The cistophorus was introduced at Pergamon sometime between 200 and 160 B.C. to provide the Attalid kingdom with a substitute for Seleucid coins and the tetradrachms of Philetairos. The denomination was also struck by other cities under Attalid control. The denomination owes its name to cista mystica, the sacred chest of Dionysus, on the obverse. It was valued at four drachms but weighed only 12.75 grams, as much as three Attic drachms (the most important weight standard of the time). Hoard evidence suggests that they did not travel outside the area which Pergamon controlled, indicating they were valued higher within that area. Cistophori continued to be minted and circulated down to the time of Hadrian, long after the kingdom was bequeathed to Rome in 133 B.C. The portrait of Augustus and later emperors replaced the cista on the obverse.

The cista mystica was a basket used for housing sacred snakes in connection with the initiation ceremony into the cult of Bacchus (Dionysus). In the Dionysian mysteries a snake, representing the god and possibly symbolic of his phallus, was carried in a cista mystica on a bed of vine leaves. The cista in the mysteries of Isis may also have held a serpent, perhaps associated with the missing phallus of Osiris.