Dosing & Uses
Dosage Forms & Strengths
powder for injection
- 300mg
powder for nebulizer solution
- 300mg
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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (48)
- amiodarone
amiodarone and pentamidine both increase QTc interval. Contraindicated.
- amitriptyline
amitriptyline and pentamidine both increase QTc interval. Contraindicated.
- amoxapine
amoxapine and pentamidine both increase QTc interval. Contraindicated.
- artemether/lumefantrine
artemether/lumefantrine and pentamidine both increase QTc interval. Contraindicated.
- chlorpromazine
chlorpromazine and pentamidine both increase QTc interval. Contraindicated.
- clarithromycin
clarithromycin and pentamidine both increase QTc interval. Contraindicated.
- clomipramine
clomipramine and pentamidine both increase QTc interval. Contraindicated.
- desipramine
desipramine and pentamidine both increase QTc interval. Contraindicated.
- disopyramide
disopyramide and pentamidine both increase QTc interval. Contraindicated.
- dofetilide
dofetilide and pentamidine both increase QTc interval. Contraindicated.
- doxepin
doxepin and pentamidine both increase QTc interval. Contraindicated.
- dronedarone
dronedarone and pentamidine both increase QTc interval. Contraindicated.
- droperidol
droperidol and pentamidine both increase QTc interval. Contraindicated.
- epinephrine
epinephrine and pentamidine both increase QTc interval. Contraindicated.
- epinephrine racemic
epinephrine racemic and pentamidine both increase QTc interval. Contraindicated.
- erythromycin base
erythromycin base and pentamidine both increase QTc interval. Contraindicated.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate and pentamidine both increase QTc interval. Contraindicated.
- erythromycin lactobionate
erythromycin lactobionate and pentamidine both increase QTc interval. Contraindicated.
- erythromycin stearate
erythromycin stearate and pentamidine both increase QTc interval. Contraindicated.
- fluconazole
fluconazole and pentamidine both increase QTc interval. Contraindicated.
- fluphenazine
fluphenazine and pentamidine both increase QTc interval. Contraindicated.
- haloperidol
haloperidol and pentamidine both increase QTc interval. Contraindicated.
- ibutilide
ibutilide and pentamidine both increase QTc interval. Contraindicated.
- imipramine
imipramine and pentamidine both increase QTc interval. Contraindicated.
- indapamide
indapamide and pentamidine both increase QTc interval. Contraindicated.
- ketoconazole
ketoconazole and pentamidine both increase QTc interval. Contraindicated.
- lofepramine
lofepramine and pentamidine both increase QTc interval. Contraindicated.
- lumefantrine
lumefantrine and pentamidine both increase QTc interval. Contraindicated.
- maprotiline
maprotiline and pentamidine both increase QTc interval. Contraindicated.
- moxifloxacin
moxifloxacin and pentamidine both increase QTc interval. Contraindicated.
- nilotinib
nilotinib and pentamidine both increase QTc interval. Contraindicated.
- nortriptyline
nortriptyline and pentamidine both increase QTc interval. Contraindicated.
- octreotide
octreotide and pentamidine both increase QTc interval. Contraindicated.
- octreotide (Antidote)
octreotide (Antidote) and pentamidine both increase QTc interval. Contraindicated.
- perphenazine
perphenazine and pentamidine both increase QTc interval. Contraindicated.
- pimozide
pentamidine and pimozide both increase QTc interval. Contraindicated.
- procainamide
pentamidine and procainamide both increase QTc interval. Contraindicated.
- prochlorperazine
prochlorperazine and pentamidine both increase QTc interval. Contraindicated.
- promazine
promazine and pentamidine both increase QTc interval. Contraindicated.
- promethazine
promethazine and pentamidine both increase QTc interval. Contraindicated.
- protriptyline
protriptyline and pentamidine both increase QTc interval. Contraindicated.
- quinidine
quinidine and pentamidine both increase QTc interval. Contraindicated.
- sotalol
pentamidine and sotalol both increase QTc interval. Contraindicated.
- thioridazine
thioridazine and pentamidine both increase QTc interval. Contraindicated.
- trazodone
trazodone and pentamidine both increase QTc interval. Contraindicated.
- trifluoperazine
trifluoperazine and pentamidine both increase QTc interval. Contraindicated.
- trimipramine
trimipramine and pentamidine both increase QTc interval. Contraindicated.
