Pentamidine

Administration

  • Type: Antifungal Agent; Antiprotozoal
  • Routes of Administration: IM, IV
  • Common Trade Names: Pentam

Adult Dosing

  • PCP treatment, mod-severe: 4mg/kg IV/IM QD x21 days
    • Not 1st-line agent; may consider decreasing dose to 3mg/kg IV/IM QD if toxicities occur
  • PCP prophylaxis: 300mg NEB q4wk
    • Not 1st-line agent; use injectable product via nebulizer; reconstitute 1 vial with 6 mL sterile water; do not mix with other nebulized meds
    • Off label use

Pediatric Dosing

  • PCP treatment [for >4 mo]: 4mg/kg IV/IM QD x21 days
    • Not 1st-line agent
    • Consider decreasing dose to 3mg/kg IV/IM QD if toxicities occur
    • Switch to PO regimen to complete course if improvement after 7-10 days
  • PCP prophylaxis [>5 yo]: 300mg NEB q4wk
    • Not 1st-line agent
    • Use injectable product via nebulizer; reconstitute 1 vial with 6 mL sterile water
    • Do not mix with other nebulized meds
    • Off label use

Special Populations

  • Pregnancy Risk Factor C

Renal Dosing

  • CrCl <10: give q24-36h
  • HD: give 750mg supplement
  • PD: no supplement

Hepatic Dosing

  • Caution advised with hepatic impairment

Contraindications

  • Allergy to class/drug
  • congenital long QT syndrome
  • electrolyte abnormalities, uncorrected
  • caution if QT prolongation

Adverse Reactions

Serious

  • extravasation/tissue damage
  • hypoglycemia
  • hyperglycemia
  • diabetes mellitus
  • pancreatitis
  • nephrotoxicity

Common

  • renal dysfunction
  • BUN, creatinine elevated
  • injection site necrosis
  • leukopenia
  • transaminitis

Pharmacology

  • Half-life: 2-4 weeks
  • Metabolism: Liver
  • Excretion: Urine

Mechanism of Action

protozocidal - interferes with nuclear metabolism

See Also

  • PCP pneumonia

References

<Epocrates, UpToDate>

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