Pentamidine isetionate


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV/IM African trypanosomiasis For early stage infection due to Trypanosomabrucei gambiense 4 mg/kg/day or on alternate days. Total: 7-10 doses. Pneumocystis (carinii) jiroveci pneumonia 4 mg/kg once daily for ≥14 days. IM Visceral leishmaniasis 3-4 mg/kg on alternate days. Max: 10 inj. May repeat course if needed. Cutaneous leishmaniasis 3-4 mg/kg 1-2 times/wk until condition resolves. Inhalation Prevention of P. (carinii) jiroveci pneumonia For HIV-positive patients: Nebulise 300 mg 4 wkly or 150 mg 2 wkly. Mild to moderate P. (carinii) jirovecii infection 600 mg/day for 3 wk via nebulisation.
Dosage Details
Inhalation/Respiratory
Mild to moderate P. (carinii) jiroveciii infection
Adult: 600 mg daily for 3 wk via nebulisation.
Child: 1 mth-18 yr: 600 mg once daily for 3 wk. For secondary prevention: 300 mg every 4 wk or 150 mg every 2 wk.

Inhalation/Respiratory
Prophylaxis of Pneumocystis (carinii) jirovecii pneumonia
Adult: In HIV-positive patients: 300 mg once every 4 wk. For patients who cannot tolerate this dose: 150 mg every 2 wk.
Child: 1 mth- 18 yr: 300 mg every 4 wk or 150 mg every 2 wk via suitable nebuliser.

Intramuscular
Leishmaniasis
Adult: For visceral leishmaniasis or mucocutaneous leishmaniasis due to Leishmanis braziliensis or L. aethiopica: 4 mg/kg 3 times wkly for 5-25 wk or longer. Alternative treatment: for visceral leishmaniasis: 3-4 mg/kg on alternate days up to a max of 10 inj, may repeat course; for cutaneous leishmaniasis due to L. aethiopica or L. guyanensis: 3-4 mg/kg 1-2 times wkly until resolution of the condition; for diffuse cutaneous leishmaniasis due to L. aethiopica: 3-4 mg/kg wkly, continue for at least 4 mth after parasites are no longer detectable on skin smears.
Child: 1 mth-18 yr: For visceral leishmaniasis: 3-4 mg/kg on alternate days; max: 10 inj; may repeat course if necessary. Dose to be given via deep IM inj. For cutaneous leishmaniasis: 3-4 mg/kg 1-2 times wkly until condition resolves.

Parenteral
Pneumocystis (carinii) jirovecii pneumonia
Adult: 4 mg/kg once daily for 14 days or longer, by IM inj or preferably slow IV infusion.
Child: 1 mth-18 yr: 4 mg/kg once daily for at least 14 days.