- ziprasidone
pentamidine and ziprasidone both increase QTc interval. Contraindicated.
Serious - Use Alternative (48)
- apalutamide
apalutamide will decrease the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP2C19 inducer, with drugs that are CYP2C19 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered.
- arsenic trioxide
arsenic trioxide and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- bacitracin
pentamidine and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs
- dasatinib
dasatinib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- dolasetron
dolasetron and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
pentamidine and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.
- escitalopram
escitalopram increases toxicity of pentamidine by QTc interval. Avoid or Use Alternate Drug.
- fedratinib
pentamidine will increase the level or effect of fedratinib by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of fedratinib (a CYP3A4 and CYP2C19 substrate) with dual CYP3A4 and CYP2C19 inhibitor. Effect of coadministration of a dual CYP3A4 and CYP2C19 inhibitor with fedratinib has not been studied.
- fexinidazole
fexinidazole and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
- flecainide
flecainide and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
fluoxetine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- formoterol
formoterol and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
foscarnet and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
pentamidine and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- iloperidone
iloperidone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- ivosidenib
ivosidenib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
- lapatinib
lapatinib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- levofloxacin
levofloxacin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- lonafarnib
pentamidine will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of lonafarnib (a sensitive CYP3A substrate) with weak CYP3A inhibitors is unavoidable, reduce to, or continue lonafarnib at starting dose. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown.
lonafarnib will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling. - macimorelin
macimorelin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
- methadone
methadone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- ofloxacin
ofloxacin and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- ondansetron
pentamidine and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
- paliperidone
paliperidone and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
pentamidine and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
- paroxetine
paroxetine and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- pitolisant
pentamidine and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- posaconazole
pentamidine and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.
- ranolazine
pentamidine and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
ribociclib increases toxicity of pentamidine by QTc interval. Avoid or Use Alternate Drug.
- risperidone
pentamidine and risperidone both increase QTc interval. Avoid or Use Alternate Drug.
- romidepsin
pentamidine and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- saquinavir
saquinavir, pentamidine. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Increased risk of PR or QT prolongation and cardiac arrhythmias.
- sulfamethoxazole
sulfamethoxazole and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- telavancin
pentamidine and telavancin both increase QTc interval. Avoid or Use Alternate Drug.
- trimethoprim
pentamidine and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- tropisetron
pentamidine and tropisetron both increase QTc interval. Avoid or Use Alternate Drug.
- umeclidinium bromide/vilanterol inhaled
pentamidine increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- vandetanib
pentamidine, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
- vemurafenib
vemurafenib and pentamidine both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
- venlafaxine
pentamidine and venlafaxine both increase QTc interval. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
pentamidine increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- voriconazole
pentamidine and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (87)
- alfuzosin
pentamidine and alfuzosin both increase QTc interval. Use Caution/Monitor.
- amikacin
amikacin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- amphotericin B deoxycholate
amphotericin B deoxycholate and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- avapritinib
pentamidine will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- axitinib
pentamidine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- azithromycin
azithromycin and pentamidine both increase QTc interval. Modify Therapy/Monitor Closely.
- bedaquiline
pentamidine and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- canagliflozin
pentamidine and canagliflozin both increase serum potassium. Use Caution/Monitor.
- cannabidiol
cannabidiol will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of sensitive CYP2C19 substrates, as clinically appropriate, when coadministered with cannabidiol.
- carboplatin
carboplatin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- cenobamate
cenobamate will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.
- cidofovir
cidofovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- ciprofloxacin
ciprofloxacin and pentamidine both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.
- cisplatin
cisplatin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- citalopram
pentamidine and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- contrast media (iodinated)
contrast media (iodinated) and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- crizotinib
crizotinib and pentamidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- cyclosporine
cyclosporine and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- elagolix
elagolix will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak CYP2C19 inhibitor. Caution with sensitive CYP2C19 substrates.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
pentamidine and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- eslicarbazepine acetate
eslicarbazepine acetate will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- etravirine
etravirine increases levels of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Potential for increased toxicity.
- ezogabine
ezogabine, pentamidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- fedratinib
fedratinib will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2C19 substrates as necessary.
- fexinidazole
fexinidazole will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.
- finerenone
pentamidine will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or weak CYP3A4 inhibitors. Adjust finererone dosage as needed.
- flibanserin
pentamidine will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased flibanserin adverse effects may occur if coadministered with multiple weak CYP3A4 inhibitors.
