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Active substance(s): COLISTIMETHATE SODIUM

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Package leaflet: Information for the patient

Colistimethate sodium


powder for solution for injection

Colistimethate sodium
Other medicines and Colistimethate sodium
Read all of this leaflet carefully before you are given this
Tell your doctor or pharmacist if you are taking, have recently taken or
medicine because it contains important information for you.
might take any other medicines, including non-prescription medicines.
• Keep this leaflet. You may need to read it again.
• Medicines which can affect your kidney function. Taking such
• If you have any further questions, ask your doctor, pharmacist
medicines at the same time as Colistimethate sodium can increase
or nurse.
the risk of kidney failure.
• If you get any side effects, talk to your doctor, pharmacist or
• Medicines which can affect your nervous system. Taking such
nurse. This includes any possible side effects not listed in this
medicines at the same time as Colistimethate sodium can increase
leaflet. See section 4.
the risk of side effects in your nervous system.
What is in this leaflet
• Medicines called muscle relaxants, often used during general
1. What Colistimethate sodium is and what it is used for
anaesthesia. Colistimethate sodium can increase the effects
2. What you need to know before you are given Colistimethate sodium
of these medicines. If you have a general anaesthetic, let your
3. How Colistimethate sodium is given
anaesthetist know that you are using Colistimethate sodium.
4. Possible side effects
If you suffer from myasthenia gravis and are also taking other
5. How to store Colistimethate sodium
antibiotics called macrolides (such as azithromycin, clarithromycin or
6. Contents of the pack and other information
erythromycin) or antibiotics called fluoroquinolones (such as ofloxacin,
1. What Colistimethate sodium is and what it is used for
Colistimethate sodium is an antibiotic. It belongs to a group of
antibiotics that are called polymyxins. This medicine works by killing
some types of bacteria that can cause various sorts of infections in
Colistimethate sodium is given by injection to treat some types of
serious infections caused by certain bacteria. It is used when other
antibiotics are not suitable.
It is recommended that this antibiotic be used in combination with
2. What you need to know before you are given Colistimethate
Colistimethate sodium must not be given:
• If you are allergic (hypersensitive) to colistimethate sodium, colistin
or to other polymyxins.
Warnings and precautions
Talk to your doctor, pharmacist or nurse before receiving
Colistimethate sodium:
• if you have or have had kidney problems;
• if you suffer from myasthenia gravis (muscle weakness);
• if you suffer from porphyria (group of disorders that can cause
nerve or skin problems).
Tell your doctor or other healthcare professional immediately if a
severe allergic reaction occurs during treatment with Colistimethate
sodium, as treatment with this medicine must be stopped.
Using Colistimethate sodium systematically requires monitoring of
kidney function by laboratory tests, starting from the first days of
treatment and throughout the entire duration of treatment.
If you have kidney failure, the dosage of Colistimethate sodium may
be adjusted by your doctor.
Tell your doctor if you experience tingling around the mouth or
extremities (fingers and toes) or if you experienced diarrhoea during
or after treatment with Colistimethate sodium.
In premature and new-born babies, special care should be taken
when using Colistimethate sodium as the kidneys are not yet fully

norfloxacin and ciprofloxacin), taking Colistimethate sodium further
increases the risk of muscle weakness and breathing difficulties.
Having Colistimethate sodium as an infusion at the same time as
receiving Colistimethate sodium as an inhalation can increase your
risk of side effects.
Pregnancy and breast-feeding
If you are pregnant or breast-feeding, think you may be pregnant or
are planning to have a baby, ask your doctor for advice before this
medicine is given to you.
You may be given Colistimethate sodium if you are pregnant or trying
to get pregnant if your doctor considers the benefits are greater than
the possible risks. It is unknown if having Colistimethate sodium may
harm your unborn baby.
It is not recommended that you breast-feed while you are taking this
medicine as Colistimethate sodium can pass into breast milk.
Driving and using machines
Colistimethate sodium may make you feel dizzy, confused or have
problems with your sight, such as blurred vision. If this happens to
you, do not drive or use any tools or machines.
Colistimethate sodium contains sodium
This medicine contains less than 1 mmol sodium (23 mg) per vial of
reconstituted solution for injection, i.e. essentially ‘sodium- free’.
3. How Colistimethate sodium is given
Your doctor will explain precisely how much Colistimethate sodium
you will be given, how often and for how long. This will depend on the
type of infection and its severity.
Tell your doctor if you have kidney problems, as the dose of medicine
to be taken may have to be adjusted.
Recommended dose in adults and adolescents
Colistimethate sodium is given to you by your doctor as an infusion
into a vein over 30 – 60 minutes.
The usual daily dose in adults is 9 million units, divided into two or
three doses. If you are quite unwell, you will be given a higher dose of
9 million units once at the start of treatment.
In some cases, your doctor may decide to give a higher daily dose of
up to 12 million units.
Use in children
The usual daily dose in children weighing up to 40 kg is 75.000 to

The following information is intended for healthcare professionals only.
This medicinal product is for single use only and any remaining
solution should be discarded.
Method of administration
This medicinal product can be administered by intravenous
administration or intrathecal and intraventricular administration.
Intravenous administration - bolus:
This medicinal product must be reconstituted, under aseptic

conditions, with not more than 10 ml of a solution of sodium chloride
solution 0.9% or water for injections (WFI). During reconstitution swirl
gently to avoid frothing.

