Nebulized Colistin.

[Oboe]

I was recently hospitalized for the usual two week course and sent home on nebulized colistin. I've never done it before outside of the hospital, so I don't know entirely how to mix it and it didn't come with directions beyond "nebulize twice daily." They gave me 3ml syringes, some sterile water, and the vials of medicine. What I've been doing is mixing 3mls of the water with the powder, then nebulizing it. Problem is that it really irritates my lungs and twice now in three days I've had bleeding episodes shortly after. Am I supposed to dilute it further or something? I didn't have this issue in the hospital.

Feel silly making a thread for such a simple thing, but I can't get a hold of my CF person because of the holiday weekend and google mostly just gives me research articles.

 

[triples15]

Hi Oboe,

Sorry they gave your crappy (or no) instructions. Colistin is a real pain. I'm afraid I won't be of much help, because I have not done it for several years. Wanted to mention that it was always quite irritating to my lungs as well, and eventually I had a very nasty reaction to it and landed in the emergency room and on IVs for 3 weeks trying to recover. Ugh. Long story, so I will spare you the details (unless you request them).

Main reason I wanted to chime in quickly though, is that I *think* you may be doing too much at one time. I remember injecting sterile water into the vial, and then only drawing 1/2 back out (leaving 1/2 the dose still in the vial). I can't remember how much sterile water I used to begin with though. But I think the vial is meant for 2 doses. Like I said, my memory is super foggy because I haven't done it in a long time, but that seems right to me. So perhaps you aren't meant to be nebbing the entire vial.

Also, I'm sure you know this, but albuterol is your friend. Pre and post dose with it since the colistin is giving you problems. It might also be that you have reactive airways like myself, and just can't tolerate it. I hope that's not the case for you though. I can't neb Tobi either due to bronchospasms, so right now the only thing I have left is Cayston. Ugh.

Anyway, hopefully someone who knows can chime in soon!

Take Care,

Autumn 34 w/cf

 

[Oboe]

Thank you for the response. It honestly wouldn't surprise me if I was doing too much, it sure feels like it, but the labels say to do two vials a day. So I'm guessing a full one is a regular dose. Plus, I was doing this in the hospital and tolerating it fine, or maybe I just didn't notice because I was sitting on my butt all day.

I posted this and then went to bed and thought about it a bit. I'm just going to skip it for today and try to get a hold of my CF nurse tomorrow. Between this and a couple other things I feel like I should've stayed in the hospital a little longer, but that's beyond the scope of this thread.

Thank you again for trying to help.

 

[nmw0615]

I'm currently in the middle of inhaled Coli. My instructions were to mix 4mL of sterile saline with each vial, and inhale as much of the 4mL as possible.

I was also warned to not use any "pre mixed" vials, as Coli becomes toxic to the lungs after a while. So a new mix and a new vial with every dose, mixed immediately before I start.

 

[vbs420]

I was prescribed this as a replacement for Tobi, as both the podhaler and nebulised versions have worse side effects than perceived benefit.

I too was given poor instructions on use and administration, and immediately received diarrhea after the first day (two doses), which sent me googling.

These CF Clinics seem willing to treat P.A. with lethal doses of drugs which have very serious side effects. Are the side effects worth the risk??

Colistin / Coly-Mycin is toxic to kidney. Tobi is toxicto liver.

Great! Save the lungs, kill all the other organs.

I'm not much help. More of a rant.

Do many other use Colistin regularly?

 

[kgfrompa]

I am on Colistin every other month and I found a larger needle is so much easier to mix with the needle is a higher gage and does not bend which makes for a fasy and easier why to mix I think i am using a 10ML and not the 5ml i hope this helps someone for me it has been a gift because of the strength of the 10ml

 

[Jennyvb17]

I'll look at one when I get home. I feel like it is more than 3mls to a vial.

Also my doctor always warns to create as little bubbles/foam as possible. Add the water super slow to the vial and super slow to the neb cup

 

[Tigrastic]

Hey, I may be late to this thread. But I will say that I have had a general good experience with nebulized colistin. I have taken it since the age of 9 (I am now 22) except for a month or two here and there. I mix 4ml of 0.9% sodium chloride (the water) with 2 mega units of colistin twice a day. In the past I used to do this with a syringe, but now I simply pour approximately 4 fifths of a 5ml bottle and wait five minutes for the powder to dilute. Then pour into into the nebulizer.
I have not experienced any side effects and have not become resistant to the drug despite using it for years. Hope it starts working for you!

 

[Chipper]

Have a compound pharma mix it for you. I use foundcare.com. No, I don't work for them. Ask about the Pari Trio.

 

[lifeisgood729]

The amount of water you use might depend on the nebulizer you use. If you are using an eFlow, then you add 6 ml of water, but you only withdraw 3ml to inhale. The eFlow delivers more of the drug to your lungs, so you only need to use half of the powder. If you use a standard nebulizer (like the Pari LC Plus) then you can mix it with 3-4 ml and inhale all of it. I have been doing it this way for years and never had a problem, but one of my brothers can't use coli because it irritates his lungs too much.

I find it less irritating to mix it with .9% saline rather than sterile water. This doesn't surprise me, because sometimes if I have a sinus infection, I add coli to my saline sinus rinses. Once or twice I have added the coli to distilled water and forgot to add the salt packet, and the coli and water burned my sinuses terribly. It feels to me like the salt neutralizes the irritation.

Martha

 

[occupyjapan]

Have a compound pharma mix it for you. I use foundcare.com. No, I don't work for them. Ask about the Pari Trio.

Nope. Definitely don't do this. Pre-mixed colistin has been linked to deaths. Colistin is made of two components: colistin A and colistin B. The longer it sits around mixed, the more colistin A builds up, which can damage your lungs; it's the component that is irritating your lungs and things even now - it's just in such small quantities that all it does is irritate rather than damage currently. If it sits around too long, too much colistin A builds up and can cause severe, fatal lung damage rather than just irritation. The vials of colistin you mix yourself say to throw it out after 24 hours of it being mixed, even if refrigerated, so I don't know why people getting premixed, compounded colistin that is going to sit around for several weeks is even an option.

More info here: http://www.fda.gov/Drugs/DrugSafety...ormationforPatientsandProviders/ucm124896.htm