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

Indications by Disease

Disease	Dose	Context
Pneumocystis jirovecii pneumonia	4mg/kg IV daily over 60 min	Severe disease

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

Indications by Disease

Disease	Dose	Context
Pneumocystis jirovecii pneumonia	4mg/kg IV daily x 21 days	Pediatric Severe, TMP/SMX intolerant

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>