Prior to treatment with capreomycin for injection and regularly during the treatment should be audiometry and vestibular function evaluation.
Renal function testing should be performed both before the start of treatment and weekly during treatment, and in patients with a detected or suspected decrease in renal function, the dose should be reduced.
Since hypokalemia may develop during treatment, serum potassium levels should be frequently measured.
During the treatment it is necessary to monitor hematologic parameters and liver function.
If surgical interventions are necessary during the treatment with capreomycin, caution should be exercised in using drugs that cause neuromuscular blockade.
During treatment, it is necessary to constantly monitor the regimen and dosage regimens, the correctness and regularity of the appointments. In the case of missed injections, administer as soon as possible, only if the time of the next dose is not reached; Doses do not double.
Capreomycin should be used with great caution in patients with renal insufficiency and already existing hearing impairment.It should be compared the risk of additional impairment of function of the VIII pair cranio-cerebral nerves and kidney damage with a positive effect of treatment.
Since other anti-tuberculosis drugs (streptomycin, viomycin) also have a similar and sometimes irreversible toxic effect, especially on the VIII cranial couple-cerebral nerves and kidney function, simultaneous administration of these drugs with capreomycin for injections is not recommended.
For elderly patients, patients with impaired renal function or dehydration and patients receiving other nephrotoxic drugs, the risk of acute tubular necrosis is much higher.
Renal damage was noted with tubular necrosis, an increase in the level of urea nitrogen in the blood (AMK) or serum creatinine and the appearance of an abnormal urinary sediment.
A slight increase in AMK and serum creatinine was observed in a significant proportion of patients undergoing long-term treatment. In a large percentage of these cases, the appearance in the urine of cylinders, erythrocytes and leukocytes. An increase in the level of AMC, more than 30 mg / 100 ml, as well as any other signs of a decrease in renal function with or without an increase in AMC level, requirescareful examination of the patient, dose reduction or complete withdrawal of the drug.
The clinically significant occurrence of an abnormal urinary sediment and a significant increase in the level of AMK (or serum creatinine) under the influence of capreomycin for injection has not been established. When intravenous administration of large doses of capreomycin for injection, partial neuromuscular blockade was observed. This effect was enhanced when anesthesia was performed using ether (as was shown for neomycin) and was attenuated by neostigmine.
Damage of the auditory and vestibular departments of the VIII pair cranio- cerebral nerves occurs in patients with impaired renal function or dehydration, as well as in those who receive drugs that have ototoxic effect. Often such patients experience dizziness and noise in the ears.
After rapid intravenous administration, neuromuscular blockade or respiratory paralysis may develop.
Care should be taken when prescribing to patients with any form of allergy, especially drug.