pentamidine (Rx)

Brand and Other Names:NebuPent, Pentam
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 300mg

powder for nebulizer solution

  • 300mg
more...

Pneumocystis Jiroveci Pneumonia

Treatment: 4 mg/kg IV/IM qDay for 14-21 days 

Prophylaxis: 4 mg/kg IV/IM q2-3Weeks OR

Nebulized 300 mg q4Weeks

African Trypanosomiasis (Off-label)

4 mg/kg IM qDay x10 days

Leishmaniasis (Off-label)

Visceral: 2-4 mg/kg IM q24-48hr x 15-30 doses

Cutaneous: 2 mg/kg IV/IM qODay x7 doses OR 3 mg/kg IM qODay x4 doses

Orphan Designations

Pancreatic cancer

Liver and intrahepatic bile duct cancer

Ovarian cancer

Orphan sponsor

  • Oncozyme Pharma, Inc; 555 Rene-Levesque West - 9th Floor; Montreal, Quebec H2Z 1B1, Canada

Renal Impairment

CrCl >10 mL/min: No adjustment necessary

CrCl <10 mL/min: 4 mg/kg IV/IM q24-36hr

Other Information

Monitor: Renal function

Dosage Forms & Strengths

powder for injection

  • 300mg

powder for nebulizer solution

  • 300mg
more...

Pneumocystis Jiroveci Pneumonia

<4 months

  • Safety and efficacy not established

>4 months

  • Treatment: 4 mg/kg IV/IM qDay for 14-21 days
  • Prophylaxis: 4 mg/kg IV/IM q2-3Weeks OR
  • Nebulized 300 mg q4Weeks

African Trypanosomiasis (Off-label)

4 mg/kg IM qDay x10 days

Leishmaniasis (Off-label)

Visceral: 2-4 mg/kg IM q24-48hr x 15-30 doses

Cutaneous: 2 mg/kg IV/IM qODay x7 doses OR 3 mg/kg IM qODay x4 doses

Renal Impairment

CrCl >30 mL/min: No adjustment necessary

CrCl 10-30 mL/min: 4 mg/kg IV/IM q36hr

CrC<10 mL/min: 4 mg/kg IV/IM q48hr

Hemodialysis: 4 mg/kg IV/IM q48hr after dialysis on dialysis day

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Interactions

Interaction Checker

and pentamidine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Injection

            • Increased SCr (23%)
            • IM site reactions (11%)
            • Leukopenia (10.3%)

            Nebulizer

            • Cough (1-63%)
            • Wheezing (32%)
            • Fever (51%)
            • Decreased appetite (50%)
            • Bronchospasm (48%)
            • Fatigue (66%)
            • Infection (15%)

            1-10%

            Injection

            • Anemia
            • Confusion/hallucinations
            • Hypoglycemia
            • Hypotension
            • Elevated LFT's
            • Fever
            • BUN increased
            • Azotemia
            • Anorexia/Nausea/Vomiting
            • Rash
            • Thrombocytopenia

            Nebulizer

            • Bitter/metallic taste
            • Headache
            • Diarrhea
            • Nausea
            • Oral Candida
            • Anemia
            • Pharyngitis
            • Night sweats
            • Upper respiratory tract infection

            <1%

            Anxiety

            Arthralgia

            Blepharitis

            Dizziness

            Neuralgia

            Anemia

            Bronchitis

            Chest tightness

            Colitis

            Blurred vision

            Neutropenia

            Pleuritis

            Rales

            Thrombocytopenia

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Hypotension, QT prolongation, and Stevens-Johnson syndrome reported with use

            Use caution in patients with history of pancreatitis, hyperglycemia, hypoglycemia, hypocalcemia, leukopenia, thrombocytopenia, anemia, hepatic/renal dysfunction

            Risk of nephrotoxicity with parenteral administration

            Risk of sudden, severe hypotension with parentera administration-keep patient supine

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            Pregnancy & Lactation

            Pregnancy Category: C

            There are no adequate and well controlled studies of aerosolized pentamidine in pregnant women; a literature report indicated that pentamidine 4 mg/kg/day IV administered to pregnant rats was embryolethal; teratogenicity was not observed in this study. It is unknown whether aerosolized pentamidine crosses the placenta at clinically significant concentrations

            Lactation: Not known if distributed in breast milk, discontinue drug or do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits synthesis of DNA, RNA, phospholipids, protein by inhibiting oxidative phosphorylation and/or interfering with incorporation of nucleotides and nucleic acids into RNA and DNA

            Pharmacokinetics

            Half-Life: 5.8 hr (IV); 7-11 hr (IM)

            Metabolism: Liver

            Vdss: 286-1356 L (IV); 1658-3790 (IM)

            Excretion: Urine (12%)

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            Administration

            IV Incompatibilities

            Y-site: aldesleukin, cefazolin, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, fluconazole, foscarnet, linezolid

            IV Compatibilities

            Solution: D5W, NS

            Y-site: diltiazem, gatifloxacin, zidovudine

            IV Preparation

            Reconstitute w/ 3-5 mL SWI or D5W (do not use NS)

            Reconstituted solutions (60-100 mg/mL) stable for 48 hr at room temp; keep between 22-30°C to prevent crystallization

            For IV infusion, dilute in 50-250 mL D5W (stable at room temp for 24 hr)

            IV/IM Administration

            IM: deep IM using Z-track technique

            IV: Slow infusion over 60-120 min

            Pts should be in supine position

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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