COLOMYCIN TABLETS

Colistin Sulphate BP 1.5MU per tablet.

Tablet.

For the treatment of gastrointestinal infections caused by sensitive Gram negative organisms. Also for bowel preparation.

Colistin sulphate is not absorbed from the gastrointestinal tract and must not, therefore, be used for systemic infections.

To be taken orally.

Adults (including the elderly) (over 30kg):

1,500,000 to 3,000,000 units every 8 hours.

Children (15-30kg):

750,000 to 1,500,000 units every 8 hours.

Children (under 15kg):

Colomycin tablets are not suitable for children under 15kg, because an appropriate dose cannot be delivered from a 1,500,000 unit tablet presentation.

A minimum of five days treatment is recommended. Dosage may be increased when clinical or bacteriological response is slow.

For bowel preparation, a 24 hour course at the normal dosage above is given. Treatment should preferably finish 12 hours before surgery.

Contra-indicated in patients with known sensitivity to colistin and those with myasthenia gravis.

Colistin is subject to limited and unpredictable absorption from the GI tract in infants under six months. Studies in older children and in adults have demonstrated no systemic absorption of colistin following oral administration.

Nevertheless, caution should be employed in the use of the preparation in patients with renal failure, patients receiving curari-form muscle relaxants and patients with porphyria.

Neurotoxicity has been reported in association with the concomitant use of either curariform agents or antibiotics with similar neurotoxic effects.

Therapy need not be discontinued and reduction of dosage may alleviate symptoms.

An in vitro study with colistin sulphate found that it became markedly and irreversibly bound to sucralfate at the pH values found in the gut. This suggests that efficacy for gut decontamination or gastrointestinal infections might be decreased.

Safety in human pregnancy has not been established. Animal studies do not indicate teratogenic properties; however, parenteral single dose studies in human pregnancy show that Colomycin crosses the placental barrier and there is a risk of foetal toxicity if repeated doses are given to pregnant patients. Colomycin should only be used in pregnancy if the potential benefit justifies the potential risk.

Colomycin is secreted in breast milk and patients to whom the drug is administered should not breast-feed an infant.

No specific warnings.

No significant systemic absorption has been found to occur in older children and adults following oral administration nor have any systemic side effects been reported.

However, since the use of colistin may be associated with unpredictable, albeit limited, absorption in infants under 6 months the potential adverse effects of systemic administration should be noted for this patient population. These adverse effects may include transient sensory disturbances such as perioral parasthesia and vertigo.

Neuro-toxicity and adverse effects on renal function have been reported in association with systemic over-dosage, failure to reduce dosage in patients with renal insufficiency and the concomitant use of either curariform agents or antibiotics with similar neurotoxic effects. Therapy need not be discontinued and reduction of dosage may alleviate symptoms. Permanent nerve damage such as deafness or vestibular damage has not been reported.

No symptoms of overdosage have been reported following oral use of colistin. However, following systemic administration overdosage can result in renal insufficiency, muscle weakness and apnoea and this should be borne in mind in the oral therapy of infants under 6 months old (see 'Undesirable Effects' above).

There is no specific antidote. Manage by supportive treatment and measures to increase the rate of elimination of colistin, e.g. mannitol diuresis, prolonged haemodialysis or peritoneal dialysis.

Colistin is a polypeptide antibiotic derived from Bacillus polymyxa var. colistinus.

It possesses a rapid bactericidal activity against a number of Gram-negative organisms, including Pseudomonas aeruginosa and is largely free from the development or transference of resistance.

Studies on the gastrointestinal absorption of colistin have shown no significant systemic absorption following oral administration in adults and older children.

Limited and unpredictable absorption is, however, evident in infants under 6 months.

There are no preclinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.

Microcrystalline cellulose

Starch (maize)

Colloidal silicon dioxide

Cutina HR.

None stated.

5 years.

Do not store above 25°C. Store in the original container.

Plastic container of 50 tablets.

None stated.

Forest Laboratories UK Limited

Riverbridge House

Anchor Boulevard

Crossways Business Park

Dartford

Kent

U.K.

PL 0108/5008R

30 May 1986 / 11 July 1996

January 2012

POM