Indications
Composition
Each vial contains Colistimethate Sodium 2 MIU or 68 mg Colistin.
Each vial contains Colistimethate Sodium 3 MIU or 102 mg Colistin.
Each vial contains Colistimethate Sodium 4.5 MIU or 150 mg Colistin.
Description
Pharmacology
Dosage
Maintenance dose: 9 MIU/day in 2-3 divided doses. In patients who are critically ill, a loading dose of 9 MIU should be administered.
Renal impairment patients: Dose adjustments in renal impairment patients are necessary. Dose reductions are recommended for patients with creatinine clearance < 50 ml/min. Twice daily dosing is recommended.
- Creatinine clearance <50-30 ml/min: daily dose 5.5-7.5 MIU
- Creatinine clearance <30-10 ml/min: daily dose 4.5-5.5 MIU
- Creatinine clearance <10 ml/min: daily dose 3.5 MIU
Haemodialysis (HD) patients:
- No-HD days: 2.25 MIU/day (2.2-2.3 MIU/day).
- HD days: 3 MIU/day (Should be given after the HD session) Twice daily dosing is recommended.
Pediatric population: The dose should be based on lean body weight.
- Children ≤40 kg: 75,000-150,000 IU/kg/day divided into 3 doses.
- Children >40 kg: >150,000 IU/kg/day has been reported in children with cystic fibrosis.
Hepatic impairment patients: There are no data in patients with hepatic impairment. Caution is advised when administering colistimethate sodium in these patients.
Administration
Direct Intermittent Administration– Slowly inject one-half of the total daily dose over a period of 3 to 5 minutes every 12 hours.
Continuous Infusion– Slowly inject one-half of the total daily dose over 3 to 5 minutes. Add the remaining half of the total daily dose of Colistimethate for injection to one of the following:
- 0.9% NaCl
- 5% dextrose in 0.9% NaCl
- 5% dextrose in water
- 5% dextrose in 0.45% NaCl
- 5% dextrose in 0.225% NaCl
- Lactated Ringer’s solution
There are not sufficient data to recommend usage of Colistimethate for injection with other drugs or other than the above listed infusion solutions. Administer the second half of the total daily dose by slow intravenous infusion, starting 1 to 2 hours after the initial dose, over the next 22 to 23 hours. In the presence of impaired renal function, reduce the infusion rate depending on the degree of renal impairment. The choice of intravenous solution and the volume to be employed are dictated by the requirements of fluid and electrolyte management. Any infusion solution containing Colistimethate sodium should be freshly prepared and used for no longer than 24 hours.
Alternative method- As per specialized references for intermittent infusion: Prescribed dose can be diluted in 50-100 ml 0.9% NaCl and administer over 30-60 minutes in IV route.
Interaction
Contraindications
Side Effects
Pregnancy & Lactation
Precautions & Warnings
Overdose Effects
Therapeutic Class
Reconstitution
For bolus injection: Reconstitute the contents of the vial with 5 ml water for injection.
For infusion: The contents of the reconstituted vial may be diluted, usually with 50 ml-100ml 0.9% sodium chloride.
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