bovis in geographic areas where resistance to streptomycin is common

ATS, US CDC, and IDSA Recommendations:
Less than 15 years AND less than 40 kg:
15 to 20 mg/kg IM or IV once a day OR 25 to 30 mg/kg IM or IV 2 times a week

15 years and older AND/OR greater than 40 kg:
15 mg/kg IM or IV once a day OR 25 mg/kg IM or IV 3 times a week
Maximum dose: 1 gram/day

Comment: Patients with renal dysfunction may require 15 mg/kg given 3 times a week.

Use: Second-line treatment of drug-susceptible tuberculosis caused by susceptible organisms

Renal Dose Adjustments

Steady-state concentrations of 10 mcg/mL may be attained by the following doses:
CrCl 110 mL/min: 13.9 mg/kg IM or IV every 24 hours
CrCl 100 mL/min: 12.7 mg/kg IM or IV every 24 hours
CrCl 80 mL/min: 10.4 mg/kg IM or IV every 24 hours
CrCl 60 mL/min: 8.16 mg/kg IM or IV every 24 hours
CrCl 50 mL/min: 7.01 mg/kg IM or IV every 24 hours OR 14 mg/kg IM or IV every 48 hours
CrCl 40 mL/min: 5.87 mg/kg IM or IV every 24 hours OR 11.7 mg/kg IM or IV every 48 hours
CrCl 30 mL/min: 4.72 mg/kg IM or IV every 24 hours OR 9.45 mg/kg IM or IV every 48 hours OR 14.2 mg/kg IM or IV every 72 hours
CrCl 20 mL/min: 3.58 mg/kg IM or IV every 24 hours OR 7.16 mg/kg IM or IV every 48 hours OR 10.7 mg/kg IM or IV every 72 hours
CrCl 10 mL/min: 2.43 mg/kg IM or IV every 24 hours OR 4.87 mg/kg IM or IV every 48 hours OR 7.3 mg/kg IM or IV every 72 hours
Anuric patients (CrCl 0 mL/min): 1.29 mg/kg IM or IV every 24 hours OR 2.58 mg/kg IM or IV every 48 hours OR 3.87 mg/kg IM or IV every 72 hours

ATS, US CDC, and IDSA Recommendations:
15 mg/kg IM or IV once a day OR 15 to 25 mg IM or IV 3 times a week

Liver Dose Adjustments

Data not available

Precautions

US BOXED WARNINGS:
OTOTOXIC AND NEPHROTOXIC EFFECTS:

The use of this drug in patients with renal dysfunction or preexisting auditory impairment must be undertaken with great caution, and the risk of additional cranial nerve VIII impairment or renal injury should be weighed against the benefits to be derived from therapy.
Refer to animal pharmacology to additional information.
Since other parenteral antituberculosis agents (streptomycin, viomycin) also have similar and sometimes irreversible toxic effects, particularly on cranial nerve VIII and renal function, simultaneous administration of these agents with this drug is not recommended.
Use with nonantituberculosis drugs (polymyxin A sulfate, colistin sulfate, amikacin, gentamicin, tobramycin, vancomycin, kanamycin, and neomycin) having ototoxic or nephrotoxic potential should be undertaken only with great caution.

USAGE IN PREGNANCY:

The safety of the use of this drug in pregnancy has not been determined.

PEDIATRIC USAGE:

Safety and effectiveness in pediatric patients have not been established.

CONTRAINDICATIONS:

Hypersensitivity to the active component or any of the ingredients

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

ATS, US CDC, and IDSA Recommendations:
Hemodialysis: 15 mg/kg 2 to 3 times per week

Comment: Doses should be given after hemodialysis on the day of hemodialysis.

Other Comments

Administration advice:

IM: Administer deep into a large muscle mass
IV: Administer over 60 minutes

Storage requirements:

Reconstituted solutions may be stored for up to 24 hours under refrigeration.

Reconstitution/preparation techniques:

Dissolve in Sterile Water for Injection or 0.9% sodium chloride; allow 2 to 3 minutes for complete dissolution.
Shake well during reconstitution.

General:

Superficial IM administration may result in increased pain and sterile abscesses.
Toxicity and/or a loss of potency is not associated with a change in the color of the solution (darkening of a pale straw color).

Monitoring:
The following tests should be performed prior to initiation and at regular intervals thereafter:

Hepatic: Liver function tests
Metabolic: Serum calcium, magnesium, potassium
Nervous System: Vestibular function
Other: Audiometric measurements
Renal: Renal function tests

Patient advice:

Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
Patients should be told to report any unusual or severe side effects, including signs/symptoms of ototoxicity and nephrotoxicity.