- fostemsavir
pentamidine and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemtuzumab
pentamidine and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- glucarpidase
glucarpidase will decrease the level or effect of pentamidine by increasing metabolism. Modify Therapy/Monitor Closely. Leucorvorin, reduced folates, and folate antimetabolites are substrates for glucarpidase (hydrolyzes glutamate residue from folic acid and antifolates)
- goserelin
goserelin increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- histrelin
histrelin increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- hydroxyzine
hydroxyzine increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- ifosfamide
ifosfamide, pentamidine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Monitor renal function.
- indacaterol, inhaled
indacaterol, inhaled, pentamidine. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- insulin aspart
pentamidine, insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin aspart protamine/insulin aspart
pentamidine, insulin aspart protamine/insulin aspart. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin degludec
pentamidine, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Pentamidine may either increase or decrease the blood glucose lowering effect of antidiabetic agents; pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.
pentamidine, insulin degludec. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required. - insulin degludec/insulin aspart
pentamidine, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Pentamidine may either increase or decrease the blood glucose lowering effect of antidiabetic agents; pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.
- insulin detemir
pentamidine, insulin detemir. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin glargine
pentamidine, insulin glargine. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin glulisine
pentamidine, insulin glulisine. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin inhaled
pentamidine, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Pentamidine may either increase or decrease the blood glucose lowering effect of antidiabetic agents; pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.
pentamidine, insulin inhaled. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required. - insulin isophane human/insulin regular human
pentamidine, insulin isophane human/insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin lispro
pentamidine, insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin lispro protamine/insulin lispro
pentamidine, insulin lispro protamine/insulin lispro. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin NPH
pentamidine, insulin NPH. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- insulin regular human
pentamidine, insulin regular human. unspecified interaction mechanism. Use Caution/Monitor. Pentamidine may cause either hypoglycemia or hyperglycemia followed by the opposing effect. Insulin dosage adjustment and increased glucose monitoring may be required.
- ioversol
ioversol and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- ivacaftor
pentamidine increases levels of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor when coadministered with weak CYP3A4 inhibitors .
- lemborexant
pentamidine will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Lower nightly dose of lemborexant recommended if coadministered with weak CYP3A4 inhibitors. See drug monograph for specific dosage modification.
- lenvatinib
pentamidine and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- leuprolide
leuprolide increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- lomitapide
pentamidine increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lomitapide dose should not exceed 30 mg/day.
- lumacaftor/ivacaftor
lumacaftor/ivacaftor, pentamidine. affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. In vitro studies suggest that lumacaftor may induce and ivacaftor may inhibit CYP2C19 substrates. .
- metformin
pentamidine decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor.
- midazolam intranasal
pentamidine will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation.
- mifepristone
mifepristone, pentamidine. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- neomycin PO
neomycin PO and pentamidine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- olodaterol inhaled
pentamidine and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- osilodrostat
osilodrostat and pentamidine both increase QTc interval. Use Caution/Monitor.
- osimertinib
osimertinib and pentamidine both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- oxaliplatin
oxaliplatin and pentamidine both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
oxaliplatin will increase the level or effect of pentamidine by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval. - ozanimod
ozanimod and pentamidine both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- pasireotide
pentamidine and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
pazopanib and pentamidine both increase QTc interval. Modify Therapy/Monitor Closely.
- peramivir
pentamidine increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.
- potassium citrate/citric acid
pentamidine and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.
- quetiapine
quetiapine, pentamidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.
- quinine
pentamidine and quinine both increase QTc interval. Use Caution/Monitor.
- rilpivirine
rilpivirine increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.
- rucaparib
rucaparib will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.
- selpercatinib
selpercatinib increases toxicity of pentamidine by QTc interval. Use Caution/Monitor.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
pentamidine decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.
- sorafenib
sorafenib and pentamidine both increase QTc interval. Use Caution/Monitor.
- stiripentol
stiripentol will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the dose of CYP2C19 substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.
- streptozocin
pentamidine and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tacrolimus
pentamidine and tacrolimus both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tazemetostat
pentamidine will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tecovirimat
tecovirimat will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Tecovirimat is a weak inhibitor of CYP2C8 and CYP2C19. Monitor for adverse effects if coadministered with sensitive substrates of these enzymes.
- teicoplanin
pentamidine and teicoplanin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.
- tenofovir DF
pentamidine and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Combination may also increase tenofovir levels.
