Colistin nebuliser solution is available as

Colistimethate (Colistin) 1 Million International Units (1,000,000 units) per vial. It is supplied as powder in vials which are to be reconstituted or prepared prior to inhaling using a nebuliser.

It is also known by the following brand name

The brand name of the product supplied to you is: Tadim ®

Supply of colistin nebuliser solution is only available through hospital pharmacies with a doctor’s prescription. The Queensland Children’s Hospital (QCH) pharmacy stocks the Tadim® brand and it is available for children being treated as inpatients and outpatients of the hospital.

Why is it important for my child to take this medicine?

Colistin nebuliser solution forms an important part of your child’s therapy for cystic fibrosis. It is used to treat or suppress lung infections caused by Pseudomonas aeruginosa. Your child’s doctor may have prescribed it to treat another type of infection. Treating or suppressing these infections could improve or maintain your child’s lung function and overall quality of life.

When should I give colistin?

Colistin nebuliser solution is usually given twice daily; once in the morning and once at night. It is important to try to give colistin at the same times each day, at least 8 hours apart.

Treatment will continue as long as your doctor believes it is necessary. It is prescribed to try to improve or maintain lung function and to reduce the number of acute infections.

How much should I give?

The dose of colistin nebuliser solution is usually 1 Million Units or 2 Million Units (ONE or TWO vials) depending on the nebuliser used.

How should I give it?

Colistin nebuliser solution is supplied as vials of dry powder. This powder needs to be reconstituted or prepared with liquid before it can be given by a nebuliser. Detailed instructions on the equipment required and how to reconstitute the vial is given over the page.

Equipment you will need

A Pari LC Sprint® nebulising bowl and an e-Flow® Rapid or Aeroneb® Go nebuliser is recommended to nebulise the colistin nebuliser solution. Your nebulising equipment needs can be discussed with the cystic fibrosis nurse.

The Pari LC Sprint® nebulising bowls should be replaced after 6 months of continual use. Write on the nebulising bowl with a permanent marker or make a note in your diary to remind yourself when this needs replacing.

You can purchase supplies for your Pari LC Sprint® and e-Flow® Rapid devices from Pulmomed (02 9897 5899 or www.pulmomed.com.au). For Aeroneb® Go supplies contact Tag Medical (1800 032 693 or www.tagmedical.com.au).

If you notice your nebulising pump is less effective than normal you will need to get it serviced. This can be arranged through a local pharmacy or the manufacturer.

A Colistin Consumable Kit (containing 60 x 3mL syringes and a small sharps container) should be collected from Pharmacy each time you pick up your colistin prescription. Do not re-use syringes.

How to reconstitute and nebulise colistin

When handling colistin, care should be taken to avoid contamination when reconstituting the powder, or when withdrawing doses.

Wash your hands with soap and water. Dry with a clean cloth.
Use a new syringe for each reconstitution.
Flip off the red plastic cover and completely remove the silver foil seal from the top of the vial. Dispose of it safely into the sharps container.
Take out the rubber bung carefully.
Draw up 2mL of sodium chloride 0.9% (commonly known as Normal Saline) into a syringe and add carefully to the colistin vial. * (Always use a new ampoule of sodium chloride 0.9%, and dispose of the remaining fluid and the ampoule after each use).
Replace the rubber bung and roll the vial gently until the powder is fully dissolved. Do not shake the vial as the solution will froth.
Pour this freshly prepared colitsin nebuliser solution into the nebuliser bowl.
Turn the nebuliser pump on and nebulise until the medication stops “misting”. Always nebulise in a well ventilated area (near an open window).
Put the used glass vial into a sharps container.
Discard all other supplies used (sodium chloride 0.9% ampoule, syringe and any wrappers) in the rubbish bin safely.
Disassemble and wash the nebulising bowl with warm soapy water and rinse with water, allowing to air dry on a clean surface away from the sink after each use. You may wash it in the dishwasher separately if you put it on a clean wash (without dirty dishes) on a program of at least 50ºC.
Return the sharps container to the cystic fibrosis clinic and any unused medication to the pharmacy on your next visit to hospital. Do not throw in the general rubbish.

