• IV, IM: Treatment of Pneumocystis jiroveciipneumonia (PJP).
• Inhaln: Prevention of PJP in AIDS or HIV-positive patients who have had PJP or who have a peripheral CD4 lymphocyte count of 200/mm³.

Unlabeled Uses:

• Inhaln: Treatment of PJP.

Contraindicated in:

• History of previous anaphylactic reaction to pentamidine.

Use Cautiously in:

• Hypotension
• Hypertension
• Hypoglycemia
• Hyperglycemia
• Hypocalcemia
• Leukopenia
• Thrombocytopenia
• Anemia
• Renal impairment (dose ↓ required)
• Diabetes mellitus
• Liver impairment
• Cardiovascular disease
• Bone marrow depression, previous antineoplastic therapy, or radiation therapy
• Asthma (aerosol can induce bronchospasm)
• OB: Lactation: Safety not established during pregnancy; breast feeding not recommended.

For parenteral form, unless otherwise indicated

EENT: inhalation: burning in throat.

Neuro: anxiety, headache, confusion, dizziness, hallucinations.

Resp: inhalation: bronchospasm, cough.

CV: ARRHYTHMIAS, hypotension, chest pain.

GI: PANCREATITIS, abdominal pain, anorexia, drug-induced hepatitis, nausea, unpleasant metallic taste, vomiting.

GU: nephrotoxicity.

Derm: pallor, rash.

Endo: hypoglycemia, hyperglycemia.

F and E: hyperkalemia, hypocalcemia.

Hemat: anemia, leukopenia, thrombocytopenia.

Local: IV: phlebitis, pruritus, urticaria at IV site.
IM: sterile abscesses at IM sites.
Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME, chills, fever.

Interactions listed for parenteral administration

Drug-Drug:

• Concurrent use with erythromycin IV may ↑ risk of potentially fatal arrhythmias.
• Additive nephrotoxicity with other nephrotoxic agents, including aminoglycosides, amphotericin B, and vancomycin.
• Additive bone marrow depression with antineoplastics or previous radiation therapy.
• ↑risk of nephrotoxicity, hypocalcemia, and hypomagnesemia with foscarnet.

(Generic available)

• Powder for injection: 300 mg/vial;
• Solution for aerosol use (NebuPent): 300 mg;

• IV, IM (Adults and Children >5 mo): 4 mg/kg once daily for 14–21 days (longer treatment may be required in AIDS patients; some patients may respond to 3 mg/kg/day).
• Inhaln (Adults): NebuPent: 300 mg q 4 wk, using a Respirgard II jet nebulizer (150 mg q 2 wk has also been used).
• Inhaln (Children >5 yr): NebuPent: 300 mg q 4 wk, using a Respirgard II jet nebulizer (for patients who cannot tolerate trimethoprim/sulfamethoxazole; unlabeled).

NebuPent, Pentam 300

• Appears to disrupt DNA or RNA synthesis.
• Also has a direct toxic effect on pancreatic islet cells.

• Death of susceptible organism.

Therapeutic Classification: anti-infectives

Absorption: Well absorbed parenterally; Minimal systemic absorption occurs following inhalation.

Distribution: Widely and extensively distributed but does not cross the blood-brain barrier. Concentrates in liver, kidneys, lungs, and spleen, with prolonged storage in some tissues.

Metabolism/Excretion: 1–30% excreted unchanged by the kidneys. Remainder of metabolic fate unknown.

Half-life: 5–11 hr (↑ in renal impairment).

(blood levels)

• Inform patient of the importance of completing the full course of pentamidine therapy, even if feeling better.
• IV: Instruct patient to notify health care professional promptly if signs and symptoms of pancreatitis, rash, fever; sore throat; signs of infection; bleeding of gums; unusual bruising; petechiae; or blood in stool, urine, or emesis occurs. Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Patient should not be given IM injections or rectal thermometers. Caution patient not to drink alcoholic beverages or take medication containing aspirin or NSAIDs, as these may precipitate gastric bleeding.
  • Caution patient to make position changes slowly to minimize orthostatic hypotension.
• Inhaln: Advise patient that an unpleasant metallic taste may occur with pentamidine administration but is not significant.
  • Inform patients who continue to smoke that bronchospasm and coughing during therapy are more likely.

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