- tinidazole
pentamidine will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- tipranavir
tipranavir, pentamidine. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Increased risk of PR or QT prolongation and cardiac arrhythmias.
- triclabendazole
triclabendazole and pentamidine both increase QTc interval. Use Caution/Monitor.
triclabendazole will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. - trimethoprim
trimethoprim and pentamidine both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.
- triptorelin
triptorelin increases toxicity of pentamidine by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
Minor (22)
- acyclovir
acyclovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- adefovir
adefovir and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- capreomycin
capreomycin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- cephaloridine
cephaloridine and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- chloroquine
chloroquine increases toxicity of pentamidine by QTc interval. Minor/Significance Unknown.
- colistin
colistin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- didanosine
didanosine, pentamidine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Enhanced risk of pancreatitis.
- entecavir
pentamidine, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.
- folic acid
pentamidine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- foscarnet
foscarnet and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
foscarnet, pentamidine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of severe hypocalcemia. - ganciclovir
ganciclovir increases toxicity of pentamidine by pharmacodynamic synergism. Minor/Significance Unknown.
- gentamicin
gentamicin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- L-methylfolate
pentamidine decreases levels of L-methylfolate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- methoxyflurane
methoxyflurane and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- paromomycin
paromomycin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- polymyxin B
pentamidine and polymyxin B both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- ruxolitinib
pentamidine will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- streptomycin
pentamidine and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- tobramycin
pentamidine and tobramycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- valganciclovir
valganciclovir increases toxicity of pentamidine by pharmacodynamic synergism. Minor/Significance Unknown.
- vancomycin
pentamidine and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.
- zidovudine
zidovudine increases toxicity of pentamidine by pharmacodynamic synergism. Minor/Significance Unknown.
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
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
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.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%)
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| pentamidine injection - | 300 mg vial |  | |
| Nebupent inhalation - | 300 mg nebulizer soln |  | |
| Pentam injection - | 300 mg vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
pentamidine injection
PENTAMIDINE ISETHIONATE - INJECTION
(pen-TAM-ih-deen eye-seh-THIGH-oh-nate)
COMMON BRAND NAME(S): Pentam 300
USES: Pentamidine is used to treat a serious lung infection (Pneumocystis pneumonia-PCP) in people with immune system problems, including people with acquired immunodeficiency syndrome (AIDS). Pentamidine belongs to a class of drugs known as antiprotozoals. It works by killing the organism that causes the infection.
HOW TO USE: This medication is given by injection into a vein or muscle as directed by your doctor, usually once a day. If it is given by injection into a vein, it is slowly injected over 1 to 2 hours. Tell your doctor right away if you notice leakage, redness, or pain during an injection into your vein. If this medication is given by injection into a muscle, it is usually injected into the buttock/hip area.The dosage is based on your medical condition, weight, and response to treatment.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Tell your doctor if your condition does not improve or if it worsens.
SIDE EFFECTS: Nausea, vomiting, loss of appetite, unusual taste/dryness in the mouth, dizziness, diarrhea, or redness/pain/leakage at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.People using this medication may have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.Tell your doctor right away if you have any serious side effects, including: easy bruising/bleeding, mental/mood changes (such as confusion, hallucinations), signs of kidney problems (such as change in the amount of urine), signs of anemia (such as severe tiredness, bluish skin/nails), signs of low blood pressure (such as severe dizziness, pale skin, fainting), signs of low blood sugar (such as sudden sweating, shaking, fast heartbeat, hunger), signs of another infection (such as increased fever, chills, persistent sore throat), abdominal pain, fast/irregular heartbeat, signs of high blood sugar (such as unusual increase in thirst or urination).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using pentamidine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding/blood disorders, heart problems, high or low blood pressure, diabetes, kidney disease, liver problems, pancreatitis.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Pentamidine may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using pentamidine, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using pentamidine safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Because breast milk can transmit HIV, do not breast-feed if you have HIV infection. Consult your doctor for details.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: other drugs that may affect the kidneys (including aminoglycosides such as tobramycin, NSAIDs such as ibuprofen or naproxen), saquinavir.Many drugs besides pentamidine may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as erythromycin), among others.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Laboratory and/or medical tests (such as kidney/liver tests, blood pressure, blood sugar, complete blood counts, EKGs) should be performed regularly before, during, and after treatment to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised October 2020. Copyright(c) 2021 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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