Note

This method of reconstitution/preparation differs from the approved product information from the manufacturer, and is the method recommended by pharmacy and the respiratory physicians at QCH Brisbane. Your doctor will discuss the preferred method of reconstitution for your child.

What if I forget to give it?

If you miss a dose of the medication, do not use another dose or double the next dose. Give the next dose at the time it is due, then continue as normal.

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side effects).

The most common unwanted side effect for nebulised colistin is unpleasant taste.

Side effects you must do something about

Excessive wheezing, chest tightness, or coughing
Coughing up blood in the sputum or blood stained mucus
Bronchospasm or difficulty breathing
Sore throat or mouth
Skin rash
Any other effects that are concerning to you

Can other medicines be given at the same time as colistin?

Colistin nebuliser solution should not be mixed in the nebulising bowl with Ipratropium nebulising solution (Atrovent®) or Dornase (Pulmozyme®). It can be mixed with preservative free salbutamol nebules (Ventolin® nebules) if the inhalation is given immediately. Keep separate nebulising bowls for different medications.
Check with your doctor or pharmacist before taking any other medicine, including those you buy without a prescription from a pharmacy, supermarket or health food shop. Your usual medications prescribed by your cystic fibrosis doctor are safe to continue.
Always check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines.

Is there anything else I need to know about colistin nebuliser solution?

If you are breastfeeding, pregnant or wish to become pregnant while you are using colistin nebuliser solution, you should talk to your doctor about continuing therapy.
Colistin can also be given by injection. Intravenous administration or injection results in different side effects. When it is inhaled or nebulised very little is absorbed into the blood stream. Please feel free to discuss further with your pharmacist or doctor.

Where should I keep this medicine?

Keep colistin vials below 25oC (room temperature storage). Do not refrigerate as there is no information on storage of either the dry powder or the reconstituted solution in the fridge.
Check the expiry date before using it.
Prepare each dose immediately before use and discard any unused solution.
Keep out of the reach of children – make sure that children cannot see or reach medicines and keep medicines away from pets.
Always keep colistin in its original packaging supplied by pharmacy.

What if I give too much?

If you believe that an overdose of colistin nebuliser solution has occurred, you should contact the Queensland Poisons Information Centre on 13 11 26 for further information. If any unusual symptoms are present, call 000 for an ambulance or present to your nearest emergency department.

General advice about medicines

Try to give the medicine around the same times each day. This will help you remember to give it every day.
Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
If you think someone else may have taken the medicine (either intentionally or by accident), contact the Queensland Poisons Information Centre on 13 11 26.
Make sure that you always have enough medicine. Ensure you have an appointment to get a new prescription before you run out.
Make sure that the medicine you have at home has not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your hospital pharmacist at Queensland Children’s Hospital to dispose of appropriately.

Who to contact for more information

Your doctor, pharmacist or nurse will be able to give you more information about colistin nebuliser solution and about other medicines used to treat cystic fibrosis. Alternatively you can contact the Pharmacy or Respiratory teams at the Queensland Children’s Hospital.

Contact us

Pharmacy department
Level 2, Queensland Children’s Hospital
501 Stanley Street, South Brisbane, QLD 4101
t: 07 3068 1901

Respiratory and sleep department
Level 5 (5a), Queensland Children’s Hospital
501 Stanley Street, South Brisbane, QLD 4101
t: 07 3068 2300
e: lcch_cf@health.qld.gov.au

In an emergency, always call 000.

Queensland Poisons Information Centre 13 11 26.

Developed by Pharmacy Department, Queensland Children’s Hospital. The primary source for the information in this leaflet is the Australian Medicines Handbook Children’s Dosing Companion.

Updated: April 2017.

For details on any other sources used to create this leaflet, please contact us via CHQMedicationSafety@health.qld.gov.au.

Disclaimer: We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something.

This leaflet is about the use of these medicines in Australia, and may not apply to other countries. Children’s Health Queensland Hospital and Health Service cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.