dosage adjustment of Capreomycin in renal failure




Capreomycin.JPG

Capreomycin

CLINICAL USE

Antibacterial agent in combination with other drugs:
  • Tuberculosis that is resistant to first-line drugs

    DOSE IN NORMAL RENAL FUNCTION

    Deep IM injection: 1 g daily (not more than 20 mg/kg) for 2–4 months, then 1 g 2–3 times each week

    PHARMACOKINETICS

  • Molecular weight                           :668.7
  • %Protein binding                           :No data
  • %Excreted unchanged in urine     : 50
  • Volume of distribution (L/kg)       :0.37–0.42
  • half-life – normal/ESRD (hrs)      :2/55.5

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : 1 g every 48 hours

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Not dialysed. Dose as in GFR <10 mL/min
  • HD                     :Dialysed. Dose as in GFR
  • <10           : mL/min
  • HDF/high flux   :Dialysed. Dose as in GFR
  • <10           : mL/min
  • CAV/VVHD      :Not dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugsIncreased risk of nephrotoxicity and ototoxicity with aminoglycosides and vancomycin

    ADMINISTRATION

    Reconstition

    Dissolve in 2 mL of sodium chloride 0.9% or water for injection. 2–3 minutes should be allowed for complete dissolution

    Route

    Deep IM injection

    Rate of Administration

    Comments

    OTHER INFORMATION

  • Nephrotoxic Check potassium levels as hypokalaemia may occur
  • Desired steady state serum capreomycin level is 10 micrograms/mLDose should not exceed 1 g/day in renal failure
  • Capreomycin sulphate 1 000 000 Units approximately equivalent to capreomycin base 1 g