Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (13)
- amphotericin B deoxycholate
amphotericin B deoxycholate and colistin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- atracurium
atracurium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- bacitracin
colistin and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs
- cholera vaccine
colistin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.
- cidofovir
cidofovir and colistin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- cisatracurium
cisatracurium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- neomycin PO
colistin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.
- onabotulinumtoxinA
onabotulinumtoxinA increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- pancuronium
pancuronium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- rapacuronium
rapacuronium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- rocuronium
rocuronium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- succinylcholine
succinylcholine increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- vecuronium
vecuronium increases effects of colistin by pharmacodynamic synergism. Avoid or Use Alternate Drug. Potentiation of neuromuscular blockade; risk of respiratory arrest.
Monitor Closely (20)
- abobotulinumtoxinA
abobotulinumtoxinA increases effects of colistin by pharmacodynamic synergism. Use Caution/Monitor. Potentiation of neuromuscular blockade; risk of respiratory arrest.
- acyclovir
acyclovir and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- amikacin
amikacin and colistin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- capreomycin
capreomycin and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- carboplatin
carboplatin and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cephaloridine
cephaloridine and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cisplatin
cisplatin and colistin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- contrast media (iodinated)
colistin and contrast media (iodinated) both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- cyclosporine
colistin and cyclosporine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
colistin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- gentamicin
colistin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- ioversol
colistin and ioversol both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- polymyxin B
colistin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
colistin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- streptozocin
colistin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tacrolimus
colistin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- teicoplanin
colistin and teicoplanin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- tenofovir DF
colistin and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tobramycin
colistin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- voclosporin
voclosporin, colistin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
Minor (8)
- adefovir
adefovir and colistin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- foscarnet
colistin and foscarnet both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- methoxyflurane
colistin and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- oxaliplatin
colistin and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- paromomycin
colistin and paromomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- pentamidine
colistin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- streptomycin
colistin and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- vancomycin
colistin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
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
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
Colistimethate sodium preferred for treatment of lower urinary tract infections because of higher urinary concentrations, including polymyxin B; use in combination with other antibiotics depending on susceptibilities
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.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
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| colistin (colistimethate sodium) injection - | 150 mg vial |  | |
| Coly-Mycin M Parenteral injection - | 150 mg vial |  | |
| Coly-Mycin M Parenteral injection - | 150 mg vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
colistin (colistimethate sodium) injection
COLISTIMETHATE - INJECTION
(koe-LIS-ti-METH-ate)
COMMON BRAND NAME(S): Coly-Mycin M
USES: Colistimethate is an antibiotic used to treat certain bacterial infections. It works by stopping the growth of bacteria.
HOW TO USE: Colistimethate for injection is usually given into a vein or a muscle as directed by your doctor. The dosage is based on your medical condition and response to treatment.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.If you are inhaling this medication, learn how to prepare the solution and use the nebulizer machine properly. See also the Storage section. If you have any questions, ask your health care professional.For the best effect, use this antibiotic at evenly spaced times. To help you remember, use this medication at the same time(s) every day.Continue to use this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may result in a return of the infection.Tell your doctor if your condition does not improve or if it worsens.
SIDE EFFECTS: Stomach upset and itching may occur. If either of these effects lasts or gets worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: numbness/tingling (especially of the arms/legs, around the mouth/tongue), strange feeling on the skin of the arms/legs, mental/mood changes (such as confusion, psychosis, seizures), difficulty walking, unsteadiness, slow/shallow/troubled breathing, dizziness/feeling of spinning, unexplained fever, trouble speaking, muscle weakness, signs of kidney problems (such as change in the amount of urine), red/pink urine.This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.Use of this medication for prolonged or repeated periods may result in a new infection. Tell your doctor if you notice any symptoms of a new infection (such as white patches in your mouth, a change in vaginal discharge).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using colistimethate, tell your doctor or pharmacist if you are allergic to it; or to polymyxin B or colistin; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: diseases of the nerves/muscles (such as myasthenia gravis), kidney disease.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery or any procedure requiring anesthesia or medications that block nerve or muscle activity, tell your doctor or dentist that you are using this medication.This medication may cause live bacterial vaccines (such as typhoid vaccine) to not work well. Tell your health care professional that you are using this medication before having any immunizations/vaccinations.Older adults may be more sensitive to the side effects of this drug, especially kidney problems.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: cephalothin.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: extreme drowsiness, slow/shallow breathing, muscle weakness, inability to move.
NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as kidney tests) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss an injection, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.If you miss an inhaled dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.
STORAGE: For colistimethate injection, consult the product instructions and your pharmacist for storage details.If you are using colistimethate as an inhalation, store the unmixed vials at room temperature. Do not use premixed solution or prepare the solution ahead of time because this increases the risk of very serious breathing problems. Prepare the inhalation solution right before use. Discard any unused solution after 24 hours. Do not store for longer periods. Ask your health care professional for details.Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised March 2022. Copyright(c) 2022 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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