Pentamidine (Systemic)

• If you have an allergy to pentamidine or any other part of pentamidine (systemic).
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.

This medicine may interact with other drugs or health problems.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this medicine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

• Pentamidine Diisetionate
• Pentamidine Isethionate
• Pentamidine Isetionate

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Injection, as isethionate:

Pentam: 300 mg (1 ea)

• Pentam

Do not use sodium chloride for initial reconstitution (sodium chloride will cause precipitation).

IM: Reconstitute with 3 mL SWFI; IV: Reconstitute with 3 to 5 mL SWFI or D5W; the manufacturer recommends further dilution in 50 to 250 mL D5W; however, stability with further dilution in NS has also been documented.

Concerns related to adverse effects:

• Hypotension: Severe hypotension (some fatalities) has been observed, even after a single dose. May occur with either IV or IM administration, although more common with rapid IV administration. Monitor blood pressure during (and after) infusion.

• QT prolongation: May cause QT prolongation and subsequent torsade de pointes; avoid use in patients with diagnosed or suspected congenital long QT syndrome.

• Stevens-Johnson syndrome: Has been reported with use.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with preexisting cardiovascular disease; hyper-/hypotension and arrhythmia, including ventricular tachycardia (eg, torsade de pointes) have been reported.

• Diabetes: Use with caution in patients with diabetes mellitus; hyper-/hypoglycemia and pancreatic islet cell necrosis with hyperinsulinemia has been reported. Symptoms may occur months after therapy; monitor blood glucose daily on therapy and periodically thereafter.

• Extravasation: Intravenous pentamidine is an irritant with vesicant-like properties. Ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. Ulceration, tissue necrosis, and/or sloughing have been reported with extravasation.

• Hematologic disorders: Use with caution in patients with current evidence and/or prior history of hematologic disorders; anemia, leukopenia and/or thrombocytopenia have been reported. Concurrent use with other bone marrow suppressants may increase the risk for myelotoxicity.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Hypocalcemia: Use with caution in patients with hypocalcemia.

• Pancreatitis: Use with caution in patients with a history of pancreatic disease or elevated amylase/lipase levels; acute pancreatitis (with fatality) has been reported. Discontinue pentamidine if signs/symptoms of acute pancreatitis occur.

• Renal impairment: Use with caution in patients with renal impairment.

Concurrent drug therapy issues:

• Drugs with QT prolongation potential: Avoid concurrent use with other drugs known to prolong QTc interval.

• Nephrotoxic drugs: Concurrent use with other nephrotoxic drugs may increase the risk for nephrotoxicity.