PENTAMIDINE injectable

Therapeutic action

• Antiprotozoal active against Pneumocystis jiroveci (carinii)

Indications

• Second-line treatment of pneumocystosis, in the event of contra-indication, intolerance or unresponsiveness to co-trimoxazole

Forms and strengths, route of administration

• Powder for injection, 200 mg and 300 mg vials, to be dissolved in 10 ml water for injection, for IM injection or infusion in 250 ml of 5% glucose

Dosage and duration

• Child and adult: 4 mg/kg once daily by IM injection or infusion (60 minutes minimum) for 14 to 21 days

Contra-indications, adverse effects, precautions

• Do not administer to patients with severe renal impairment.
• Reduce dosage in patients with renal impairment.
• May cause:
  • aseptic abscess by IM route; venous thrombosis by IV route;
  • malaise, hypotension, particularly if administered too rapidly by IV route;
  • gastrointestinal disturbances; renal, hepatic and haematologic disorders; pancreatitis, arrhythmia, torsades de pointes, hypoglycaemia followed by hyperglycaemia.
• Do not combine with drugs inducing torsades de pointes: anti-arrhythmics, neuroleptics, tricyclic antidepressants, IV erythromycin, halofantrine, etc.
• Avoid combination with: mefloquine, cardiac glycosides, azole antifungals, drugs inducing hypokalaemia (diuretics, glucocorticoids, injectable amphotericin B, etc.).
• Administer on a empty stomach, keep the patient supine during injection and 30 minutes after.
• Monitor blood pressure, blood glucose level, serum creatinine level, blood counts.
• Pregnancy and breast-feeding: CONTRA-INDICATED, except if vital and there is no therapeutic alternative.

Remarks

• For the prophylaxis of pneumocystosis, pentamidine may be used by inhalation of nebulised solution using suitable equipment.
• Pentamidine is also used in the treatment of African trypanosomiasis and leishmaniasis.

Storage