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

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            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.

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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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              colistin (colistimethate sodium) injection
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              150 mg vial
              Coly-Mycin M Parenteral injection
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              150 mg vial
              Coly-Mycin M Parenteral injection
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              150 mg vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              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 persists or worsens, 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 as well. Do not have any immunizations/vaccinations while using this medication unless your doctor tells you to.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 August 2021. Copyright(c) 2021 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.

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              Formulary

              FormularyPatient Discounts

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              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
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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.