How is Cayston® used?
Cayston® is an inhaled antibiotic. It is used to improve breathing in people with Cystic Fibrosis
(CF) who have Pseudomonas aeruginosa (P. aeruginosa) in their lungs.
What supplies do I need?
At this time, only certain specialty pharmacies are dispensing Cayston®. With the first shipment
of Cayston, you will receive a carton of 28 amber-colored Cayston vials, 32 ampules of saline
(diluent) and a free Altera® nebulizer with 2 handsets. The 4 extra ampules of saline are in case
Are there any side effects?
Do not take if you are allergic to aztreonam.
ξ Severe allergic reactions. Stop your treatment with Cayston® and call your doctor right
away if you have any symptoms of an allergic reaction which include:
o rash or swelling of your face
o throat tightness
ξ Trouble breathing right after treatment with Cayston® (bronchospasm). To decrease the
chance of this happening, be sure to use your inhaled bronchodilator medicine before
each treatment with Cayston®. See “How is the treatment done?”
ξ Other common side effects include:
o Stuffy nose
o Sore throat
o Fever (may be more common in children)
o Chest discomfort
o Stomach area (abdominal) pain
Tell your doctor if you have any new or worsening side effects while taking Cayston®.
How is Cayston® prepared for inhalation?
1. Before beginning, wash your hands with soap and warm water, or use anti-bacterial hand
gel, to reduce the risk of infection.
2. Mix (reconstitute) Cayston® with the saline only when ready to take a dose. Take one
amber vial of Cayston® and one ampule of saline from the carton. Gently pull the saline
3. Look at the ampule of saline. If it looks cloudy, do not use it. Throw it away and get
another ampule of saline.
4. Gently tap the vial so the powder settles to the bottom. This helps you get the proper
dose of medicine. Open the amber drug vial by lifting up the metal flap on the top and
pulling down to carefully remove the entire metal ring from the vial. Safely dispose of
the ring in household garbage. Carefully remove the rubber stopper.
5. Open the ampule of saline by twisting off the tip. Squeeze the contents completely into
the vial. Next, close the vial with the rubber stopper. Gently swirl the vial until the
powder has completely dissolved and the liquid is clear.
6. After mixing the vial with the saline, check to make sure the diluted medicine is clear. If
it is cloudy or has particles in it, do not use this medicine. Throw away this dose and
start over again with a new vial of Cayston® and a new ampule of saline.
7. Use Cayston® right away after you mix it with the saline.
How is the treatment done?
Cayston® should only be used with the Altera® Nebulizer Handset. You should use a
bronchodilator before taking the Cayston® treatment. See the manufacturer’s insert that comes
with your Altera® Nebulizer System for complete instructions on taking a treatment.
ξ Cayston® should not be mixed with any other drugs.
ξ Take all of your medicine and airway clearance treatments in the following order. If you
have not been prescribed a certain medicine you can skip that step. Please follow any
specific orders you have been given from your doctor.
1. Bronchodilator (Albuterol)
2. Hypertonic Saline (Hyper-Sal™)
3. DNase (Pulmozyme®)
4. Airway clearance (Vest, Acapella, Flutter, Manual Chest Physiotherapy)
5. Asthma Controller Medications (Flovent®, Advair, Symbicort)
6. Aerosolized antibiotic (Cayston®, TOBI®, Colistin)
ξ Make sure the handset is on a flat, stable surface.
ξ Remove the rubber stopper from the vial. Pour all of the mixed Cayston® and saline into
the medicine reservoir of the handset. Be sure to completely empty the vial. Gently tap
the vial against the side of the medicine reservoir if needed. Close the medicine
ξ Begin your treatment by sitting in a relaxed, upright position. Hold the handset level.
Place the mouthpiece in your mouth. Close your lips around it.
ξ Breathe in and out normally (inhale and exhale) through the mouthpiece. Do not breathe
through your nose. Continue to inhale and exhale comfortably until the treatment is
ξ The empty vial, stopper, and saline ampule should be thrown away in household garbage
when you have finished the treatment.
How often are treatments done?
The dose of Cayston® for both adults and children 7 years of age and older is one vial of
Cayston® mixed with one ampule of saline 3 times a day.
Doses of Cayston® should be taken at least four hours apart.
Cayston® should be taken for 28 days followed by at least 28 days off. It is important for
you to finish the full 28-day course of Cayston® even if you are feeling better. If you
skip a dose or do not finish the full 28-day course, your infection may not be fully
How do I clean and disinfect my Altera® Nebulizer Handset?
Disconnect the Handset from the nebulizer connection cord. Remove the medicine cap from the
medicine reservoir. Remove the mouthpiece from the aerosol chamber. Gently pull up on the
tab of the medicine reservoir to release the aerosol chamber. Remove the inhalation valve from
the aerosol chamber. Be careful! Only touch the plastic outer ring, not the center.
The Handset needs to be cleaned in sterile water as soon as possible after every treatment. To
make sterile water, boil your tap water for 5 minutes. Let the water cool. You can make up a
gallon of water at a time, but only use it once. Do not pour used water back into the gallon.
Can I use tap water to clean and disinfect my Altera® Nebulizer Handset?
No. Tap water can contain bacteria as well as damage the Handset. You must use sterile water.
To clean after each use
1. Rinse each of the disassembled parts for 10 seconds under warm running tap water.
Rinse the inhalation valve for 10 seconds on each side under warm running tap water.
2. Fill a bowl of warm sterile water and add 1 drop of clear dishwashing soap. Avoid white
soap such as Ivory® because it leaves a residue on equipment. Gently wash all the
disassembled parts and rinse with sterile water.
3. Let them air dry on a towel until they are needed for the evening treatment.
The Handset needs to be disinfected every day. Make sure you have cleaned Handset before
To disinfect every day
Electric steam sterilizer such as a baby bottle steamer (one that has a 6-8 minute steam cycle)
Cold method: Control III
1. Control III
2. Soak in 3% hydrogen peroxide for 30 minutes
3. Rinse: When using the cold method rinse afterward. Rinse using sterile water.
To make water sterile: Heat a bowl of water for 5 minutes; this will remove any
impurities from the water. Let cool. Do not save this water.
The CF Foundation website has an excellent step by step 4 minute video on U-Tube called
“Cleaning and Disinfecting Your Altera® Nebulizer”
How should I store Cayston®?
Each kit contains enough vials of Cayston® and ampules of saline for 28 days of
treatment. There are 4 extra saline ampules in case some saline spills.
Always keep your Cayston® and saline together.
Store Cayston® and saline in the refrigerator at 36° F to 46° F (2° C to 8° C) until needed.
When you remove Cayston® and saline from the refrigerator, they may be stored at room
temperature (less than 77° F) for up to 28 days. Do not use any Cayston® that has been
stored at room temperature for more than 28 days.
Keep Cayston® away from light.
Do not use Cayston® or the saline after the expiration date.
Keep Cayston® and all medicines out of reach of children.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 3/2017 University of Wisconsin Hospital
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7020