• Assess patient for infection (vital signs, sputum, WBC) and monitor respiratory status (rate, character, lung sounds, dyspnea, sputum) at beginning of and throughout therapy.
• Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.
• Assess for rash periodically during therapy. May cause Stevens-Johnson syndrome or toxic epidermal necrolysis. Discontinue therapy if severe or if accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia.
• IV: IM: Monitor BP frequently during and following IM or IV administration of pentamidine. Patient should be lying down during administration. Sudden, severe hypotension may occur following a single dose. Resuscitation equipment should be immediately available.
• Assess patient for signs of hypoglycemia (anxiety; chills; diaphoresis; cold, pale skin; headache; increased hunger; nausea; nervousness; shakiness) and hyperglycemia (drowsiness; flushed, dry skin; fruit-like breath odor; increased thirst; increased urination; loss of appetite), which may occur up to several mo after therapy is discontinued.
• Pulse and ECG should be monitored prior to and periodically during therapy. Fatalities due to cardiac arrhythmias, tachycardia, and cardiotoxicity have been reported.
• Assess patient for signs of pancreatitis (nausea, vomiting, abdominal pain, increased serum lipase, or amylase) periodically during therapy. May require discontinuation of therapy.
• Inhaln: A tuberculin skin test, chest x-ray, and sputum culture should be performed prior to administration to rule out tuberculosis.

Lab Test Considerations:

• IM, IV: Monitor blood glucose concentrations prior to, daily during, and for several mo following therapy. Severe hypoglycemia and permanent diabetes mellitus have occurred.
  • Monitor BUN and serum creatinine prior to and daily during therapy to monitor for nephrotoxicity. Concentrations may be ↑.
  • Monitor CBC and platelet count prior to and every 3 days during therapy. Pentamidine may cause leukopenia, anemia, and thrombocytopenia.
  • May cause ↑ serum bilirubin, alkaline phosphatase, AST, and ALT concentrations. Monitor liver function tests prior to and every 3 days during therapy.
  • Monitor serum calcium and magnesium concentrations prior to and every 3 days during therapy; may cause hypocalcemia and hypomagnesemia.
  • May cause ↑ serum potassium concentrations.