Parenteral
African trypanosomiasis
Adult: For early stage infection due to Trypanosomabrucei gambiense: 4 mg/kg daily or on alternate days by IM inj or IV infusion for a total of 7-10 doses. Not effective for trypanosomiasis involving CNS but 2 doses may be given in late-stage infection prior to starting treatment with eflornithine or melarsoprol.
Child: 1 mth- 18 yr: 4 mg/kg daily or on alternate days by IM inj or IV infusion; total of 7-10 doses.
Renal Impairment
Inhalation:
Mild to moderate P. (carinii) jiroveciii infection: Dose adjustment may be needed.
Prophylaxis of Pneumocystis(carinii) jirovecii pne...:
CrClDosage
<10Administer dose every 48 hr.
10-50Administer dose every 24-36 hr.
Intramuscular:
Dose adjustment may be needed.
Parenteral:
Pneumocystis (carinii) jirovecii pneumonia:
CrClDosage
<10Administer dose every 48 hr.
10-50Administer dose every 24-36 hr.
African trypanosomiasis: Dose adjustment may be needed.
Reconstitution
Inhalation:
Prophylaxis of Pneumocystis(carinii) jirovecii pne...: Reconstitute: 600mg in 6 ml of water.
Intramuscular:
Reconstitute with water for injection according to manufacturers instructions.
Parenteral:
For IV administration: 300mg reconstituted with 3-5 ml of water for inj and dilute with 50-250 ml of 5% glucose or 0.9% sodium chloride.
Incompatibility
Inhalation:
Prophylaxis of Pneumocystis(carinii) jirovecii pne...: Reconstituted solutions must not be mixed with anything apart from water for inj, 5% glucose or 0.9% sodium chloride. Should not be mixed with other drugs or be administered with a bronchodilator in the same nebuliser.
Intramuscular:
Once reconstituted, do not mix with anything apart from water for inj, 5% glucose or 0.9% sodium chloride.
Parenteral:
Once reconstituted, do not mix with anything apart from water for inj, 5% glucose or 0.9% sodium chloride. At Y-site: aldesleukin, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, fluconazole, foscarnet, linezolid.
Special Precautions
History of asthma, smoking, hypokalaemia, hypomagnesaemia, coronary heart disease, bradycardia, history of ventricular arrhythmias, concomitant use with other drugs which prolong QT interval (if QTc interval >550 msec: consider alternative therapy), hypertension or hypotension, hyperglycaemia or hypoglycaemia, leucopenia, thrombocytopenia, anaemia, hepatic and renal impairment. Patients at risk of pneumothorax with nebulised therapy. Pregnancy and lactation. Patients should remain supine during admin due to risk of severe hypotension following admin. Monitor: BP, hepatic and renal function, blood-glucose and serum-calcium concentrations, blood counts and ECG. Direct IV inj should be avoided where possible and given slowly (at least 60-120 min); IM inj should be deep and administered in the buttocks.
Adverse Reactions
Impaired renal function, acute renal failure, raised liver enzymes and haematological disturbances eg, leucopenia, anaemia, thrombocytopenia. Hypoglycaemia followed by hyperglycaemia and type 1 DM; acute pancreatitis. IM/IV: Sudden hypotension. IV (rapid injection): Dizziness, headache, vomiting, breathlessness, tachycardia and fainting. IM: Pain, swelling, rhabdomyolysis, sterile abscess formation and tissue necrosis at site of inj. Inhalation: Cough and bronchoconstriction; bitter taste. Hypocalcaemia, hyperkalaemia, skin rashes, fever, flushing, convulsions, hallucinations, GI effects e.g., nausea, vomiting, taste disturbances, abdominal pain and anorexia.
Potentially Fatal: Cardiac arrhythmias, sudden hypotension; hypoglycaemia; pancreatitis; Stevens-Johnson syndrome, nephrotoxicity (in up to 25% of patients with pneumocystis pneumonia receiving parenteral treatment).
IM/Inhalation/Respiratory/IV/Parenteral: C
Overdosage
Symptoms: cardiac rhythm disorders, including torsades de pointes. Treatment: symptomatic.
Drug Interactions
Increases risk of ventricular arrhythmias with amiodarone or levacetylmethadol. Increases risk of hypocalcaemia with foscarnet. Nephrotoxic drugs e.g. amphotericin B; increased risk of CNS depression and hypoglycaemic aggravation with alcohol; aminoglutethimide, carbamazepine, phenytoin, rifampicin may decrease levels of pentamidine; omeprazole, delavirdine, fluconazole, fluvoxamine, gemfibrozil, isoniazid, ticlopidine may increase levels of pentamidine.
Potentially Fatal: Increased risk of QT interval prolongation with phenothiazines, TCAs, terfenadine, astemizole, IV erythromycin, halofantrine and quinolone antibiotics.
Action
Description: Pentamidine isetionate inhibits oxidative phosphorylation and interferes with nucleotides and nucleic acid incorporation into the DNA/RNA, thus interfering with DNA/RNA, phospholipids and protein synthesis of susceptible protozoa.
Pharmacokinetics:
Absorption: IM: Absorbed well; inhalation: Limited systemic absorption.
Distribution: IV: rapid (except to lung). Volume of distribution greater after IM administration.
Excretion: Elimination half life: IV: 6 hr; IM: 9 hr (may be prolonged in renal impairment; excretion via urine (33-66% as unchanged drug).
Storage
Inhalation:
Prophylaxis of Pneumocystis(carinii) jirovecii pne...: Before reconstitution: protect from light and keep at room temperature (do not refrigerate as crystals may form); once reconstituted: store at 2-8 °C and use within 24 hr.
Intramuscular:
Before reconstitution: protect from light and keep at room temperature (do not refrigerate as crystals may form); once reconstituted: store at 2-8 °C and use within 24 hr.
Parenteral:
Before reconstitution: protect from light and keep at room temperature (do not refrigerate as crystals may form); once reconstituted: store at 2-8 °C and use within 24 hr.
Disclaimer: This information is independently developed by MIMS based on Pentamidine isetionate from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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