Capreomycin is a second-line anti-TB antibiotic of the cyclic peptide group, with tuberculostatic activity. It is used in MDR-TB regimens.
Also known as: Capastat
Capreomycin and amikacin are both ototoxic and nephrotoxic. Coadministration significantly increases the risk of auditory and renal toxicity.
Capreomycin and amikacin are both second-line injectable drugs with the same toxicity profile: ototoxicity (cochlear and vestibular) and tubular nephrotoxicity. Coadministration causes significant additive toxicity — studies in MDR-TB regimens demonstrated that combining two injectables increases hearing loss incidence to >20% and nephrotoxicity to >15%. WHO recommends using only one second-line injectable at a time. If switching between injectables is necessary, discontinue the first before starting the second (1-2 week washout period to allow elimination).
Capreomycin + amikacin: additive ototoxicity and nephrotoxicity. Always avoid.
Both cause damage to cochlear and vestibular hair cells. The combination potentiates ototoxicity and nephrotoxicity.
Audiogram, creatinine, electrolytes, vestibular.
Deafness, vestibulopathy, nephrotoxicity.
AVOID coadministration. If necessary, monitor audiogram and renal function weekly.
EMC-UK (MHRA) — approved Capreomycin SmPC: https://www.medicines.org.uk/emc/product/6852/smpc ; DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890
No documented food or drink interactions.
No documented disease interactions.
CONTRAINDICATED in pregnancy. Cyclic peptides cause fetal ototoxicity.
CONTRAINDICATED in all trimesters.
Not applicable (contraindicated in pregnancy).
Reliable contraception is mandatory.
EMC-UK (MHRA) — approved Capreomycin SmPC: https://www.medicines.org.uk/emc/product/6852/smpc
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Capreomycin is a cyclic peptide that binds to the 70S bacterial ribosomal subunit, inhibiting protein synthesis. It has tuberculostatic activity against M. tuberculosis.
Binds to the 70S ribosomal subunit, causing mRNA misreading — mechanism similar to aminoglycosides but with a different binding site.
Must be administered intramuscularly. Oral absorption: non-existent. Tmax (IM): 1-2 hours.
Not metabolised — excreted essentially unchanged by glomerular filtration. Exclusively parenteral administration (IM).
3-6 hours. Elimination: >90% unchanged in urine. Adjust dose according to GFR.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
