Pentamidine Isethionate

A to Z Drug Facts

Pentamidine Isethionate

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(pen-TAM-ih-deen ice-uh-THIGH-uh-nate)

NebuPent, Pentacarinat, Pentam 300, Pentacarinet

Class: Anti-infective/Antiprotozoal

Action Mechanism of action not fully understood. Interferes with synthesis of DNA, RNA, phospholipids and proteins.

Indications

Parenteral form: Treatment of Pneumocystis carinii pneumonia (PCP). Inhalation: Prevention of PCP in highrisk HIV-infected patients. Unlabeled use(s): Treatment of trypanosomiasis and visceral leishmaniasis.

Contraindications

Parenteral form: Once diagnosis of PCP is made, there are no absolute contraindications. Inhalation: History of anaphylactic reaction to pentamidine.

Route/Dosage

ADULTS & CHILDREN: IM/IV 4 mg/kg qd for 14 days. ADULTS: Inhalation 300 mg once q 4 wk administered via Respirgard II nebulizer.

Interactions INCOMPATIBILITIES: Do not reconstitute with saline solutions. Do not mix with other drugs.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Hypotension; ventricular tachycardia; cardiac arrhythmias; chest pain; edema; phlebitis. CNS: Confusion; hallucinations; dizziness; fatigue; headache. DERM: Stevens-Johnson syndrome; sterile abscess, pain or induration at IM injection site; rash. EENT: Bad or metallic taste. GI: Nausea; anorexia; vomiting; diarrhea; abdominal pain. GU: Acute renal failure; elevated serum creatinine. HEMA: Leukopenia; thrombocytopenia; anemia; pancytopenia. HEPA: Elevated liver function test results. META: Hypoglycemia; hypocalcemia; hyperkalemia. RESP: Shortness of breath; cough; pharyngitis; chest congestion; bronchospasm; pneumothorax (generally associated with inhalation). OTHER: Neuralgia; myalgia; night sweats, chills.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy of inhalation solution not established. Special-risk patients: Use drug with caution in patients with hypertension, hypotension, hypoglycemia, hyperglycemia, hypocalcemia, leukopenia, thrombocytopenia, anemia, hepatic or renal dysfunction, ventricular tachycardia, pancreatitis, Stevens-Johnson syndrome. Development of acute PCP: Acute PCP may develop despite pentamidine prophylaxis. Fatalities: Fatalities from severe hypotension (even after one dose), hypoglycemia and cardiac arrhythmias have been reported with IM and IV routes. Renal failure: Reduction of dosage, longer infusion time, or extension of dosing interval may be required.

PATIENT CARE CONSIDERATIONS

Administration/Storage

For parenteral use, dissolve contents of vial in Sterile Water for Injection or D5W as directed.
For IV infusion, solution may be diluted further in D5W.
Infuse pentamidine IV over 1 hr with patient supine to minimize severe hypotension and arrhythmias.
Monitor BP continuously throughout infusion, every 30 min for 2 hr thereafter and then every 4 hr until BP stabilizes.
For IM administration, inject deeply and rotate sites.
Reconstitute medication for inhalation in Sterile Water for Injection, USP. Do not mix with any other drugs.
Deliver aerosol dose until nebulizer chamber is empty (»30 to 45 min).
Reconstituted aerosol preparation is stable up to 48 hr at room temperature, if protected from light source. Discard unused portion.
IV solutions prepared with D5W are stable at room temperature for up to 48 hr. Discard unused portion.
Store unopened vial at room temperature. Protect from light.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Assess for adverse reactions throughout course of therapy (eg, hypotension, chest pain, neuralgia, phlebitis, edema, headache, nausea, night sweats, chills).
If patient is coughing, provide physical support to patient's chest. Institute measures to reduce nonproductive coughing to decrease expenditure and chest pain.
Protect immunocompromised patient from additional infections and stress.
Consult with nutritionist to maintain optimal diet for patient.
Inspect injection sites periodically for signs of induration or sterile abscess.
Obtain prescription for antiemetic agent if needed.
Keep emergency resuscitation equipment available.
Monitor lab studies for leukopenia, thrombocytopenia, elevated serum creatinine, elevated liver function studies, hypoglycemia, hypocalcemia, or hyperkalemia.
Monitor vital signs ³ q 4 hr during therapy.
Monitor BP before, during, and after pentamidine administration.
Monitor I&O throughout therapy. If urinary output is decreased, notify physician immediately.
If patient experiences anorexia, nausea, and vomiting, increased hydration will be necessary.
If vertigo, emotional changes, or seizures occur, take safety precautions.
Notify physician if GI reactions persist or worsen.

Patient/Family Education

Inform the patient that there may be pain at the injection site with IM administration.
Caution patient to avoid crowds and persons with known infections.
Instruct patient to report the following symptoms to physician: Nausea, vomiting, anorexia, diarrhea, oliguria, dizziness, chest pain, or edema.
Advise patient that drug may cause dizziness, and to use caution while driving or performing other tasks requiring mental alertness.