Adult: 4 mg/kg daily for 14 days via slow IV infusion or IM inj.
Pneumocystis (carinii) jirovecii pneumonia:
In life threatening cases: 4 mg/kg once daily for 7-10 days then on alternate days for the remaining 14-dose course. In less severe cases: 4 mg/kg on alternate days for 14 doses.
IM: Reconstitute with 3 mL of sterile water for injection. IV: Initially, reconstitute with 3-5 mL of sterile water for injection or 5% dextrose in water. Further dilute with 50-250 mL of 5% dextrose in water or 0.9% NaCl. Inhalation: Reconstitute with 6 mL of sterile water for injection.
Incompatible with foscarnet.
Patient with CV disease, long QT syndrome, history of ventricular arrhythmias, bradycardia, hypotension, hypertension, haematologic disorders (e.g. anaemia, leucopenia, thrombocytopenia), diabetes mellitus, hypoglycaemia, hyperglycaemia, hypocalcaemia, hypokalaemia, hypomagnesaemia, pancreatic disease, elevated amylase or lipase levels, asthma. Renal and hepatic impairment. Pregnancy and lactation.
Significant: Extravasation, ulcerations, tissue necrosis, hyperkalaemia, hypocalcaemia, hypomagnesaemia, hypertension, hypotension, ventricular tachycardia, QT prolongation, torsades de pointes, hyperglycaemia, pancreatic islet cell necrosis with hyperinsulinaemia, anaemia, leucopenia, thrombocytopenia; bronchospasm, cough, extrapulmonary infection with P. jirovecii. Gastrointestinal disorders: Nausea, vomiting, anorexia, dysgeusia. General disorders and administration site conditions: Discomfort and pain to indurations, abcess formation, muscle necrosis. Metabolism and nutrition disorders: Anorexia. Nervous system disorders: Dizziness, syncope. Renal and urinary disorders: Renal insufficiency, azotaemia. Reproductive system and breast disorders: Shortness of breath, wheezing. Skin and subcutaneous tissue disorders: Rash. Vascular disorders: Flushing. Potentially Fatal: Severe hypotension, hypoglycaemia, acute pancreatitis, cardiac arrhythmia.
Monitor ECG, blood pressure, LFTs, BUN, serum bilirubin, transaminases, renal function, blood glucose, serum electrolytes (e.g. K, Ca, Mg), haematologic status (e.g. CBC and platelets).
Increased risk of arrhythmias with medicines that prolong QT interval (e.g. erythromycin, amiodarone, terfenadine, fluoroquinolones, phenothiazines, TCAs). Increased risk of hypocalcaemia with foscarnet. Increased risk of pancreatitis with didanosine, stavudine, zalcitabine. Increased risk of hyperkalaemia with K sparing diuretics.
Description: Pentamidine, an aromatic diamidine derivative, antiprotozoal agent that acts by inhibition of oxidative phospohorylation and/or interference with the incorporation of nucleotides and nucleic acid into RNA and DNA. Pharmacokinetics: Absorption: Well absorbed (IM); Limited systemic absorption (inhalation). Distribution: Widely distributed in the body with high concentrations specifically in liver, kidney, adrenals, spleen, lungs, and pancreas. Excretion: Via urine (as unchanged drug). Elimination half-life: 5-8 hours (IV); 7-11 hours (IM).
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