capreomycin sulfate: clinical use

Prescribing considerations

• Restrict initiation and supervision to clinicians experienced in tuberculosis management.
• Confirm microbiological susceptibility and use only within an effective multidrug combination.
• Review previous exposure to ototoxic or nephrotoxic agents and avoid additive toxicity where possible.
• Renal impairment can cause accumulation and substantially increase toxicity.
• Current WHO guidance does not recommend capreomycin in MDR/RR-TB regimens.

Contraindications and cautions

• Hypersensitivity to capreomycin.
• The selected product should not be used in children; safety and effectiveness have not been established.
• Exercise particular caution with pre-existing renal impairment or auditory or vestibular dysfunction.

Monitoring

• Assess renal function before and throughout treatment.
• Check potassium and consider magnesium and calcium because renal electrolyte wasting can occur.
• Assess hearing and vestibular function at baseline and during treatment, especially in higher-risk patients.
• Monitor liver function and blood-cell counts.
• Investigate injection-site pain, bleeding or persistent nodules.

Clinical pharmacology

A parenteral cyclic polypeptide antibiotic that inhibits mycobacterial protein synthesis at the ribosomal subunit interface. Gastrointestinal absorption is negligible, and elimination is predominantly renal.

Formulation and product differences

• The selected product is a powder requiring reconstitution before administration.
• The UK patient leaflet specifies intramuscular administration by a healthcare professional.
• It is not an oral formulation and is not intended for self-administration.