Colistimethate sodium

Generic Medicine Info
Indications and Dosage
Pseudomonal lung infections in cystic fibrosis
Adult: 1-2 MIU bid or tid. Max: 6 MIU daily. Dose may be adjusted based on patient’s condition and clinical response.
Child: <2 yr 0.5 to 1 MIU bid. Max: 2 MIU daily; ≥2 yr Same as adult dose.

Severe Gram-negative infections
Adult: ≤60 kg: 50,000 IU/kg daily in 3 divided dose. Max: 75,000 IU/kg daily; >60 kg: 1-2 MIU tid. Max: 6 MIU 24 hrly. Doses are given via IM inj or slow IV inj or infusion.
Child: Same as adult dose.
Renal Impairment
Dosage reduction needed (according to individual products).
IV: Reconstitute vial containing 1 MIU w/ not more than 10 mL sterile water for inj or NaCl 0.9%. IV infusion: Further dilute reconstituted solution w/ 50 mL NaCl 0.9%. Gently swirl to avoid frothing.
Hypersensitivity to colistimethate or colistin.
Special Precautions
Patient w/ myasthenia gravis, porphyria. Renal impairment. Childn (esp infants <1 yr). Pregnancy and lactation.
Adverse Reactions
Significant: Bronchospasm and cough (inhalation); nephrotoxicity or neurotoxicity (IM/IV).
Nervous: Confusion or psychosis, transient sensory disturbances (e.g. facial paraesthesia, vertigo), slurred speech, dizziness, vertigo.
CV: Vasomotor instability.
GI: Sore mouth or throat, dysgeusia, GI disturbance.
Resp: Haemoptysis, dysphonia, epistaxis, pharyngolaryngeal pain, apnoea, dyspnoea, cough, wheezing.
Musculoskeletal: Arthralgia.
Ophthalmologic: Visual disturbances.
Otic: Tinnitus.
Dermatologic: Rash, pruritus, urticaria.
Immunologic: Anaphylaxis.
Others: Pain and local irritation, fever.
Potentially Fatal: Antibiotic-associated colitis and pseudomembranous colitis, resp arrest.
IM/Inhalation/Respiratory/IV/Parenteral: C
Patient Counseling Information
This drug may cause dizziness, confusion, or visual disturbance, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor serum creatinine, BUN, urine output; signs of neurotoxicity or bronchospasm.
Symptoms: Muscular weakness, apnoea. Resp arrest and acute renal failure may also occur. Management: Supportive treatment, including mannitol diuresis. May be removed by prolonged haemodialysis or peritoneal dialysis.
Drug Interactions
Additive nephrotoxic/neurotoxic effects w/ aminoglycosides, amphotericin B, bacitracin, capreomycin, cefazedone, methoxyflurane, polymyxin B, vancomycin. May prolong the effect of non-depolarising muscle relaxants (e.g. tubocurarine). May diminish therapeutic effect w/ Na picosulfate.
Description: Colistimethate Na is an inactive prodrug which is hydrolysed to colistin. Colistin acts as a cationic detergent which penetrates and disrupts the bacterial cytoplasmic membrane, causing leaking of intracellular substances and cell death.
Absorption: Time to peak plasma concentration: 2-3 hr (IM).
Distribution: Widely distributed, except in CNS and in synovial, pleural, and pericardial fluids; crosses placenta and enters breast milk. Plasma protein binding: 50%.
Metabolism: Undergoes hydrolysis to the active substance colistin.
Excretion: Mainly via urine, as unchanged drug. Elimination half-life: 2-3 hr.
Chemical Structure

Chemical Structure Image
Colistimethate sodium

Source: National Center for Biotechnology Information. PubChem Database. Colistimethate, CID=216258, (accessed on Jan. 22, 2020)

Store between 20-25°C. Protect from light. 
MIMS Class
Other Antibiotics
Anon. Colistimethate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. Accessed 06/06/2017.

Buckingham R (ed). Colistimethate Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. Accessed 06/06/2017.

Colistimethate Sodium Injection (Par Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. Accessed 06/06/2017.

Joint Formulary Committee. Colistimethate Sodium. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. Accessed 06/06/2017.

McEvoy GK, Snow EK, Miller J et al (eds). Colistimethate Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). Accessed 06/06/2017.

Disclaimer: This information is independently developed by MIMS based on Colistimethate sodium from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by
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