Ver el código de «Spiramycin»

==Administration==
*Type: [[macrolide]] antibiotic
*Dosage Forms: 250, 500
*Routes of Administration: PO, IV
*Common Trade Names: Rovamycine

==Adult Dosing==
*1-2g PO BID OR 500-1000mg PO TID. May increase to 2-2.5g BID for severe infections
*[[Toxoplasmosis]] in pregnant women: 
**1st trimester: 3g PO daily in 3-4 divided doses
**2nd/3rd trimesters: 25-50mg [[pyrimethamine]] PO daily AND 2-3g [[sulfadiazine]] daily AND folinic acid 5mg daily for 3 weeks, alternating with 1g PO spiramycin TID for 3 weeks


===Indications by Disease===
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==Pediatric Dosing==
*>20kg: 25mg/kg PO BID or 16.7mg/kg PO TID
*Subclinical congenital toxoplasmosis: 0.5-1mg/kg PO daily [[pyrimethamine]] AND 50-100mg/kg PO daily [[sulfadiazine]] x 4 weeks, alternating with 50-100mg/kg spiramycin x 6 weeks, alternating courses for 1 year
*Overt congenital toxoplasmosis: 0.5mg/kg PO [[pyrimethamine]] daily AND 50-100mg/kg [[sulfadiazine]] PO daily AND 5mg folinic acid q3d for 6 months, alternating with 50-100mg/kg spiramycin AND pyrimethamine AND sulfadiazine for 4 weeks. Repeat dosing courses x 18mo


===Indications by Disease===
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==Special Populations==
===[[Drug pregnancy categories|Pregnancy Rating]]===
*Category B, Safe in pregnancy<ref>Stray-Pedersen B. Treatment of toxoplasmosis in the pregnant mother and newborn child. Scand J Infect Dis 1992; 84(suppl): 23-31</ref>

===[[Lactation risk]]===
*Distributed in breast milk

===Renal Dosing===
*Adult: n/a
*Pediatric: n/a

===Hepatic Dosing===
*Caution in hepatic impairment

==Contraindications==
*Allergy to class/drug

==Adverse Reactions==
===Serious===
*Cardiac toxicity, specifically QT prolongation
*Thrombocytopenia
*Cholestatic hepatitis
*GI toxicity, specifically acute colitis, C. diff colitis, or other intestinal injury
*Ulcerated esophagitis
*Worsening hepatic impairment in patients with pre-existing liver disease

===Common===
*Injection site pain
*Nausea/vomiting, diarrhea, abdominal pain

==Pharmacology==
*Half-life: 4.5-13.5h (increases with increasing age)
*Metabolism: Hepatic
*Excretion: Fecal (predominant), renal

==Mechanism of Action==
*Reversibly binds to the 50 S subunit of bacterial ribosomes, resulting in blockage of the transpeptidation or translocation reactions, inhibiting protein synthesis and subsequent cell growth<ref>Rovamycine (spiramycin) [product monograph]. Quebec, Canada: Aventis Pharma Inc; April 2018.</ref>

==Comments==
*Not approved in US for standard use, though exceptions can be made to treat toxoplasmosis in pregnant women<ref>Spiramycin. Lexicomp. http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7697?searchUrl=%2Flco%2Faction%2Fsearch%3Forigin%3Dapi%26t%3Dglobalid%26q%3D6982%26nq%3Dtrue. Accessed March 5, 2020.</ref>

==See Also==
*[[Toxoplasmosis]]
*[[Macrolide]]

==References==
<references/>

[[Category:Pharmacology]]