Intravenous administration - infusion:
After reconstitution, the solution may be diluted usually with 50 ml of
a solution of sodium chloride 0.9% for administration by infusion over
30-60 minutes. During reconstitution swirl gently to avoid frothing.
Intrathecal and intraventricular administration:
It is recommended to use the 1 MIU strength vial for both intrathecal

150.000 units per kilogram body weight, divided into three doses.
Higher doses have occasionally been given in cystic fibrosis.

may occur from the first days of treatment onwards, and is usually
reversible on discontinuation of therapy.

Patients with kidney impairment
Children and adults with kidney problems, including those on dialysis,
are usually given lower doses.
Your doctor will monitor your kidney function regularly while you
receive Colistimethate sodium.

With intrathecal or intraventricular administration, meningeal irritation
can be observed.

Colistimethate sodium may occasionally be given directly
into the fluid surrounding the brain (called “intrathecal” or
“intraventricular” routes) in the treatment of meningitis.
Intraventricular route in adults: 125,000 IU/day.
The doses administered via the intrathecal route must not exceed
those recommended for intraventricular administration.
No specific dosing recommendation can be made in children for
intrathecal and intraventricular routes of administration.
If you are given more Colistimethate sodium than you should
As a doctor or nurse will be giving you Colistimethate sodium, it is
unlikely that you will receive an incorrect dose. Tell your doctor or
nurse if you have any concerns about the amount of medicine that
you are given.
The symptoms of having too much Colistimethate sodium can include
dizziness and spinning sensation (vertigo), tingling around the mouth
and extremities (fingers and toes), slurred speech, visual disturbance,
confusion, mental disturbance, flushing (reddening of the face), kidney
problems, muscle weakness, feeling as though you cannot breathe.
If you have not received your dose of Colistimethate sodium
If you think a dose has been missed, talk to your doctor or other
healthcare professional immediately. You must not be given a double
dose to make up for a forgotten dose.

Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse.
This includes any possible side effects not listed in this leaflet. You
can also report side effects directly via Yellow Card Scheme Website: By reporting side effects you can help
provide more information on the safety of this medicine.
5. How to store Colistimethate sodium
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the
vial or carton as “EXP”. The expiry date refers to the last day of that
This medicine does not require any special storage conditions.
The chemical and physical in-use stability of reconstituted solution
with a concentration ≥ 80,000 IU/mL, has been demonstrated for
24 hours at 2 to 8°C.
From a microbiological point of view, the product should be used
immediately. If not used immediately, in-use storage times and
conditions following reconstitution/dilution are the sole responsibility
of the user.
For solutions for infusion, which have been diluted beyond the original
vial volume and / or with a concentration < 80,000 IU/mL and for
intrathecal and intraventricular routes should be used immediately.
Do not throw away any medicines via wastewater or household waste.
Ask your pharmacist how to throw away medicines you no longer use.
These measures will help protect the environment.

If you stop using Colistimethate sodium
Your doctor will decide how long you should be given Colistimethate
sodium. It is important that your treatment is completed as advised by 6. Contents of the pack and other information
your doctor or your symptoms may get worse.
What Colistimethate sodium contains
If you have any further questions on the use of this medicine, ask your The active substance is Colistimethate sodium (Colistin
methasulfonate sodium salt) 2 million international units (IU)
(equivalent to approximately 160 mg)
4. Possible side effects
What Colistimethate sodium looks like and contents of the pack
Like all medicines, this medicine can cause side effects, although not Colistimethate sodium is a white powder supplied in a glass vial.
everybody gets them.
Box of 1 vial with powder
Allergic reactions
Box of 10 vials with powder
Colistimethate sodium can sometimes cause allergic reactions like
Box of 30 vials with powder
skin rash, swelling of the face, lips, mouth or tongue. Breathing
Box of 50 vials with powder
difficulties have also been observed. If this happens, your
Not all pack sizes may be marketed.
Colistimethate sodium treatment will be stopped immediately.
Marketing Authorisation Holder
If you experience signs of an allergic reaction you should seek
urgent medical attention.
69/71, avenue Pierre Grenier
Neurological problems
92100 Boulogne-Billancourt
The most serious side effects in the nervous system is inability to
breathe because of paralysis of the chest muscles.
If you experience any difficulty breathing you should seek urgent
medical attention.
Dalslandsgade 11,
Other possible side effects:
2300 Copenhagen S,
–– headache,
–– tingling or numbness around the mouth, lips, face or extremities
This medicinal product is authorised in the Member States of the
(fingers and toes),
EEA under the following names:
–– itching, muscle weakness,
–– dizziness,
–– difficulty in controlling movements,
poudre pour solution injectable
–– soreness at the site of injection.
Colistimethate sodium 2 MIU, powder for solution for
Colistimethate sodium can affect your kidneys, especially if the dose
Kingdom: injection
is high, in case of long-term treatment with this medicine or you are
This leaflet was last revised in 05/2017.
taking other medicines that may affect your kidneys. Blood tests may
show changes in the way the kidneys are working. Kidney failure

and intraventricular routes of administration. For reconstitution
instructions of the 1 MIU strength, please refer to the product
information of the 1 MIU strength.

If the 2 MIU strength is used, one vial must be reconstituted,
under aseptic conditions, with no more than 10 ml of sodium
chloride 0.9% solution. During reconstitution swirl gently to avoid
frothing. After reconstitution, the solution should be diluted to a
total volume of 16 ml of sodium chloride 0.9% solution.
The concentration of the reconstituted solution is 125,000 IU/mL. The

volume administered should not exceed 1 mL.

The pH of the reconstituted or diluted solution is 6.5-8.5.
After reconstitution
Hydrolysis of colistimethate is significantly increased when
reconstituted and diluted below its critical micelle concentration of
about 80,000 IU per ml. Solutions below this concentration should be
used immediately.
Any unused product or waste material should be disposed of in
accordance with local requirements.

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