pentamidine

IM:

REMS

IV: Treatment of Pneumocystis jirovecii pneumonia (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 Use:

Inhaln: Treatment of PJP.

Contraind./Precautions ⬆ ⬇

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: Safety not established during pregnancy; breast feeding not recommended.

Adv. Reactions/Side Effects ⬆ ⬇

For parenteral form, unless otherwise indicated

EENT: inhalationburning in throat

Neuro: anxiety, headache, confusion, dizziness, hallucinations

Resp: inhalationbronchospasm, 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: IVphlebitis, pruritus, urticaria at IV site, IMsterile abscesses at IM sites

Misc: ANAPHYLAXISALLERGIC REACTIONS INCLUDING , STEVENS-JOHNSON SYNDROME, chills, fever

Interactions ⬆ ⬇

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.

Availability ⬆ ⬇

(Generic available)

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

Route/Dosage ⬆ ⬇

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).

Renal Impairment

IV (Adults ): CCr 10–30 mL/min- Administer normal dose q 24 hr; CCr <10 mL/min- Administer normal dose q 48 hr.

US Brand Names ⬆ ⬇

NebuPent, Pentam 300

Action ⬆ ⬇

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

Therapeutic effects:

Death of susceptible organism.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacokinetics ⬆ ⬇

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).

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
IV	unknown	end of infusion	24 hr
Inhaln	unknown	unknown	unknown

Patient/Family Teaching ⬆ ⬇

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.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

13925- Seton Pharmaceuticals
- 13925-515- Pentamidine Isethionate
  - 13925-515-10- 10 VIAL in 1 TRAY (13925-515-10) > 300 mg in 1 VIAL

13925- Seton Pharmaceuticals
- 13925-522- Pentamidine Isethionate
  - 13925-522-01- 1 VIAL in 1 CARTON (13925-522-01) > 300 mg in 1 VIAL

63323- Fresenius Kabi USA, LLC
- 63323-113- Pentam 300
  - 63323-113-10- 10 VIAL in 1 TRAY (63323-113-10) > 3 mL in 1 VIAL

63323- Fresenius Kabi USA, LLC
- 63323-877- NebuPent
  - 63323-877-15- 1 VIAL, SINGLE-DOSE in 1 CARTON (63323-877-15) > 6 mL in 1 VIAL, SINGLE-DOSE

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Indications ⬇