Colistimethate Sodium

Renal impairment

• Dose recommendations in renal impairment vary according to preparation used- consult individual product literature.
• HD/HDF/High Flux/PD: Dialysed; give after dialysis.

Hepatic impairment

No dose adjustment is necessary.

• Colistimethate sodium therapeutic drug levels should be checked in all cases with renal impairment, neonates and cystic fibrosis patients.
• Aim for peak (1 hour post dose) concentrations of 10-15 mg/L; Trough (pre-dose) concentration of 2-6mg/L.
• Always discuss with Micro/ID and pharmacist. 

Pregnancy

Use only if potential benefit outweighs risk. 

Breastfeeding

Discuss with pharmacy.

• Contraindicated in patients allergic to colistimethate sodium and hypersensitive to any ingredients, or to polymyxin B.
• Risk of respiratory arrest in myasthenia gravis or with concomitant anaesthetics or neuromuscular blocking drugs.
• Use with extreme caution in patients with acute porphyria.
• Use with extreme caution in patients with myasthenia gravis.
• Adverse effects include nephrotoxicity, neurotoxicity and skin rashes.
• Use nephrotoxic drugs with caution when the patient is receiving colistimethate sodium.
• Use with caution in renal impairment.
• Renal function monitoring should be performed at the start of treatment and regularly in all patients.

1. Summary of Product Characteristics (SPC) for Colistimethate Sodium 1 million I.U. Powder for Solution for Injection. Accessed via www.medicines.org.uk 26/03/18. Last updated 29/01/18
2. The Renal Drug Database. Colistimethate sodium. Accessed via renaldrugdatabase.com 26/03/18. Last updated 20/02/18