colistin (Rx)

Brand and Other Names:colistimethate sodium, Coly Mycin M
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 150mg/vial

Susceptible Infections

Dosage expressed in terms of colistin base

2.5-5 mg/kg/day divided q6-12hr IV/IM; not to exceed 5 mg/kg/day  

Renal Impairment

CrCl >80 mL/min: No dosage adjustment required

CrCl 50-79 mL/min: 2.5-3.8 mg/kg/day IV/IM divided q12hr

CrCl 30-49 mL/min: 2.5 mg/kg/day IV/IM qDay or divided q12hr

CrCl 10-29 mL/min: 1.5 mg/kg IV/IM q36hr

Other Indications & Uses

Gram-neg. infection (e.g., Enterobacter aerogenes, E. coli, Klebsiella, Pseudomonas) unresponsive to other antibiotics

Multi-drug resistant gram-neg. infection

Dosage Forms & Strengths

powder for injection

  • 150 mg/vial

Susceptible Infections

Dosage expressed in terms of colistin bas

<12 years old: Safety and efficacy not established

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Interactions

Interaction Checker

and colistin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Dizziness

            Paresthesia

            Tingling of extremities and tongue

            <1%

            Neurotoxicity

            Nephrotoxicity

            Acute respiratory failure (inhalation route)

            Respiratory tract paralysis

            Frequency Not Defined

            Slurred speech

            Vertigo

            Seizures

            Anaphylaxis

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            Warnings

            Contraindications

            Hypersensitivity

            Caution

            Do not exceed 5 mg/kg/day (as colistin base) with normal renal function (see Dosing for renal impairment)

            Not indicated for infections by Proteus or Neisseria (most strains are resistant)

            Risk of nephrotoxicity, neurotoxicity; discontinue if elevated BUN/creatinine

            Risk of respiratory arrest in myasthenia gravis or concomitant anesthetics or neuromuscular blocking drugs

            Risk of C. difficile-associated pseudomembranous colitis

            Sedative effects may impair driving, operating machinery

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: unknown; use caution

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Half-Life

            Normal renal function: 2-3hr

            CrCl < 20 mL/min: 10-20 hr

            Peak Plasma

            IV: 10 min

            Time: 2 hr (IM)

            Concentration: 5-7.5 mcg/mL (IM); higher IV

            Other Information

            Protein Bound: 50%

            Metabolism: colistimethate sodium hydrolyzed in vivo

            Metabolites: colistin (active)

            Excretion: urine

            Dialyzable: unknown

            Mechanism of Action

            Structurally similar to polymyxin B; colistimethate hydrolyzed to colistin in vitro or in vivo

            Cationic detergent that damages bacterial cytoplasmic membrane, causing cell death

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            Administration

            IV Incompatibilities

            Additive: erythromycin, hydrocortisone Na-succinate, kanamycin, cefazolin

            IV Compatibilities

            Additive: amikacin, ascorbic acid, chlormaphenicol, diphenhydramine, heparin, penicillin G Na/K, phenobarbital, polymyxin B, ranitidine, vit B/C

            Syringe: ampicillin, penicillin G Na

            IV Preparation

            Reconstitute with 2 mL SWI to obtain a 75 mg/mL solution

            IV/IM Administration

            IM or

            IV push: half of daily dose injected over 3-5 min q12 hr

            IV infusion: half of daily dose injected over 3-5 min; other half mixed with compatible IV solution and administered 1-2 hr later at 5-6 mg/hr

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.