Spiramycin

(BAN, USAN, rINN)
Spiramycin Chemical formula
Synonyms: Espiramicina; IL-5902; NSC-55926; NSC-64393 (spiramycin hydrochloride); RP-5337; Spiramicin; Spiramicinas; Spiramisin; Spiramycine; Spiramycinum; Spiramysiini. A mixture comprised principally of (4R,5S,6S,7R,9R,10R,16R)-(11E,13E)-6-[(O-2,6dideoxy-3C-methyloxy-3-dimethylamino4-hydroxy-5-methoxy-9,16-dimethyl-10-[(2,3,4,6-tetradeoxy-4dimethylaminoca-11,13-dien-2-one (Spiramycin I).
Cyrillic synonym: Спирамицин.

💊 Chemical information

Chemical formula: C43H74N2O14 = 843.1.
CAS — 8025-81-8.
ATC — J01FA02.
ATC Vet — QJ01FA02; QJ51FA02.

Pharmacopoeias.

In Eur.. Also in BP (Vet). Jpn includes Acetylspiramycin.

Ph. Eur. 6.2

(Spiramycin). A macrolide antibiotic produced by the growth of certain strains of Streptomyces ambofaciens or obtained by any other means. The potency is not less than 4100 units/mg, calculated with reference to the dried substance. A white or slightly yellowish, slightly hygroscopic powder. Slightly soluble in water; freely soluble in alcohol, in acetone, and in methyl alcohol. A 0.5% solution in methyl alcohol and water has a pH of 8.5 to 10.5. Store in airtight containers.

💊 Adverse Effects and Precautions

As for Erythromycin. The most frequent adverse effects are gastrointestinal disturbances. Transient paraesthesia has been reported during parenteral use.

💊 Interactions

For a discussion of drug interactions of macrolide antibacterials, see Erythromycin.

Cytochrome P450 isoenzymes.

Spiramycin is reported to have little or no effect on hepatic cytochrome P450 isoenzymes and may therefore produce fewer interactions than erythromycin with other drugs metabolised by this enzyme system. The lack of interactions between spiramycin and theophylline and ciclosporin would appear to support this. Nevertheless, a report of torsade de pointes in a patient with a congenital long QT syndrome during treatment with spiramycin and mequitazine1 suggests that caution is still needed. Reduced plasma concentrations of levodopa have been reported when given with spiramycin.
1. Verdun F, et al. Torsades de pointes sous traitement par spiramycine et méquitazine: à propos d’un cas. Arch Mal Coeur Vaiss 1997; 90: 103–6.

💊 Antimicrobial Action

As for Erythromycin, although it is somewhat less active in vitro against many species. It is active against Toxoplasma gondii.

💊 Pharmacokinetics

Spiramycin is incompletely absorbed from the gastrointestinal tract and absorption is reduced by food. It is widely distributed into tissues, although it does not cross the blood-brain barrier. Spiramycin crosses the placenta and is distributed into breast milk. Plasma protein binding ranges from 10 to 25%. An oral dose of 6 million units produces peak blood concentrations of 3.3 micrograms/mL after 1.5 to 3 hours; the half-life is about 5 to 8 hours. High tissue concentrations are achieved and persist long after the plasma concentration has fallen to low levels. Spiramycin is metabolised in the liver to active metabolites; substantial amounts are excreted in the bile and about 10% in the urine.

💊 Uses and Administration

Spiramycin is a macrolide antibacterial that is used similarly to erythromycin in the treatment of susceptible bacterial infections. It has also been used in the protozoal infections cryptosporidiosis and toxoplasmosis. Spiramycin is given orally as the base or intravenously as the adipate; it has also been given rectally as the adipate. The usual oral adult dose is 6 to 9 million units daily, in 2 or 3 divided doses. Doses of up to 15 million units have been given daily in divided doses for severe infections. A dose of 1.5 million units of spiramycin may be given by slow intravenous infusion every 8 hours; in severe infection the dose may be doubled. Spiramycin is available in combination preparations with metronidazole in some countries. Acetylspiramycin is also used.
1. Rubinstein E, Keller N. Spiramycin renaissance. J Antimicrob Chemother 1998; 42: 572–6.

💊 Preparations

Proprietary Preparations

Arg.: Rovamycine; Austria: Rovamycin; Belg.: Rovamycine; Braz.: Rovamicina; Canad.: Rovamycine†; Cz.: Rovamycine; Fr.: Rovamycine; Ger.: Rovamycine; Selectomycin; Gr.: Rovamycine; Hong Kong: Rovamycine; Hung.: Rovamycine; India: Rovamycin; Indon.: Ethirov; Hypermycin; Ismacrol; Medirov; Osmycin; Provamed; Rofacin; Rovadin; Rovamycine; Sorov; Spirabiotic; Spiradan; Spiranter; Spirasin; Varoc; Vipram; Israel: Rovamycine; Ital.: Rovamicina; Spiromix; Malaysia: Rovamycine; Mex.: Provamicina; Neth.: Rovamycine; Norw.: Rovamycin; Pol.: Rovamycine; Port.: Rovamycine; Rus.: Rovamycine (Ровамицин); Singapore: Rovamycine; Spain: Dicorvin; Rovamycine; Switz.: Rovamycine; Thai.: Rovamycin; Spiracin; Turk.: Rovamycine; Venez.: Provamicina. Multi-ingredient: Arg.: Estilomicin; Braz.: Periodontil; Cz.: Rodogyl†; Fr.: Birodogyl; Missilor; Rodogyl; Malaysia: Rodogyl; Mex.: Rodogyl; Spain: Rhodogil.
Published May 08, 2019.